CORR Insights®: Patients Who Undergo Early Aseptic Revision TKA Within 90 Days of Surgery Have a High Risk of Re-revision and Infection at 2 Years: A Large-database Study

AbstractInstability is a common indication for early revision total knee arthroplasty (rTKA). The comparative performance of instability rTKA performed after primary TKA and instability rerevision TKA (rrTKA) performed after a previous rTKA performed for any aseptic indication have not been defined. This study was performed to determine the rate of adverse outcomes for patients undergoing aseptic instability TKA revision following a primary TKA or a previous aseptic any-cause rTKA. After obtaining Institutional Review Board approval, we retrospectively identified 126 rTKA and 28 rrTKA component revision procedures performed for an exclusive instability diagnosis between January 1, 2011 and April 30, 2018. We excluded patients undergoing isolated liner exchange, single component revision for mid-flexion instability, and patients treated with a constrained hinge. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and adverse postrevision outcomes (reoperation, component revision, infection, amputation) were assessed using paired Student's t-test or Fisher's exact test with a p-value < 0.05 used to determine significance. Patients in the rrTKA cohort were more commonly female (57.1 vs. 27.8%, p < 0.01), with no other demographic differences. The rrTKA cohort had higher reoperation (39.3 vs. 18.4%, p = 0.02) and component revision rates (25.0 vs. 8.7%, p = 0.03), with a trend towards early reoperation < 2 years after surgery (25.0 vs. 11.1%, p = 0.07). The rrTKA cohort also had higher adverse outcomes related to infection (14.3 vs. 1.6%, p = 0.01), extensor mechanism failure (14.3 vs. 3.2%, p = 0.04) and above-knee amputation (14.3 vs. 2.4%, p = 0.02). Component revision is beneficial for patients with TKA instability; however, higher adverse outcome rates occur after instability rrTKA performed after a previous aseptic any-cause rTKA. Infection prevention and extensor mechanism protection are important to minimize the most common adverse outcomes identified among patients undergoing aseptic rrTKA for instability.

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Can Revision TKA Patients Achieve Similar Clinical Functional Improvement Compared to Primaries?

The Journal of Knee Surgery ◽

10.1055/s-0039-1693415 ◽

2019 ◽

Vol 33 (12) ◽

pp. 1219-1224 ◽

Cited By ~ 1

Author(s):

Shikha Sachdeva ◽

James F. Baker ◽

Jesse E. Bauwens ◽

Langan S. Smith ◽

Nipun Sodhi ◽

...

Keyword(s):

Range Of Motion ◽

Primary Total Knee Arthroplasty ◽

Clinical Results ◽

Implant Design ◽

Functional Improvement ◽

P Value ◽

Average Improvement ◽

Aseptic Revision ◽

Revision Tka

AbstractThe etiology of failure following primary total knee arthroplasty (TKA) leading to revision surgery are multifactorial, including infection, instability, loosening, contracture, and wear. Although the majority of patients have successful outcomes following revision TKA, postoperative complications are still increased in these patients when compared to primary patients. For this reason, there has been a continued search to identify options, including prosthesis types, to potentially improve outcomes. Therefore, the purpose of this study was to determine if the clinical results achieved following revision TKA are comparatively similar to primaries using the same implant design. Specifically, we compared (1) Knee Society Functional and Range-of-Motion Knee Scores and (2) component survivorship. This was a retrospective analysis of 100 patients undergoing revision TKA due to an aseptic etiology, who were matched to a cohort of 100 patients who underwent primaries with the same prosthesis. There were no differences in the groups with respect to age at surgery, sex, and body mass index. The mean follow-up was 57 months in the revision group (range 24–105 months) and 67 months in the primary TKA group (range 55–123 months). American Knee Society Scores (KSS) and range of motion measurements recorded preoperatively and at the most recent postoperative visit were compared between both cohorts in order to compare postoperative outcomes. A p value of 0.05 was used for significance. The average improvement between the pre- and postoperative KSS function scores in both groups was similar, with both cohorts demonstrating a 28-point improvement. At 2-year follow-up, all-cause survivorship of the aseptic revision surgeries was 87%. Patients undergoing revision TKA for aseptic loosening can potentially expect similar improvements in clinical function scores and survivorship compared to primary TKA when controlling for implant type.

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