AccScience Publishing / STI / Volume 46 / Issue 1 / DOI: 10.36922/sti.0244
Submit to STI
Cite this article
2
Download
42
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
RESEARCH ARTICLE

Total Knee Arthroplasty Following Unsuccessful Subchondroplasty

Michaela N. Dukes1 ,  Jacob Williamson2 ,  Adam J. Miller2 ,  Langan S. Smith1 ,  Andrew Swiergosz2 ,  Arthur L. Malkani2*
Show Less
1 Department of Orthopedics, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
2 Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, United States of America
3 ULP Orthopedics, UofL Health, Louisville, Kentucky, United States of America
STI 2026, 46(1), 22–28; https://doi.org/10.36922/sti.0244
Received: 9 August 2025 | Revised: 14 November 2025 | Accepted: 14 November 2025 | Published online: 15 January 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
XML
Cite
Abstract

Background: Subchondroplasty has been used as a non-arthroplasty solution for treating osteoarthritic knee pain.

Objective: To determine the results of primary total knee arthroplasty (TKA) following a prior subchondroplasty procedure.

Methods: A total of 344 patients who underwent subchondroplasty were identified from an institutional registry. Of the 344 patients, 86 (25%) progressed to TKA; among them, 62 were available for review. The average age of the patients was 63.32 years (± 10.68 years), and the average body mass index was 34 kg/m² (± 6.59 kg/m²). The study group was matched 2:1 with a control group of 124 TKAs that had no prior subchondroplasty. Patient-reported outcome measures (PROMs) and complications were compared.

Results: Preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores in the subchondroplasty group were lower compared to the control group (40.2 vs. 47 [p = 0.07] and 79.2 vs. 84.6 [p = 0.06], respectively). Preoperative and postoperative Knee Society Clinical Rating System knee scores were lower in the subchondroplasty group, at 38.9 vs. 44.9 (p = 0.02) and 88.2 vs. 93.5 (p = 0.0004), respectively. The two-year postoperative Forgotten Joint Score was lower in the study group, at 60.2 vs. 73.8 in the control (p = 0.01). There were no differences in revision incidence. The subchondroplasty group had three cases of aseptic loosening, compared to none in the control group (p = 0.08). Additionally, there were two intraoperative tibial fractures in the subchondroplasty group.

Conclusion: The indications for subchondroplasty should be re-evaluated, given the high incidence of failure leading to TKA. Patients undergoing TKA following subchon-droplasty demonstrated inferior results compared to the control group. Hence, surgeons should remove all cement during tibial broaching to minimize the risk of intraoperative fracture from retained cement.

Keywords
Bone marrow lesions
Intraoperative fractures
Patient-reported outcome measures
Primary total knee arthroplasty
Subchondroplasty
Total knee arthroplasty
References
  1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2163-2196. doi: 10.1016/s0140-6736(12)61729-2
  2. Pietro Randelli, Compagnoni R, Paolo Ferrua, et al. Efficacy of subchondroplasty in the treatment of pain associated with bone marrow lesions in the osteoarthritic knee. Orthop J Sports Med. 2023;11(5). doi: 10.1177/23259671231163528
  3. Kraus VB, Feng S, Wang S, et al. Subchondral bone trabecular integrity predicts and changes concurrently with radiographic and magnetic resonance imaging-determined knee osteoarthritis progression. Arthritis & Rheumatism. 2013;65(7):1812-1821. doi: 10.1002/art.37970
  4. Tanamas SK, Wluka AE, Pelletier JP., et al. Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study. Rheumatol. 2010;49(12):2413-2419. doi: 10.1093/rheumatology/keq286
  5. Skou ST, Roos EM, Laursen MB, et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015;373(17):1597-1606. doi: 10.1056/nejmoa1505467
  6. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63. doi: 10.1007/s11999-009-1119-9
  7. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: A Systematic Review. HSS J®. 2018;14(2):192-201. doi: 10.1007/s11420-018-9614-8
  8. Verhaar J. Patient satisfaction after total knee replacement—still a challenge. Acta Orthop. 2020;91(3):241-242. doi: 10.1080/17453674.2020.1763581
  9. Sharkey P, Leinberry C. Osteoarthritis treatment and device. 2011;(US8574303B2).
  10. Tran Y, Pelletier-Roy R, Merle G, Aubin CÉ, Nault ML. Subchondroplasty in the treatment of bone marrow lesion in early knee osteoarthritis: a systematic review of clinical and radiological outcomes. The Knee. 2022;39:279-290. doi: 10.1016/j.knee.2022.10.004
  11. Pasqualotto S, Sgroi AV, Causero A, Di Benedetto P, Zorzi C. Subchondroplasty in the treatment of bone marrow lesions of the knee: preliminary experience on first 15 patients. Joints. Published online June 18, 2021. doi: 10.1055/s-0041-1730984
  12. Sharkey P, Cohen S. Subchondroplasty for treating bone marrow lesions. J Knee Surg. 2015;29(07):555-563. doi: 10.1055/s-0035-1568988
  13. Levy AS, Cousins K. The rational for and efficacy of subchondroplasty in the injured worker. Journal of Orthopaedics. 2020;22:48-52. doi: 10.1016/j.jor.2020.03.047
  14. Nairn LN, Subramaniam M, Ekhtiari S, Axelrod DE, Grant JA, Khan M. Safety and early results of Subchondroplasty® for the treatment of bone marrow lesions in osteoarthritis: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;29(11):3599-3607. doi: 10.1007/s00167-020-06294-w
  15. Wood DS, Paulson S, Nolan JR, Spanyer J, Harm RG, Heis FT. What factors are associated with conversion to knee arthroplasty after subchondroplasty? Clin. Orthop. Relat. Res. 2023;481(8):1543-1550. doi: 10.1097/corr.0000000000002557
  16. Lyman S, Lee YY, McLawhorn AS, Islam W, MacLean CH. What are the minimal and substantial improvements in the hoos and koos and jr versions after total joint replacement? Clin Orthop Relat Res. 2018;476(12):2432-2441. doi: 10.1097/corr.0000000000000456
  17. Holtz N, Hamilton DF, Giesinger JM, Jost B, Giesinger K. Minimal important differences for the womac osteoarthritis index and the forgotten joint score-12 in total knee arthroplasty patients. BMC Musculoskelet. Disord. 2020;21(1). doi: 10.1186/s12891-020-03415-x
  18. Lee WC, Kwan YH, Chong HC, Yeo SJ. The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;25(11):3354-3359. doi: 10.1007/s00167-016-4208-9
  19. Syrikas I, Engbäck C, Tsikandylakis G, Karikis I, Desai N. Increased complications rates and inferior patient reported outcomes following total knee arthroplasty due to post-traumatic osteoarthritis with previous fracture treatment: a systematic review. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 2023;31(10):4124-4141. doi: 10.1007/s00167-023-07407-x
  20. Khan IA, DeSimone CA, Sonnier JH, et al. Prior meniscectomy in patients undergoing primary total knee arthroplasty is associated with worse short-term outcomes. J Arthroplasty. 2023;38(7):S187-S193. doi: 10.1016/j.arth.2023.01.062
  21. Gu A, Malahias MA, Cohen JS, et al. Prior Knee Arthroscopy Is Associated With Increased Risk of Revision After Total Knee Arthroplasty. J Arthroplasty. 2020;35(1):100-104. doi: 10.1016/j.arth.2019.08.043
  22. Su Q, Wan X, Wang D, Zhou Z. A commentary on "the influence of prior arthroscopy on outcomes of primary total lower extremity arthroplasty: a systematic review and meta-analysis" (Int J Surg 2022;98:106218). Int J Surg. 2022;104:106679. doi: 10.1016/j.ijsu.2022.106679
  23. Detsch R, Mayr H, Ziegler G. Formation of osteoclast-like cells on ha and tcp ceramics. Acta Biomater. 2007;4(1):139-148. doi: 10.1016/j.actbio.2007.03.014
  24. Zeng J, Lin J, Yao G, Kong K, Wang X. Effect of modified compound calcium phosphate cement on the differentiation and osteogenesis of bone mesenchymal stem cells. J Orthop Surg Res. 2017;12(1). doi: 10.1186/s13018-017-0598-8
  25. Eline-Claire G, Hoekstra JA, Herber RP, Ulrich D, Jansen JA. Long-term biological performance of injectable and degradable calcium phosphate cement. Biomedical Materials. 2016;12(1):015009-015009. doi: 10.1088/1748-605x/12/1/015009
  26. Fokter SK, Kuhta M, Marko H, Živa L, Rok K. Tissue integration of calcium phosphate compound after subchondroplasty: 4-year follow-up in a 76-year-old female patient. Bioeng. 2023;10(2):208-208. doi: 10.3390/bioengineering10020208
  27. Krüger R, Groll J. Fiber reinforced calcium phosphate cements – On the way to degradable load bearing bone substitutes? Biomater. 2012;33(25):5887-5900. doi: 10.1016/j.biomaterials.2012.04.053
Share
Back to top
Surgical Technology International, Electronic ISSN: 1090-3941 Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept