Association between surgically treated knee injury and knee arthroplasty: an explorative study based on Finnish nationwide register-based data
DOI:
https://doi.org/10.2340/17453674.2026.46170Keywords:
Arthroplasty, Fractures, Knee, Ligament, StatisticsAbstract
Background and purpose: Knee injuries are established risk factors for knee osteoarthritis (OA). We aimed to investigate whether surgically treated knee injuries are associated with an increased incidence of end‑stage knee OA necessitating knee arthroplasty (KA).
Methods: Using nationwide Finnish registers, we identified all individuals aged 15–99 years who underwent surgery for knee injuries between 1986 and 2024. Injuries were categorized as knee fracture surgeries or non‑fracture knee injury surgeries. The date of the first identified injury surgery served as the index point from which person years under the exposure of interest were accrued. The control population comprised all Finnish residents without a recorded knee injury diagnosis and surgical treatment. Diagnoses and procedures were retrieved from the Care Register for Health Care (CRHC); KAs were identified from the Finnish Arthroplasty Register (FAR) and CRHC. Incidence rates of KA were calculated for both injury categories and the control population, stratified by age, sex, and year. Incidence comparisons between exposure and control groups were performed using age‑, sex‑, and year-standardized standardized incidence ratios (SIRs).
Results: In the fracture surgery cohort, there were 2,163 KAs with over 489,000 person‑years of follow‑up. In the non‑fracture injury surgery cohort there were 13,570 KAs with over 3.01 million person‑years of follow‑up. In the control population there were 205,440 KAs with over 167 million person‑years of follow‑up. Relative to the corresponding general population, the incidence of KA was increased in both injury categories, non-fracture injury surgery SIR 3.74 (95% confidence interval [CI] 3.68–3.80) and fracture surgery SIR 2.08 (CI 1.99–2.17). The greatest excess was among the youngest group (15–54 years): fracture surgery SIR 8.12 (CI 7.40–8.89); non‑fracture injury surgery SIR 6.05 (CI 5.84–6.27).
Conclusion: Surgically treated knee injuries were associated with an increased incidence of KA, most notably in those aged 15–54 years. In older age groups, the additional effect of the injury surgery appears smaller, likely because age itself markedly increases the baseline incidence of KA.
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Hsu H, Siwiec R M. Knee osteoarthritis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 [accessed 12. September 2025]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507884/
Long H, Liu Q, Yin H, Wang K, Diao N, Zhang Y, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the global burden of disease study 2019. Arthritis Rheum 2022; 74(7): 1172-83. doi: 10.1002/art.42089.
Cooper C, Snow S, McAlindon T E, Kellingray S, Stuart B, Coggon D, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 2000; 43(5): 995–1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1.
Blagojevic M, Jinks C, Jeffery A, Jordan K P. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta‑analysis. Osteoarthritis Cartilage 2010; 18(1): 24-33. doi: 10.1016/j.joca.2009.08.010.
Whittaker J L, Losciale J M, Juhl C B, Thorlund J B, Lundberg M, Truong L K, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta‑analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med 2022; 56(24): 1406-21. doi: 10.1136/bjsports-2022-105496.
Poulsen E, Goncalves G H, Bricca A, Roos E M, Thorlund J B, Juhl C B. Knee osteoarthritis risk is increased 4‑6 fold after knee injury: a systematic review and meta‑analysis. Br J Sports Med 2019; 53(23): 1454-63. doi: 10.1136/bjsports-2018-100022.
Snoeker B, Turkiewicz A, Magnusson K, Frobell R, Yu D, Peat G, et al. Risk of knee osteoarthritis after different types of knee injuries in young adults: a population‑based cohort study. Br J Sports Med 2020; 54(12): 725-30. doi: 10.1136/bjsports-2019-100959.
Jordan K M, Arden N K, Doherty M, Bannwarth B, Bijlsma J W J, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62(12): 1145-55. doi: 10.1136/ard.2003.011742.
Skou S T, Roos E M, Laursen M B, Rathleff M S, Arendt‑Nielsen L, Simonsen O H, et al. Total knee replacement plus physical and medical therapy or treatment with physical and medical therapy alone: a randomised controlled trial in patients with knee osteoarthritis (the MEDIC‑study). BMC Musculoskelet Disord 2012; 13: 67. doi: 10.1186/1471-2474-13-67.
Visnes H, Gifstad T, Persson A, Lygre S H L, Engebretsen L, Drogset J O, et al. ACL reconstruction patients have increased risk of knee arthroplasty at 15 years of follow‑up: data from the Norwegian Knee Ligament Register and the Norwegian Arthroplasty Register from 2004 to 2020. JB JS Open Access 2022; 7(2): e22.00023. doi: 10.2106/JBJS.OA.22.00023.
Abram S G F, Judge A, Khan T, Beard D J, Price A J. Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years. Acta Orthop 2019; 90(6): 568-74. doi: 10.1080/17453674.2019.1639360.
Tapper V S, Pamilo K J, Haapakoski J J, Toom A, Paloneva J. Risk of total knee replacement after proximal tibia fracture: a register‑based study of 7,701 patients. Acta Orthop 2022; 93: 179-84. doi: 10.2340/17453674.2021.1006.
Abram S G F, Judge A, Beard D J, Carr A J, Price A J. Long‑term rates of knee arthroplasty in a cohort of 834 393 patients with a history of arthroscopic partial meniscectomy. Bone Joint J 2019; 101‑B (9): 1071-80. doi: 10.1302/0301-620X.101B9.BJJ-2019-0335.R1.
Muthuri S G, McWilliams D F, Doherty M, Zhang W. History of knee injuries and knee osteoarthritis: a meta‑analysis of observational studies. Osteoarthritis Cartilage 2011; 19(11): 1286-93. doi: 10.1016/j.joca.2011.07.015.
PxWeb. Population 31.12. by Year, Sex, Age and Information [Internet] [accessed December 17, 2025]. Available from https://pxdata.stat.fi:443/PxWebPxWeb/pxweb/en/StatFin/StatFin__vaerak/statfin_vaerak_pxt_11rd.px/
Peltola M, Juntunen M, Häkkinen U, Rosenqvist G, Seppälä T T, Sund R. A methodological approach for register‑based evaluation of cost and outcomes in health care. Ann Med 2011; 43(Supol 1): S4-13. doi: 10.3109/07853890.2011.586364.
Mäkelä K T, Peltola M, Sund R, Malmivaara A, Häkkinen U, Remes V. Regional and hospital variance in performance of total hip and knee replacements: a national population‑based study. Ann Med 2011; 43(Suppl 1): S31-8. doi: 10.3109/07853890.2011.586362.
Turppo V, Sund R, Sirola J, Kröger H, Huopio J. Cross‑validation of arthroplasty records between arthroplasty and hospital discharge registers, self‑reports, and medical records among a cohort of 14,220 women. J Arthroplasty 2018; 33(12): 3649-54. doi: 10.1016/j.arth.2018.08.010.
Medvedeva E V, Grebenik E A, Gornostaeva S N, Telpuhov V I, Lychagin A V, Timashev P S, et al. Repair of damaged articular cartilage: current approaches and future directions. Int J Mol Sci 2018; 19(8): 2366. doi: 10.3390/ijms19082366.
Deichsel A, Oeckenpöhler S, Raschke M J, Grunenberg O, Peez C, Briese T, et al. Recurrent instability rate and subjective knee function following accelerated rehabilitation after ACL reconstruction in comparison to a conservative rehabilitation protocol. J Clin Med 2023; 12(14): 4567. doi: 10.3390/jcm12144567.
Elsoe R, Johansen M B, Larsen P. Tibial plateau fractures are associated with a long‑lasting increased risk of total knee arthroplasty: a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis Cartilage 2019; 27(5): 805-9. doi: 10.1016/j.joca.2018.12.020.
Coon M S, Best B J. Distal femur fractures. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2026 [cited April 1, 2026]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551675/ PubMed PMID: 31869139.
Cordtz R L, Hawley S, Prieto‑Alhambra D, Højgaard P, Zobbe K, Overgaard S, et al. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time‑series analysis using nationwide Danish healthcare registers. Ann Rheum Dis 2018; 77(5): 684-9. doi: 10.1136/annrheumdis-2017-212424.
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Copyright (c) 2026 Olli Heikkilä, Reijo Sund, Heikki Kröger, Antti Jaroma, Joonas Sirola
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