First-time revision knee arthroplasty using a hinged prosthesis

Abstract

Aims The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision. Methods Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021). Results There were 3,855 patient episodes analyzed with a median age of 73 years (interquartile range (IQR) 66 to 80), and the majority were female (n = 2,480, 64.3%). The median time to revision from primary knee arthroplasty was 1,219 days (IQR 579 to 2,422). Younger age (p < 0.001), decreasing ASA grade (p < 0.001), and indications for revision of sepsis (p < 0.001), unexplained pain (p < 0.001), non-polyethylene wear (p < 0.001), and malalignment (p < 0.001) were all associated with an earlier time to revision from primary implantation. The median follow-up was 4.56 years (range 0.00 to 17.52), during which there were 410 re-revisions. The overall unadjusted probability of re-revision for all revision HKAs at one, five, and ten years after surgery were 2.7% (95% confidence interval (CI) 2.2 to 3.3), 10.7% (95% CI 9.6 to 11.9), and 16.2% (95% CI 14.5 to 17.9), respectively. Male sex (p < 0.001), younger age (p < 0.001), revision for septic indications (p < 0.001) or implant fracture (p = 0.010), a fixed hinge (p < 0.001), or surgery performed by a non-consultant grade (p = 0.023) were independently associated with an increased risk of re-revision. Conclusion There were several factors associated with time to first revision. The re-revision rate was 16.2% at ten years; however, the risk factors associated with an increased risk of re-revision could be used to counsel patients regarding their outcome. Cite this article: Bone Joint J 2023;105-B(1):47–55.

A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone Cement

“…Postoperative complications developed in 29% of patients (infection, n = 12; aseptic loosening, n = 11; and fracture, n = 7). The National Joint Register of England, Wales, and Northern Ireland reported a 5-year revision rate for hinged prostheses of 10.7% (95% CI 9.6 to 11.9) [ 27 ]. This is consistent with the revision rate in our study for a rotating hinge prosthesis ( Table 1 ).…”

75 years young

“…It is always reassuring to read reflections from those heavily involved in the analysis of registry data about its advantages, disadvantages, value moving forward, and in particular, how it could be improved. [8][9][10][11][12][13][14][15][16][17][18][19][20] We also broach optimal management in acute trauma with an excellent annotation from Vallier, 21 which will hopefully give insight and stimulate debate.…”

Application strategy of finite element analysis in artificial knee arthroplasty

“…CCK is designed to restrict knee motion through the postcam and femoral box and is considered a semirestricted prosthesis ( Andreani et al, 2020 ; Athwal et al, 2021 ). RHK connects the femoral prosthesis to the tibial prosthesis via a rotating shaft, thereby achieving maximum restraint ( Clement et al, 2023 ). The contact pressure and contact area of the tibiofemoral joint after TKA are related to the prosthesis design, with the contact stress being inversely proportional to the contact area.…”