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Clinical Orthopaedics and Related Research®

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01-08-2012 | Clinical Research

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

Authors: Paul Baker, MBBS, MSc, FRCS (Trauma & Orthop), Paul Cowling, MBBS, MRCS, Steven Kurtz, PhD, Simon Jameson, MBBS, MRCS, Paul Gregg, MD, FRCS (Ed), FRCS, David Deehan, MD, MSc, FRCS (Trauma & Orthop)

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2012

Abstract

Background

Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear.

Questions/purposes

We determined differences in patient-reported outcomes and rates of satisfaction between primary and revision TKAs, and determine whether the reason for revision influences patient-reported outcomes after revision TKA.

Methods

We retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) for 24,190 patients (23,393 TKAs; 797 aseptic revision TKAs). We compared patient-reported outcomes using the Oxford Knee Score (OKS), EuroQol (EQ-5D), and patient satisfaction between primary TKA and revision TKA, and for subsets of the revision TKA cohort. The followup data were collected between 6 and 12 months (7 months average) postoperatively.

Results

Improvements in the OKS (10) and EQ-5D (0.231) were smaller after revision when compared with primary TKA (OKS, 15; EQ-5D, 0.303). Patients who had revision TKA were less satisfied (66% versus 83%). Revisions for aseptic loosening or lysis were associated with the best patient outcomes (OKS improvement = 11; EQ-5D improvement = 0.232; satisfaction = 72%). Revisions for stiffness had the worst results (OKS improvement = 6; EQ-5D improvement = 0.176; satisfaction = 47%).

Conclusions

The early improvements in knee function and general health after revision TKA are only 69% to 76% of those observed for primary TKA. Levels of patient-reported knee function, general health, and satisfaction after revision are varied and related to the reason for revision. Even the best revision group does not approach the levels of function and satisfaction observed after primary TKA at a mean of 7 months postoperatively. Longer-term followup would be required to determine whether conclusions from these early data will need to be modified.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Australian Orthopaedic Association. The Australian Orthopaedic Association National Joint Replacement Registry Annual report 2009: Hip and knee Arthroplasty September 1998 to December 2008. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2009.pdf. Accessed December 15, 2011.

Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br. 2007;89:893–900.PubMedCrossRef

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed

Bertin KC, Freeman MAR, Samuelson KM, Ratcliffe SS, Todd RC. Stemmed revision arthroplasty for aseptic loosening of total knee replacement. J Bone Joint Surg Br. 1985;67:242–248.PubMed

Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.PubMedCrossRef

Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–272.PubMedCrossRef

Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.PubMedCrossRef

Deehan D, Murray JD, Birdsall PD, Pinder IM. Quality of life after knee revision arthroplasty. Acta Orthop. 2006;77:761–766.PubMedCrossRef

Dunbar MJ, Robertsson O, Ryd L, Lidgren L. Appropriate questionnaires for knee arthroplasty: results of a survey of 3600 patients from the Swedish knee Arthroplasty Registry. J Bone Joint Surg Br. 2001;83:339–344.PubMedCrossRef

10.

EuroQol Group. EQ-5D: a standardised instrument for use as a measure of health outcome. Available at: http://www.euroqol.org/home.html. Accessed June 8, 2011.

11.

Fieller EC. Some problems in interval estimation. J R Stat Soc Ser C Appl Stat. 1954:16:2:175–185.

12.

Ghomrawi HM, Kane RL, Eberly LE, Bershadsky B. Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am. 2009;91:2838–2845.PubMedCrossRef

13.

Gooding CR, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:985–993.PubMedCrossRef

14.

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

15.

Hanssen AD, Rand JA. A comparison of primary and revision total knee arthroplasty using the kinematic stabilizer prosthesis. J Bone Joint Surg Am. 1988;70:491–499.PubMed

16.

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

17.

Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.PubMed

18.

Hossein F, Patel S, Haddad FS. Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res. 2010;468:1221–1228.CrossRef

19.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed

20.

KAT Trial Group, Johnston L, MacLennan G, McCormack K, Ramsay C, Walker A. The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement J Bone Joint Surg Am. 2009;91:134–141.PubMedCrossRef

21.

Katz JN, Mahomed NN, Baron JA, Barrett JJ, Fossel AH, Creel AH, Wright J, Wright EA, Losing E. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum. 2007;56:568–574.PubMedCrossRef

22.

Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. J Bone Joint Surg Am. 2004;86:1479–1484.PubMedCrossRef

23.

Malviya A, Bettinson K, Kurtz SM, Deehan DJ. When do patient-reported assessments peak after revision knee arthroplasty? Clin Orthop Relat Res. 2011 Nov 5. [Epub ahead of print].

24.

March LM, Barcenilla AL, Cross MJ, Lapsley HM, Parker D, Brooks PM. Costs and outcomes of total hip and total knee joint replacement for rheumatoid arthritis. Clin Rheumatol. 2008;27:1235–1242.PubMedCrossRef

25.

National Joint Registry. National Joint Registry 7^th Annual Report 2010.Available at: http://www.njrcentre.org.uk/njrcentre/AbouttheNJR/Publicationsandreports/Annualreports/Archivedannualreports/tabid/87/Default.aspx. Accessed December 15, 2011.

26.

Nilsdotter AK, Toksvig-Larsen S, Roos EM. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis Cartilage. 2009;17:601–606.PubMedCrossRef

27.

Pearse AJ, Hooper GJ, Rothwell A, Frampton C. Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br. 2010;92:508–512.PubMed

28.

Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patients satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRef

29.

Saleh KJ, Dykes DC, Tweedie RL, Mohamed K, Ravichandran A, Saleh RM, Gioe TJ, Heck DA. Functional outcome after total knee arthroplasty revision: a meta- analysis. J Arthroplasty. 2002;17:967–977.PubMedCrossRef

30.

Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to Their Development and Use. Oxford, UK: Oxford University Press; 2008.

31.

Ware J Jr, Kosinski M, Keller SD. A 12-item Short Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.PubMedCrossRef

32.

Woolhead GM, Donovan JL, Dieppe PA. Outcomes of total knee replacement: a qualitative study. Rheumatology. 2005;44:1032–1037.PubMedCrossRef

33.

Wright J, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA. Patient-reported outcome and survivorship after kinemax total knee arthroplasty. J Bone Joint Surg Am. 2004;86;2464–2470.PubMed

34.

Wylde V, Learmonth I, Potter A, Bettinson K, Lingard E. Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement. J Bone Joint Surg Br. 2008;90:1172–1179.PubMed

Title: Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision
Authors: Paul Baker, MBBS, MSc, FRCS (Trauma & Orthop)
Paul Cowling, MBBS, MRCS
Steven Kurtz, PhD
Simon Jameson, MBBS, MRCS
Paul Gregg, MD, FRCS (Ed), FRCS
David Deehan, MD, MSc, FRCS (Trauma & Orthop)
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2278-7

At a glance: The STEP trials

Springer Medicine

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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