Long-Term (Up to 21 Years) Survival of Revision Total Knee Arthroplasty with Use of a Constrained Condylar Knee Prosthesis

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.

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

EFORT Open Reviews ◽

10.1302/2058-5241.6.210007 ◽

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

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Condylar constrained knee prosthesis and rotating hinge prosthesis for revision total knee arthroplasty for mechanical failure have not the same indications and same results

SICOT-J ◽

10.1051/sicotj/2021046 ◽

2021 ◽

Vol 7 ◽

pp. 45

Author(s):

William Barnoud ◽

Axel Schmidt ◽

John Swan ◽

Elliot Sappey-Marinier ◽

Cécile Batailler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Rate ◽

Knee Prosthesis ◽

Revision Total Knee Arthroplasty ◽

Mechanical Failure ◽

Complication Rates ◽

Rotating Hinge ◽

Total Knee

Purpose: This study aimed to evaluate whether there are any differences in outcomes and complication rates between condylar constrained knee (CCK) and rotating hinge knee (RHK) prostheses used for the first revision of total knee arthroplasty (rTKA) after mechanical failure. Methods: Sixty-three consecutive non-septic revisions of posterior stabilized implants using 33 CCK and 30 RHK prostheses were included. Clinical evaluation and revision rate were compared between the two groups at two years minimum follow-up. Results: The CCK group had significantly better clinical outcomes and satisfaction rates compared to patients with RHK (KSS-knee 70.5 versus 60.7 (p < 0.003) and KSS-function 74.9 versus 47.7 (p < 0.004) at 3.7 (2.0–9.4) years mean follow-up. Moreover, the clinical improvement was significantly higher for the CCK group concerning the KSS-Knee (+23.9 vs. +15.2 points, p = 0.03). The postoperative flexion was significantly better in the CCK group compared to the RHK group (115° vs. 103°, p = 0.01). The prosthesis-related complications and the re-revision rate were higher in the RHK group, especially due to patellofemoral complications and mechanical failures. Conclusions: CCK prostheses provided better clinical and functional outcomes and fewer complications than RHK prostheses when used for the first non-septic rTKA. CCK is a safe and effective implant for selected patients, while RHK should be used with caution as a salvage device for complex knee conditions, with particular attention to the balance of the extensor mechanism.

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