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.
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References
Babis GC, Trousdale RT, Morrey BF (2002) The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am 84:64–68
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 15:990–993
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 464:146–150
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 80:426–431
Christensen CP, Crawford JJ, Olin MD, Vail TP (2002) Revision of the stiff total knee arthroplasty. J Arthroplasty 17:409–415
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 68:642–647
Dahm DL, Barnes SA, Harrington JR, Berry DJ (2007) Patient reported activity after revision total knee arthroplasty. J Arthroplasty 22:106–110
Dennis DA, Berry DJ, Engh G, Fehring T, MacDonald SJ, Rosenberg AG, Scuderi G (2008) Revision total knee arthroplasty. J Am Acad Orthop Surg 16:442–454
Engh GA, Ammeen DJ (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am 29:205–217
Fehring TK, Odum S, Griffin WL, Mason JB (2005) Outcome comparison of partial and full component revision TKA. Clin Orthop Relat Res 440:131–134
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 91:889–895
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 461:54–59
Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75B:822–824
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14
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 91:38–47
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 80:67–77
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 34:649–653
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 89:780–785
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 169:1113–1121
Mendes MW, Caldwell P, Jiranek WA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19:167–174
Murray DW, Carr AJ, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75B:697–704
Nelson CL, Kim J, Lotke PA (2005) Stiffness after total knee arthroplasty. J Bone Joint Surg Am 87:264–270
Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:945–948
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 275:204–210
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 466:2628–2633
Piedade SR, Pinaroli A, Servien E, Neyret P (2009) Revision after early aseptic failures in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:248–253
Pun SY, Ries MD (2008) Effect of gender and preoperative diagnosis on results of revision total knee arthroplasty. Clin Orthop Relat Res 466:2701–2705
Riaz S, Umar M (2006) Revision knee arthroplasty. J Pak Mad Assoc 10:456–460
Ritter MA, Campbell ED (1987) Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 2:95–97
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 90:777–784
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 17:667–675
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 404:7–13
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 88:1425–1430
Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S (2008) Why do revision knee arthroplasties fail? J Arthroplasty 23:99–102
The Swedish Knee Arthroplasty register. Annual report 2007. http://www.knee.nko.se/english/online/uploadedFiles/110_SKAR2007_Engl1.2.pdf
Uematsu O, Hsu HP, Kelly KM, Ewald FC, Walker PS (1987) Radiographic study of kinematic total knee arthroplasty. J Arthroplasty 2:317–326
van den Broek CM, van Hellemondt GG, Jacobs WC, Wymenga AB (2006) Stepcut tibial tubercle osteotomy for access in revision total knee replacement. Knee 13:430–434
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 18:367–374
Vince KG, Droll K, Chivas D (2008) New concepts in revision total knee arthroplasty. J Surg Orthop Adv 17:165–172
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 11:45–49
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 468:96–101
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Hardeman, F., Londers, J., Favril, A. et al. Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20, 1049–1056 (2012). https://doi.org/10.1007/s00167-011-1624-8
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DOI: https://doi.org/10.1007/s00167-011-1624-8