Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Abstract

Purpose The number of revision total knee arthroplasties (rTKA) is increasing. Unfortunately, not all patients benefit from revision surgery. The aim of this study was to develop a clinical prediction model that can be used to predict the functional outcome 5 years after rTKA. Methods Data of patients receiving rTKA at Sint Maartenskliniek, Nijmegen, The Netherlands, from 2004 onwards were prospectively collected. Demographic and clinical variables and patient-reported outcome scores were collected and considered as potential predictors. Beneficial outcome was defined as an increase of ≥ 20 points on the functional knee society scores (fKSS) or an absolute fKSS ≥ 80 points 5 years after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. Results Overall, 295 rTKA patients were included of whom 157 (53%) had beneficial fKSS 5 years later. Age, gender, femoral bone defects, preoperative fKSS, and stiffness as reason for revision were included in the model. Men had a higher chance of beneficial fKSS than women (OR 1.59, 95% CI 0.91–2.78). Patients with major bone defects (OR 0.44, 95% CI 0.22–0.85), higher age (IQR OR 0.39, 95% CI 0.26–0.58), higher preoperative fKSS (IQR OR 0.42, 95% CI 0.30–0.59), and severe stiffness (OR 0.48, 95% CI 0.20–1.15) had a lower chance of successful outcome. The model’s AUC was 0.76, 95% CI 0.70–0.81. Conclusion Easily determinable characteristics of patients who need rTKA can be used to predict future functional outcome. Young men with low preoperative fKSS without severe stiffness are more likely to achieve a beneficial outcome. Level of evidence IV.

Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty

“…The mean knee KSS improved from 51 points to 80 points at latest follow-up (D knee KSS ¼ 29 vs 35.1 for the TM þ SS group in this study). Comparison of results with other studies is complex because of the multitude of different implants used and the different distribution of factors predictive of poor outcomes as defined by Verbeek et al [37]. In this study, not only the absence of significant differences between the different groups in terms of preoperative characteristics, causes of revision, and type of bone defect but also the use of the same type of prosthesis reinforces the strength in terms of better functional results of the TM þ SS group.…”

Recovery patterns in patients undergoing revision surgery of the primary knee prosthesis

“…These findings indicates that patients react differently during their recovery period within the first year after revision knee arthroplasty. Possible explanations for different recovery trajectories may lie in patient characteristics, such as age, gender, preoperative function scores and indication for revision [ 15 , 33 , 35 ]. In this study, age differed significantly between the groups, in particular between the no improvement group and short improvement group.…”

“…improvements in function and pain scores [ 15 , 26 , 30 , 33 , 35 ]. In addition, postoperative quality of life demonstrated good scores after knee revision arthroplasty [ 28 ].…”

LncRNA MEG3 promotes osteogenesis of hBMSCs by regulating miR-21-5p / SOD3 axis

“…Autologous bone transplantation, especially autogenous bone transplantation with microvascular anastomosis to reconstruct blood vessels, can minimize adverse recipient reactions, and change the process of creeping substitution to direct fracture healing. The disadvantage of autologous bone transplantation is that the amount of bone to be taken is limited and it may cause a series of potential complications at the donor site such as trauma (Li et al, 2019;Verbeek et al, 2019). Compared with other seed cells, human bone marrow mesenchymal stem cells (hBMSCs) have a number of advantages.…”