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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2011

01-01-2011 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

Authors: Benjamin Zmistowski, BS, Camilo Restrepo, MD, Lauren K. Kahl, BS, Javad Parvizi, MD, FRCS, Peter F. Sharkey, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2011

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Abstract

Background

A dramatic increase in the demand for TKA is expected. The current burden of revision TKA is well known but the incidence and etiology of nonrevision reoperations after primary TKA is not.

Questions/purposes

We determined the rate, reason, timing, and predictors of nonrevision reoperation after TKA.

Methods

Using our institutional joint arthroplasty database, we identified 10,188 TKA performed on 7,613 patients between April 2000 and March 2008. A nonrevision reoperation was defined as any procedure requiring anesthetic in which components with bony interfaces were not removed or exchanged. Procedures after revision TKA were excluded. Potential risk factors investigated included age, gender, laterality, and simultaneous bilateral versus staged bilateral versus unilateral TKA. The minimum followup was 1 year (median, 4.1 years; range, 1.1 to 9.1 years).

Results

Three hundred fifty-three patients of 7,613 (4.6%) underwent 434 nonrevision reoperations on 384 of 10,188 (3.8%) knees. The most common indication for nonrevision reoperation was stiffness (58%; 252 of 434), followed by patellar clunk (12%; 53), infection (12%; 52), wound revision (6%; 26), hematoma (4.4%; 19), among others. The median time to reoperation was 74.5 days (range, 1–3058 days) but varied widely. Younger patients and those with unilateral TKA were more likely to have a nonrevision reoperation.

Conclusions

The majority of nonrevision reoperations are performed for stiffness. Patellar clunk and infection also result in a large number of nonrevision reoperations. In weighing the future economic and workforce burden of TKA, nonrevision reoperations need to be acknowledged, and preventive measures need to be implemented.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Dajani KA, Stuart MJ, Dahm DL, Levy BA. Arthroscopic treatment of patellar clunk and synovial hyperplasia after total knee arthroplasty. J Arthroplasty. 2010;25:97–103.CrossRefPubMed
2.
Fukunaga K, Kobayashi A, Minoda Y, Iwaki H, Hashimoto Y, Takaoka K. The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. J Bone Joint Surg Br. 2009;91:463–468.CrossRefPubMed
3.
Hartman MB, Fehring TK, Jordan L, Norton HJ. Periprosthetic knee sepsis. The role of irrigation and debridement. Clin Orthop Relat Res. 1991;273:113–118.PubMed
4.
Hozack WJ, Rothman RH, Booth RE, Jr., Balderston RA. The patellar clunk syndrome. A complication of posterior stabilized total knee arthroplasty. Clin Orthop Relat Res. 1989;241:203–208.PubMed
5.
Iorio R, Robb WJ, Healy WL, Berry DJ, Hozack WJ, Kyle RF, Lewallen DG, Trousdale RT, Jiranek WA, Stamos VP, Parsley BS. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90:1598–1605.CrossRefPubMed
6.
Ip D, Ko PS, Lee OB, Wu WC, Lam JJ. Natural history and pathogenesis of the patella clunk syndrome. Arch Orthop Trauma Surg. 2004;124:597–602.CrossRefPubMed
7.
Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am. 2004;86:1479–1484.CrossRefPubMed
8.
Kim YH, Choi YW, Kim JS. Simultaneous bilateral sequential total knee replacement is as safe as unilateral total knee replacement. J Bone Joint Surg Br. 2009;91:64–68.PubMed
9.
Koh YG, Kim SJ, Chun YM, Kim YC, Park YS. Arthroscopic treatment of patellofemoral soft tissue impingement after posterior stabilized total knee arthroplasty. Knee. 2008;15:36–39.CrossRefPubMed
10.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.CrossRefPubMed
11.
Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468:52–56.CrossRefPubMed
12.
Lonner JH, Jasko JG, Bezwada HP, Nazarian DG, Booth RE, Jr. Incidence of patellar clunk with a modern posterior-stabilized knee design. Am J Orthop (Belle Mead NJ). 2007;36:550–553.
13.
Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009;24(6 Suppl):84–88.CrossRefPubMed
14.
Mauerhan DR, Mokris JG, Ly A, Kiebzak GM. Relationship between length of stay and manipulation rate after total knee arthroplasty. J Arthroplasty. 1998;13:896–900.CrossRefPubMed
15.
Memtsoudis SG, Vougioukas VI, Ma Y, Gaber-Baylis LK, Girardi FP. Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery. Spine (Phila Pa 1976). 2010 May 5. [Epub ahead of print].
16.
Mont MA, Waldman B, Banerjee C, Pacheco IH, Hungerford DS. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty. 1997;12:426–433.CrossRefPubMed
17.
Noble J, Goodall JR, Noble DJ. Simultaneous bilateral total knee replacement: a persistent controversy. Knee. 2009;16:420–426.CrossRefPubMed
18.
Oakes DA, Hanssen AD. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop Relat Res. 2004;428:87–91.CrossRefPubMed
19.
Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res. 2010 May 25. [Epub ahead of print].
20.
Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res. 2009;467:1732–1739.CrossRefPubMed
21.
Parvizi J, Tarity TD, Steinbeck MJ, Politi RG, Joshi A, Purtill JJ, Sharkey PF. Management of stiffness following total knee arthroplasty. J Bone Joint Surg Am. 2006;88 Suppl 4:175–181.CrossRefPubMed
22.
Pulido L, Parvizi J, Macgibeny M, Sharkey PF, Purtill JJ, Rothman RH, Hozack WJ. In hospital complications after total joint arthroplasty. J Arthroplasty. 2008;23 (6 Suppl 1):139–145.CrossRefPubMed
23.
Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89:1220–1226.CrossRefPubMed
24.
Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg Am. 2003;85:1532–1537.PubMed
25.
Rubinstein RA, Jr., DeHaan A. The incidence and results of manipulation after primary total knee arthroplasty. Knee. 2010;17:29–32.CrossRefPubMed
26.
Severson EP, Mariani EM, Bourne MH. Bilateral total knee arthroplasty in patients 70 years and older. Orthopedics. 2009;32:316.CrossRefPubMed
27.
Silva M, Tharani R, Schmalzried TP. Results of direct exchange or debridement of the infected total knee arthroplasty. Clin Orthop Relat Res. 2002;404:125–131.CrossRefPubMed
28.
Takahashi M, Miyamoto S, Nagano A. Arthroscopic treatment of soft-tissue impingement under the patella after total knee arthroplasty. Arthroscopy. 2002;18:E20.CrossRefPubMed
29.
Webb BG, Lichtman DM, Wagner RA. Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds. Orthopedics. 2008;31:445.CrossRefPubMed
30.
Yercan HS, Sugun TS, Bussiere C, Ait Si ST, Davies A, Neyret P. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee. 2006;13:111–117.CrossRefPubMed
31.
Zeni JA, Jr., Snyder-Mackler L. Clinical outcomes after simultaneous bilateral total knee arthroplasty: comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty. 2010;25:541–546.CrossRefPubMed
Metadata
Title
Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty
Authors
Benjamin Zmistowski, BS
Camilo Restrepo, MD
Lauren K. Kahl, BS
Javad Parvizi, MD, FRCS
Peter F. Sharkey, MD
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1558-3

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