scholarly journals Poor outcomes of revision total knee arthroplasty in patients with septic loosening compared to patients with aseptic loosening

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ji-Hoon Baek ◽  
Su Chan Lee ◽  
Hosun Jin ◽  
Jin-Woo Kim ◽  
Hye Sun Ahn ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Functional Outcomes ◽  
Survival Rates ◽  
Revision Total Knee Arthroplasty ◽  
Activity Levels ◽  
Implant Survival ◽  
Septic Loosening ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications in revision total knee arthroplasty (TKA) of patients with septic loosening with those in patients with aseptic loosening over a minimum 10-year follow-up period. Methods A cohort of 78 patients (36 septic loosening and 42 aseptic loosening) was selected between January 2008 and December 2009. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of revision TKA in patients with septic and aseptic loosening were compared. Results The mean Knee Society knee scores in the septic and aseptic groups improved from 36.7 and 37.4 preoperatively to 65.3 and 76.8 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 20 of 29 (69.0%) patients in the septic group and 35 of 39 (89.7%) patients in the aseptic group (p < 0.05). The cumulative mortality rates in the septic and aseptic groups were 19.4% (7/36) and 7.1% (3/42) (p = 0.102) at final follow-up, respectively. Kaplan–Meier survivorship analysis with re-revision of either component as an endpoint in the septic and aseptic groups estimated 86.5% and 95.5% chance of survival for 10 years, respectively. Conclusions Revision TKA in patients with septic loosening had worse functional outcomes and higher mortality over a minimum 10-year follow-up period compared with that in patients with aseptic loosening. Level of evidence IV.

scholarly journals Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review

Joints ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 019-024 ◽  
Author(s):  
Tommaso Bonanzinga ◽  
Ibrahim Akkawi ◽  
Akos Zahar ◽  
Thorsten Gehrke ◽  
Carl Haasper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Bone Defect ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Septic Loosening ◽  
Total Knee ◽  
Revision Tka

Abstract Purpose Bone loss is a challenging problem during revision total knee arthroplasty (TKA). Several studies have been published on the use of metaphyseal sleeves during revision TKA. Therefore, the aim of this systematic review was to summarize the clinical and radiographic outcomes of the use of metaphyseal sleeves in the setting of revision TKA. Methods A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar was performed, covering the period between January 1, 2000, and August 12, 2017. Various combinations of the following key words were used: “metaphyseal,” “sleeves,” “knee,” and “revision.” A total of 10 studies were included in the present systematic review. Results A total of 904 patients with 928 implants were recorded with a mean age of 69 years. They were evaluated at a mean follow-up of 45 months. Overall 1,413 sleeves, 888 in the tibia and 525 in the femur, were implanted. There were 36 septic re-revisions of the prosthetic components (4%). Five sleeves were found loose during septic re-revision; therefore, the rate of septic loosening of the sleeves was 0.35%. An aseptic re-revision of the prosthetic components was performed 27 times (3%). Ten sleeves were found loose during aseptic re-revision; therefore, the rate of aseptic loosening of the sleeves was 0.7%. Intraoperative fractures occurred 44 times (3.1%). Finally, clinical outcome was improved at final follow-up. Conclusion Metaphyseal sleeves demonstrate high radiographic signs of osteointegration, low septic loosening rate, low intraoperative fractures rate, and a good-to-excellent clinical outcome. Hence, they are a valid option to treat large metaphyseal bone defect during revision TKA. Level of Evidence This is a systematic review of level IV studies.

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

scholarly journals Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty

2020 ◽  
Vol 28 (12) ◽  
pp. 3843-3848 ◽  
Author(s):  
Sebastian M. Klim ◽  
Florian Amerstorfer ◽  
Gerwin A. Bernhardt ◽  
Patrick Sadoghi ◽  
Georg Hauer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Treatment Option ◽  
Knee Arthroplasty ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
Sf 36 ◽  
Total Knee ◽  
Mid Term Results

Abstract Purpose Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence Retrospective cohort study, level III.

scholarly journals Long-term result of a second or third two-stage revision total knee arthroplasty for infected total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Young-Hoo Kim ◽  
Jang-Won Park ◽  
Young-Soo Jang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Recurrent Infection ◽  
Revision Total Knee Arthroplasty ◽  
Two Stage ◽  
Total Knee ◽  
The Mean ◽  
Revision Tka

Abstract Background Persistent or recurrent infection after two-stage revision total knee arthroplasty (TKA) for the treatment of an infected TKA is a dreaded complication. The purpose of the current study was to determine the ability of a second or third two-stage revision TKA to control infection, evaluate the long-term survivorship of the TKA prosthesis, and measure the functional outcome after a second or third two-stage revision TKA for reinfection. Methods We evaluated 63 patients (65 knees) with failed two-stage TKA treated with a second or a third two-stage revision TKA. There were 25 men and 38 women (mean age, 67 ± 10.2 years). The mean follow-up from the time of a second two-stage TKA revision was 15.1 years (range, 10 to 19 years) and the mean follow-up from the time of a third two-stage TKA revision was 7 years (range, 5 to 10 years). Results Overall, infection was successfully controlled in 49 (78%) of 65 knees after a second two-stage revision TKA was performed. In the remaining 16 knees, recurrent infection was successfully controlled in 12 knees (75%) after a third two-stage revision TKA. Survivorship, free of implant removal for recurrent infection, was 94% at 15.1 years (95% CI, 91 to 100%). Survival free of revision TKA for mechanical failure was 95% (95% CI, 92 to 100%). Conclusions The results of the current study suggest that a second or a third two-stage revision TKA is a reasonable option for controlling infection, relieving pain, and achieving a satisfactory level of function for patients with infected TKAs.

scholarly journals Management of bone loss in revision total knee arthroplasty: therapeutic options and results

2021 ◽  
Vol 6 (11) ◽  
pp. 1073-1086
Author(s):  
E. Carlos Rodríguez-Merchán ◽  
Primitivo Gómez-Cardero ◽  
Carlos A. Encinas-Ullán
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Porous Metal ◽  
Reoperation Rate ◽  
Revision Total Knee Arthroplasty ◽  
Septic Loosening ◽  
Total Knee

The treatment of small to moderate size defects in revision total knee arthroplasty (rTKA) has yielded good results with various techniques (cement and screws, small metal augments, impaction bone grafting and modular stems). However, the treatment of severe defects remains problematic. Severe defects have typically been treated with large allograft and metaphyseal sleeves. The use of structural allograft has decreased in recent years due to increased long-term failure rates and the introduction of highly porous metal augments (cones and sleeves). A systematic review of level IV evidence studies on the outcomes of rTKA metaphyseal sleeves found a 4% rate of septic revision, and a rate of septic loosening of the sleeves of 0.35%. Aseptic re-revision was required in 3% of the cases. The rate of aseptic loosening of the sleeves was 0.7%, and the rate of intraoperative fracture was 3.1%. The mean follow-up was 3.7 years. Another systematic review of tantalum cones and sleeves found a reoperation rate of 9.7% and a 0.8% rate of aseptic loosening per sleeve. For cones, the reoperation rate was 18.7%, and the rate of aseptic loosening per cone was 1.7%. The reported survival of metal sleeves was 99.1% at three years, 98.7% at five years and 97.8% at 10 years. The reported survival free of cone revision for aseptic loosening was 100%, and survival free of any cone revision was 98%. Survival free of any revision or reoperation was 90% and 83%, respectively. Cite this article: EFORT Open Rev 2021;6:1073-1086. DOI: 10.1302/2058-5241.6.210007

scholarly journals No difference in long-term functional outcomes or survivorship after total knee arthroplasty with or without computer navigation: a 17-year survivorship analysis

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ng Jonathan Patrick ◽  
Lau Lawrence Chun Man ◽  
Chau Wai-Wang ◽  
Ong Michael Tim-Yun ◽  
Cheung Kin Wing ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Survival Rates ◽  
Computer Navigation ◽  
Survivorship Analysis ◽  
Long Term Study ◽  
Navigation Group ◽  
Total Knee ◽  
The Mean

Abstract Background The literature comparing the long-term outcomes and survivorship of computer navigation-assisted and conventional total knee replacement (TKR) is sparse. Moreover, of the available comparative studies with follow-up duration of more than 10 years, the results seem to be conflicting. The purpose of this long-term study was to compare the clinical and radiological outcomes, and implant survivorship, of TKR performed with and without computer navigation. Methods We retrospectively compared the results of 49 computer-navigated TKRs and 139 conventional TKRs. The mean age of the patients was 67.9 (range 52–81) years for the navigation group and 67.1 (range 50–80) years for the conventional TKR group. The mean duration of follow-up for the conventional and navigation TKR groups was 12.9 and 13.2 years, respectively. Clinical and radiographic follow-up examinations of the patients were performed at 2 weeks, 1 month, 3 months and 6 months post-operatively, and at 1-year intervals thereafter. Results There were no significant differences in the post-operative Knee Society knee and function score between the two groups. The mean overall deviation from neutral alignment and the radiological outliers were significantly higher in the conventional TKR group. The overall survival rates at 17 years were 92.9% for the navigation group and 95.6% for the conventional TKR group (p = 0.62). Conclusions Navigated TKR resulted in fewer radiological outliers; however, this did not translate to better long-term functional outcomes or implant survival.

scholarly journals AB0881 COMPARISION OF FUNCTIONAL OUTCOMES BETWEEN PRIMARY AND REVISION TOTAL KNEE ARTHROPLASTY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1746.1-1746
Author(s):  
K. Sevik ◽  
T. Ünver ◽  
B. Unver
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Fall Risk ◽  
Revision Total Knee Arthroplasty ◽  
Population Increase ◽  
Walk Test ◽  
Total Knee ◽  
And Function ◽  
Revision Tka

Background:Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis (OA). An increase in the prevalance of primary and revision TKA is projected due to aging of the population, increase in the obesity and OA prevalence, patients‘ quality of life perceptions and primary TKA procedures. Although TKA reliably improves pain and function; gait ability and function are still low compared to normal levels [1]. It is important to understand the prognosis to decide to undergo a rTKA (revision total knee arthroplasty) or enhance treatment protocols [2].Objectives:The aim of the study is to compare the functional results of primary and revision TKA.Methods:Hospital Of Special Surgery knee score (HSS), The Figure-Of-8 Walk Test (F8WT), The Modified Four Step Square Test (mFSST) and the 3-Meter Backwards Walk Test (3MBWT) were used for function assessment.Table 1.Characteristics of the patientsTKArTKApHSS83.00 (74.00-90.00)78.50 (68.75-90.25)0.179Age-years65.00 (57.00 – 70.25)69.00 (59.50-75.75)0.178BMI-kg/cm230.90 28.41 -34.65)31.61 (25.54-36.41)0.748Time after surgery-years2.00 (1.50-4.25)3.00 (2.00-6.50)0.038Female25 (80.6 %)20 (69.0 %)0.296Male6 (19.4 %)9 (31.0 %)Pain0.00 (0.00-0.00)0.00 (0.00-0.75)0.127*p<0.05Table 2.Functional Performances Of The PatientsTKArTKAP3MBWT6.2 (3.80-8.69)7.68 (6.10- 11.25)0.042*mFSST10.20 (9.00-12.98)13.10 (11.25-15.07)0.001*F8WT6.23 (4.74-8.6)9.11 (7.15-12.05)0.001**p<0.05Conclusion:Functional status, fall risk, balance and walking skills of the rTKA patients were lower than the TKA patients. rTKA patients experience longer operation time, hospital stay and make fewer functional gains. Improvement after rTKA is also reported to be lower than TKA and balance could be worsened or does not improve after TKA [2].Walking skills of the rTKA patients were worse than the TKA patients which may cause rTKA patients to be more cautious and tentative due to fear of falling and failure of the implant leading a more impaired function [2]. rTKA patients’ balance was lower and had more fall risk than the patients with TKA. These may be due to the recurrent incision of soft tissues causing a loss of more mechanoreceptors and a greater impairment of proprioception. These findings can help clinicians to make a more informed decision for both primary and revision procedures [3].References:[1]Jiang Y, Sanchez-Santos MT, Judge AD et al. Predictors of Patient-Reported Pain and Functional Outcomes Over 10 Years After Primary Total Knee Arthroplasty: A Prospective Cohort Study. J Arthroplasty 2017; 32: 92-100.e102.[2]Vincent KR, Vincent HK, Lee LW, Alfano AP. Inpatient rehabilitation outcomes in primary and revision total knee arthroplasty patients. Clin Orthop Relat Res 2006; 446: 201-207.[3]Wodowski AJ, Swigler CW, Liu H et al. Proprioception and knee arthroplasty: a literature review. Orthopedic Clinics 2016; 47: 301-309.Disclosure of Interests:None declared

scholarly journals Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Joseph T. Cline ◽  
Eduard Alentorn-Geli ◽  
J. H. James Choi ◽  
Joseph J. Stuart ◽  
Terry Kruger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Posterolateral Corner ◽  
Polyethylene Liner ◽  
Total Knee ◽  
Persistent Instability ◽  
Revision Tka ◽  
Posterolateral Corner Reconstruction

Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.

Outcomes of Rotating-hinge Total Knee Arthroplasty Following Complex Primary and Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
Daniel Pfeufer ◽  
Jeremy Gililland ◽  
Priscila Monteiro ◽  
Marissa Stagg ◽  
Mike Anderson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Revision Total Knee Arthroplasty ◽  
Salvage Procedure ◽  
Rotating Hinge ◽  
Total Knee ◽  
The Mean ◽  
Revision Tka

In complex primary and revision total knee arthroplasty (TKA), rotating-hinge TKA (RH-TKA) prostheses play an important role. Compared to early fixed-hinge knee designs, new implants that include rotating platforms and improved hinge constructs may offer improvements in both survival and clinical outcomes. We sought to evaluate early survival following complex primary and revision TKA with a rotating-hinge knee prosthesis. We retrospectively reviewed a consecutive series of patients (n=47, 48 knees) who underwent revision TKA using an RH-TKA system. The mean age was 73 years (range, 37 – 86). The mean body mass index was 29 (range, 16.3 – 45.9) and the median ASA score was 3 (IQR, 2 – 3). As mortality was high, we performed a Kaplan-Meier analysis to evaluate survival, with death as failure. The median follow-up was 2.5 years (range, 0.07 – 9.8). Revision-free survival was 97% at a median 2.5 years of follow-up. Overall mortality was 46% (17/37) and survival free from death was 69% (49% - 82%) at a median of 2.5 years. Most reoperations were due to infection (5/12), following by wound-related complications (2/12) and hematomas (2/12). A high postoperative complication rate and mortality are evident in TKA using a hinged knee prosthesis in complex revision TKA. If the indication and surgical technique are matched to the complexity of the case, this type of implant offers a feasible salvage procedure.

Mid-term results of tibial cones

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 158-164 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Zoe W. Hinton ◽  
Christine J. Wu ◽  
Sean P. Ryan ◽  
Michael P. Bolognesi
Keyword(s):  
Bone Loss ◽  
Aseptic Loosening ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Survivorship Analysis ◽  
Total Knee ◽  
Grade 3 ◽  
Mid Term Results ◽  
Revision Tkas

Aims Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival and complications in revision TKAs with tibial cones at minimum follow-up of five years. Methods A retrospective review was completed from September 2006 to March 2015, evaluating 67 revision TKAs (64 patients) that received one specific porous tibial cone during revision TKA. The final cohort was composed of 62 knees (59 patients) with five years of clinical follow-up or reoperation. The mean clinical follow-up of the TKAs with minimum five-year clinical follow-up was 7.6 years (5.0 to 13.3). Survivorship analysis was performed with the endpoints of tibial cone revision for aseptic loosening, tibial cone revision for any reason, and reoperation. We also evaluated periprosthetic joint infection (PJI), risk factors for failure, and performed a radiological review. Results The rate of cone revision for aseptic loosening was 6.5%, with an eight-year survival of 95%. Significant bone loss (Anderson Orthopaedic Research Institute grade 3) was associated with cone revision for aseptic loosening (p = 0.002). The rate of cone revision for any reason was 17.7%, with an eight-year survival of 84%. Sixteen percent of knees developed PJI following revision. A pre-revision diagnosis of reimplantation as part of a two-stage exchange protocol for infection was associated with both PJI (p < 0.001) and tibial cone revision (p = 0.001). Conclusion Mid-term results of tibial cones showed a survivorship free of cone revision for aseptic loosening of 95%. Patients with significant bone loss were more likely to have re-revision for tibial cone failure. Infection was common, and patients receiving cones at reimplantation were more likely to develop PJI and undergo cone revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):158–164.

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