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Knee Surgery, Sports Traumatology, Arthroscopy

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21-10-2021 | KNEE

Aseptic revision total knee arthroplasty outcomes were equivalent to patients’ own pre-failure state but inferior to patients without revision

Authors: Yong Zhi Khow, Ming Han Lincoln Liow, Graham S. Goh, Jerry Yongqiang Chen, Ngai Nung Lo, Seng Jin Yeo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

Abstract

Purpose

The purpose of this study was to (1) longitudinally compare the patient-reported outcome measures (PROMs) of the same patients who underwent primary TKA and revision TKA, and (2) compared the results of these revision TKA with a matched cohort of well-functioning primary TKA. The hypothesis was revision TKA could result in equivalent outcomes to patients’ own primary TKA or the primary TKA of patients who did not require revision.

Methods

Prospectively collected data of 123 patients who underwent primary TKA and subsequently aseptic revision TKA (“revised group”), were matched using nearest-neighbor method to 123 well-functioning primary TKA that did not require revision (“control group”). Preoperative (prior to primary TKA), at time of failure (prior to revision TKA), postoperative 6-month and 2-year PROMs included Knee Society scores (KSS), Oxford Knee Score (OKS) and Short Form-36 (SF-36). Minimal clinically important difference (MCID) attainment was analyzed. Wilcoxon and McNemar’s tests were used to compare outcomes within the revised group (primary vs revision), Mann–Whitney U test and Chi-Square test for the revised and control groups.

Results

The revised group had poorer KSS objective (p = 0.045), KSS functional (p < 0.001), OKS (p = 0.011) and SF-36 PCS (p < 0.001) at time of failure (prior to revision TKA), compared to their preoperative PROMs (prior to primary TKA). Revision TKA resulted in restoration of KSS objective, OKS and SF-36 PCS (NS) that were equivalent to their primary TKA, but poorer KSS functional (p < 0.050). Patients in the revised group had a lower proportion of MCID attainment in KSS objective (p = 0.014) and OKS (p < 0.001) at 2-year after primary TKA when compared to the control group. Revision TKA also led to poorer KSS objective, KSS functional and SF-36 PCS (p < 0.050) when compared to primary TKA of the control group.

Conclusion

Outcomes following aseptic revision were equivalent to patients' own pre-failure state but inferior to patients with non-revised implants. An individualized approach toward goal setting and assessing adequacy of aseptic revision TKA can be adopted based on patients’ pre-failure outcomes.

Level of evidence

III.

Akbari Shandiz M, Boulos P, Saevarsson SK, Ramm H, Fu CKJ, Miller S et al (2018) Changes in knee shape and geometry resulting from total knee arthroplasty. Proc Inst Mech Eng H 232:67–79 CrossRefPubMed

Bakaa N, Chen LH, Carlesso L, Richardson J, Shanthanna H, Macedo L (2021) Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty. Disabil Rehabil. https://doi.org/10.1080/09638288.2021.19652321-8 CrossRefPubMed

Baker P, Cowling P, Kurtz S, Jameson S, Gregg P, Deehan D (2012) Reason for revision influences early patient outcomes after aseptic knee revision. Clin Orthop Relat Res 470:2244–2252 CrossRefPubMedPubMedCentral

Bohl DD, Samuel AM, Basques BA, Della Valle CJ, Levine BR, Grauer JN (2016) How much do adverse event rates differ between primary and revision total joint arthroplasty? J Arthroplasty 31:596–602 CrossRefPubMed

Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1933–1939 CrossRefPubMed

Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthr Cartil 15:273–280 CrossRef

Greidanus NV, Peterson RC, Masri BA, Garbuz DS (2011) Quality of life outcomes in revision versus primary total knee arthroplasty. J Arthroplasty 26:615–620 CrossRefPubMed

Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW (2002) Early patient outcomes after primary and revision total knee arthroplasty. A prospective study. J Bone Joint Surg Br 84:994–999 CrossRefPubMed

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 13–14

10.

Lee JA, Koh YG, Kang KT (2020) Biomechanical and clinical effect of patient-specific or customized knee implants: a review. J Clin Med 9

11.

Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25:3354–3359 CrossRefPubMed

12.

Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014 CrossRefPubMed

13.

Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682 CrossRefPubMed

14.

Sachdeva S, Baker JF, Bauwens JE, Smith LS, Sodhi N, Mont MA et al (2019) Can revision TKA patients achieve similar clinical functional improvement compared to primaries? J Knee Surg. https://doi.org/10.1055/s-0039-1693415 CrossRefPubMed

15.

Scott CE, Oliver WM, MacDonald D, Wade FA, Moran M, Breusch SJ (2016) Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Joint J 98-b:1625–1634 CrossRefPubMed

16.

van Kempen RW, Schimmel JJ, van Hellemondt GG, Vandenneucker H, Wymenga AB (2013) Reason for revision TKA predicts clinical outcome: prospective evaluation of 150 consecutive patients with 2-years followup. Clin Orthop Relat Res 471:2296–2302 CrossRefPubMedPubMedCentral

17.

van Schie P, van Steenbergen LN, van Bodegom-Vos L, Nelissen R, Marang-van de Mheen PJ (2020) Between-Hospital variation in revision rates after total hip and knee arthroplasty in the Netherlands: directing quality-improvement initiatives. J Bone Joint Surg Am 102:315–324 CrossRefPubMed

18.

Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33:As264-279 PubMed

19.

Williams DP, O’Brien S, Doran E, Price AJ, Beard DJ, Murray DW et al (2013) Early postoperative predictors of satisfaction following total knee arthroplasty. Knee 20:442–446 CrossRefPubMed

20.

Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK, Murray DW et al (2013) The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 95-b:38–44 CrossRefPubMed

Title: Aseptic revision total knee arthroplasty outcomes were equivalent to patients’ own pre-failure state but inferior to patients without revision
Authors: Yong Zhi Khow
Ming Han Lincoln Liow
Graham S. Goh
Jerry Yongqiang Chen
Ngai Nung Lo
Seng Jin Yeo
Publication date: 21-10-2021
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-021-06776-5

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Aseptic revision total knee arthroplasty outcomes were equivalent to patients’ own pre-failure state but inferior to patients without revision

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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