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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2012

01-06-2012 | Knee

Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty

Authors: Francois Hardeman, Jürgen Londers, Alexander Favril, Erik Witvrouw, Johan Bellemans, Jan Victor

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2012

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Abstract

Purpose

The objective of this study was to investigate the outcome of revision total knee arthroplasty (TKA) in relation to the cause of index failure, the characteristics of the index procedure, and the elapsed time between index TKA and revision.

Methods

A retrospective review based on a prospective database was performed on 146 consecutive revision TKA’s. Variables tested were the cause of index failure; the elapsed time between the index and revision procedure; patient age at time of revision; partial or total revision of the implants; the performance of a tibial tubercle osteotomy; the presence of radiolucent lines; postoperative patellar tracking; and coronal plane alignment. Outcomes were measured with the Knee Society Knee Score (KS), Function Score (FS), and X-ray evaluation.

Results

Mean KS improved from 27.6 (SD 21.6) to 71.5 (SD 24.2) after revision (P < 0.0001), mean FS from 27.5 (SD 22.7) to 53.3 (SD27.7), P < 0.0001. Overall survival rate was 90% at 5 years and 85% at 10 and 14 years. The cause of index failure had no significant influence on any of the outcome parameters. Significantly, better outcomes were noted for partial revisions and for revisions in older patients. Early revisions (<2 years) were mostly performed for infection and instability, whereas late revisions (>2 years) were mostly performed for polyethylene wear and loosening. The survival rate for late revisions was significantly better than for early revisions (P = 0.002).

Conclusion

Revision TKA leads to a significant reduction in symptoms and improvement in function. The worst results can be expected for early revisions in young patients. Revision TKA is a demanding procedure with variable results and should therefore be performed by experienced surgeons.

Level of evidence

Therapeutic study—Level IV.
Literature
1.
Babis GC, Trousdale RT, Morrey BF (2002) The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am 84:64–68PubMed
2.
Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey M (2000) Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty. J Arthroplasty 15:990–993PubMedCrossRef
3.
Barrack RL, McClure JT, Burak CF, Clohisy JC, Parvizi J, Sharkey P (2007) Revision total knee arthroplasty: the patient’s perspective. Clin Orthop Relat Res 464:146–150PubMed
4.
Chalidis BE, Ries MD (2009) Does repeat tibial tubercle osteotomy or intramedullary extension affect the union rate in revision total knee arthroplasty? A retrospective study of 74 patients. Acta Orthop 80:426–431PubMedCrossRef
5.
Christensen CP, Crawford JJ, Olin MD, Vail TP (2002) Revision of the stiff total knee arthroplasty. J Arthroplasty 17:409–415PubMedCrossRef
6.
Cushnaghan J, Bennett J, Reading I, Croft P, Byng P, Cox P, Dieppe P, Coggon D, Cooper C (2009) Long-term outcome following total knee arthroplasty: a controlled longitudinal study. Ann Rheum Dis 68:642–647PubMedCrossRef
7.
Dahm DL, Barnes SA, Harrington JR, Berry DJ (2007) Patient reported activity after revision total knee arthroplasty. J Arthroplasty 22:106–110PubMedCrossRef
8.
Dennis DA, Berry DJ, Engh G, Fehring T, MacDonald SJ, Rosenberg AG, Scuderi G (2008) Revision total knee arthroplasty. J Am Acad Orthop Surg 16:442–454PubMed
9.
Engh GA, Ammeen DJ (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am 29:205–217PubMedCrossRef
10.
Fehring TK, Odum S, Griffin WL, Mason JB (2005) Outcome comparison of partial and full component revision TKA. Clin Orthop Relat Res 440:131–134PubMedCrossRef
11.
Ghandhi R, Tsvetkov D, Davey JR, Mahomed NNN (2009) Survival and clinical function of cemented and uncemented prosthesis in total knee replacement: a meta-analysis. J Bone Joint Surg Br 91:889–895CrossRef
12.
Ghanem E, Restrepo C, Joshi A, Hozack W, Sharkey P, Parvizi J (2007) Periprosthetic infection does not preclude good outcome for revision arthroplasty. Clin Orthop Relat Res 461:54–59PubMed
13.
Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75B:822–824
14.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
15.
Jämsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk factors for infection after knee arthroplasty. A register-based analysis of 43, 149 cases. J Bone Joint Surg Am 91:38–47PubMedCrossRef
16.
Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT (2009) Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop 80:67–77PubMedCrossRef
17.
Järvenpää J, Kettunen J, Miettinen H, Kröger H (2010) The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. Int Orthop 34:649–653PubMedCrossRef
18.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedCrossRef
19.
Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, Holt HL, Solomon DH, Yelin E, Paltiel AD, Katz JN (2009) Cost-effectiveness of total knee arthroplasty in the United States. Arch Intern Med 169:1113–1121PubMedCrossRef
20.
Mendes MW, Caldwell P, Jiranek WA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19:167–174PubMedCrossRef
21.
Murray DW, Carr AJ, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75B:697–704
22.
Nelson CL, Kim J, Lotke PA (2005) Stiffness after total knee arthroplasty. J Bone Joint Surg Am 87:264–270PubMedCrossRef
23.
Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:945–948PubMedCrossRef
24.
Parsley BS, Engh GA, Dwyer KA (1992) Preoperative flexion: does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty? Clin Orthop Relat Res 275:204–210PubMed
25.
Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL (2008) Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res 466:2628–2633PubMedCrossRef
26.
Piedade SR, Pinaroli A, Servien E, Neyret P (2009) Revision after early aseptic failures in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:248–253PubMedCrossRef
27.
Pun SY, Ries MD (2008) Effect of gender and preoperative diagnosis on results of revision total knee arthroplasty. Clin Orthop Relat Res 466:2701–2705PubMedCrossRef
28.
Riaz S, Umar M (2006) Revision knee arthroplasty. J Pak Mad Assoc 10:456–460
29.
Ritter MA, Campbell ED (1987) Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 2:95–97PubMedCrossRef
30.
Ritter MA, Lutgring JD, Davis KE, Berend ME (2008) The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 90:777–784PubMedCrossRef
31.
Savarino L, Tigani D, Baldini N, Bochicchio V, Giunti A (2009) Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc 17:667–675PubMedCrossRef
32.
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper: why are total knee arthroplasties failing today. Clin Orthop Relat Res 404:7–13PubMedCrossRef
33.
Sheng PY, Konttinen L, Lehto M, Ogino D, Jämsen E, Nevalainen J, Pajamäki J, Halonen P, Konttinen YT (2006) Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am 88:1425–1430PubMedCrossRef
34.
Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S (2008) Why do revision knee arthroplasties fail? J Arthroplasty 23:99–102PubMedCrossRef
35.
36.
Uematsu O, Hsu HP, Kelly KM, Ewald FC, Walker PS (1987) Radiographic study of kinematic total knee arthroplasty. J Arthroplasty 2:317–326PubMedCrossRef
37.
van den Broek CM, van Hellemondt GG, Jacobs WC, Wymenga AB (2006) Stepcut tibial tubercle osteotomy for access in revision total knee replacement. Knee 13:430–434PubMedCrossRef
38.
Van der Bracht H, Van Maele G, Verdonk P, Almqvist KF, Verdonk R, Freeman M (2010) Is there any superiority in the clinical outcome of mobile-bearing knee prosthesis designs compared to fixed-bearing total knee prosthesis designs in the treatment of osteoarthritis of the knee joint? A review of the literature. Knee Surg Sports Traumatol Arthrosc 18:367–374PubMedCrossRef
39.
Vince KG, Droll K, Chivas D (2008) New concepts in revision total knee arthroplasty. J Surg Orthop Adv 17:165–172PubMed
40.
Wang CJ, Hsieh MC, Huang TW, Wang JW, Chen HS, Liu CY (2004) Clinical outcome and patient satisfaction in aseptic and septic revision total knee arthroplasty. Knee 11:45–49PubMedCrossRef
41.
Willson SE, Munro ML, Sandwell JC, Ezzet KA, Colwell CW Jr (2010) Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res 468:96–101PubMedCrossRef
Metadata
Title
Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty
Authors
Francois Hardeman
Jürgen Londers
Alexander Favril
Erik Witvrouw
Johan Bellemans
Jan Victor
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1624-8

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