Rapid Recovery Is Feasible for Aseptic Revision Total Knee Arthroplasty at an Academic Medical Center

Aims It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons. Methods This retrospective study involved patients who underwent aseptic unilateral rTKA between January 2016 and March 2019, using the database of a large urban academic medical centre. Surgeons who performed ≥ 19 aseptic rTKAs per year during the study period were considered HV and those who performed < 19 per year were considered LV. Demographic characteristics, surgical factors, and postoperative outcomes were compared between the two groups. Results A total of 308 rTKAs were identified, 132 performed by HV surgeons and 176 by 22 LV surgeons. The LV group had a significantly greater proportion of non-smokers (59.8% vs 49.2%; p = 0.029). For all types of revision, HV surgeons had significantly shorter mean operating times by 17.75 minutes (p = 0.007). For the 169 full revisions (85 HV, 84 LV), HV surgeons had significantly shorter operating times (131.12 (SD 33.78) vs 171.65 (SD 49.88) minutes; p < 0.001), significantly lower re-revision rates (7.1% vs 19.0%; p = 0.023) and significantly fewer re-revisions (0.07 (SD 0.26) vs 0.29 (SD 0.74); p = 0.017). Conclusion Patients of HV rTKA surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centres of excellence to offer patients the best possible outcomes following rTKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):131–136.

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Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.06.057 ◽

2019 ◽

Vol 34 (12) ◽

pp. 3018-3022 ◽

Cited By ~ 10

Author(s):

Hussein Abdelaziz ◽

Rodrigo Jaramillo ◽

Thorsten Gehrke ◽

Malte Ohlmeier ◽

Mustafa Citak

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Aseptic Revision ◽

Total Knee

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Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty

The Journal of Arthroplasty ◽

10.1054/arth.2000.16504 ◽

2000 ◽

Vol 15 (8) ◽

pp. 990-993 ◽

Cited By ~ 130

Author(s):

Robert L. Barrack ◽

Gerard Engh ◽

Cecil Rorabeck ◽

Jaswin Sawhney ◽

Michael Woolfrey

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Aseptic Revision ◽

Total Knee

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Intraoperative Fracture During Aseptic Revision Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2014.05.009 ◽

2014 ◽

Vol 29 (11) ◽

pp. 2187-2191 ◽

Cited By ~ 5

Author(s):

Adam A. Sassoon ◽

Cody C. Wyles ◽

German A. Norambuena Morales ◽

Matthew T. Houdek ◽

Robert T. Trousdale

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Aseptic Revision ◽

Total Knee

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Variation of synovial fluid leucocyte cell count and polymorphonuclear percentage in patients with aseptic revision total knee arthroplasty

Bone & Joint Open ◽

10.1302/2633-1462.28.bjo-2021-0109 ◽

2021 ◽

Vol 2 (8) ◽

pp. 566-572

Author(s):

Michael Fuchs ◽

Felix Kirchhoff ◽

Heiko Reichel ◽

Carsten Perka ◽

Martin Faschingbauer ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Synovial Fluid ◽

Cell Count ◽

Knee Arthroplasty ◽

Revision Surgery ◽

Joint Infection ◽

Revision Total Knee Arthroplasty ◽

Time Points ◽

Aseptic Revision ◽

Total Knee

Aims Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). Methods We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11). Results Overall, 80 synovial fluid samples of 40 patients were analyzed. The average time period between the joint aspirations was 50 days (SD 32). There was a significantly higher percentage change in LC when compared to PMN% (44.1% (SD 28.6%) vs 27.3% (SD 23.7%); p = 0.003). When applying standard definition criteria, LC counts were found to skip back and forth between the two time points with exceeding the thresholds in up to 20% of cases, which was significantly more compared to PMN% for the European Bone and Joint Infection Society (EBJIS) criteria (p = 0.001), as well as for Musculoskeletal Infection Society (MSIS) (p = 0.029). Conclusion LC and PMN% are subject to considerable variation. According to its higher interindividual variance, LC evaluation might contribute to false-positive or false-negative results in PJI assessment. Single LC testing prior to TKA revision surgery seems to be insufficient to exclude PJI. On the basis of the obtained results, PMN% analyses overrule LC measurements with regard to a conclusive diagnostic algorithm. Cite this article: Bone Jt Open 2021;2(8):566–572.

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