Poorer survival after a primary implant during revision total knee arthroplasty

Abstract

Purpose Revision total knee arthroplasty (rTKA) is a complex procedure. Depending on the degree of ligament and bone damage, either primary or revision implants are used. The purpose of this study was to compare survival rates of primary implants with revision implants when used during rTKA. Methods A retrospective comparative study was conducted between 1998 and 2009 during which 69 rTKAs were performed on 65 patients. Most common indications for revision were infection (30 %), aseptic loosening (25 %) and wear/ osteolysis (25 %). During rTKA, a primary implant was used in nine knees and a revision implant in 60. Results Survival of primary implants was 100 % at one year, 73 % [95 % confidence interval (CI) 41-100] at two years and 44 % (95 % CI 7-81) at five years. Survival of revision implants was 95 % (95 % CI 89-100) at one year, 92 % (95 % CI 84-99) at two years and 92 % (95 % CI 84-99) at five years. Primary implants had a significantly worse survival rate than revision implants when implanted during rTKA [P00.039 (hazard ratio04.56, 95 % CI 1.08-19.27)]. Conclusions Based on these results, it has to be considered whether primary implants are even an option during rTKA.

Predictive factors for failure after total knee replacement revision

“…According to the literature, our medium-term aseptic survival (60 months) was 93.4 %, similar to reviewed series, e.g. 87.4 % aseptic survival at five years [36], 89 % at five years [19], 92 % at five years [37], and 100 % at seven years [9].…”

Constraint choice in revision knee arthroplasty

“…Constraint choice depends on the state of collateral ligaments and other peripheral stabilisers of the knee, and on the severity of bone loss [12][13][14]. Primary postero-stabilised (PS) designs may be used if the ligaments are intact and bone defects are minimal [12], whereas hinged prostheses are necessary in cases of ligament absence/disruption with moderate or severe bone loss [5,15].…”

“…Primary postero-stabilised (PS) designs may be used if the ligaments are intact and bone defects are minimal [12], whereas hinged prostheses are necessary in cases of ligament absence/disruption with moderate or severe bone loss [5,15]. Condylar constrained knee (CCK) prostheses are semi-constrained nonhinged implants, which represent an excellent alternative to the hinged prostheses.…”

Constraints in total knee arthroplasty: current status and review of literature

“…CR or PS prostheses in these scenarios are fraught with dangers of instability and early failure. 7 Adherence to good surgical technique, meticulous soft tissue handling, and use of an appropriate constrained prostheses can impact the success of revision procedure and tide over the complex problem.…”

“…6 Therefore, PS implants can only be considered in presence of intact functioning ligaments and good quality bone. 7 They have been used successfully in case of conversion of unicompartmental knee arthroplasty (UKA) to TKA. 8 Another development in case of absent or nonfunctioning PCL is ultracongruent (UC) insert.…”