Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

Abstract

Background Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear. Questions/purposes We determined differences in patientreported outcomes and rates of satisfaction between primary and revision TKAs, and determine whether the reason for revision influences patient-reported outcomes after revision TKA. Methods We retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) for 24,190 patients (23,393 TKAs; 797 aseptic revision TKAs). We compared patient-reported outcomes using the Oxford Knee Score (OKS), EuroQol (EQ-5D), and patient satisfaction between primary TKA and revision TKA, and for subsets of the revision TKA cohort. The followup data were collected between 6 and 12 months (7 months average) postoperatively. Results Improvements in the OKS (10) and EQ-5D (0.231) were smaller after revision when compared with primary TKA (OKS, 15; EQ-5D, 0.303). Patients who had revision TKA were less satisfied (66% versus 83%). Revisions for aseptic loosening or lysis were associated with the best patient outcomes (OKS improvement = 11; EQ-5D improvement = 0.232; satisfaction = 72%). Revisions for stiffness had the worst results (OKS improvement = 6; EQ-5D improvement = 0.176; satisfaction = 47%). Conclusions The early improvements in knee function and general health after revision TKA are only 69% to 76% of those observed for primary TKA. Levels of patient-reported knee function, general health, and satisfaction after revision are varied and related to the reason for revision. Even the best revision group does not approach the levels of function and satisfaction observed after primary TKA at a mean of 7 months postoperatively.

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…Despite similar or better function and pain scores for patients undergoing a revision surgery than for those undergoing a primary joint surgery, a revision surgery does not seem to bring as much pain and functional improvement 12 months later. This finding is congruent with the existing literature 351,352 and needs to be kept in mind when patients and clinicians discuss post-surgical expectations.…”

CORR Insights®: Reason for Revision TKA Predicts Clinical Outcome: Prospective Evaluation of 150 Consecutive Patients With 2-years Followup

“…It emphasizes the growing appreciation that patient satisfaction and associated functional outcomes are heavily dependent upon the reason for implant revision. This finding is consistent with previous reports from independent series [6] and a recent registry analysis of patient reported outcome data [1]. These studies, along with the work of van Kempen and colleagues, reveal that functional outcomes are best when revision is performed for a single, well-defined nonseptic cause.…”

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“…Ong et al [11] showed that a RTKA has a 5 to 6 times increased risk of re-revision. In a recent study, Baker et al [12] showed that improvement after a RTKA was only 69%-76% of a primary TKA and that the Medicare database showed the 5-year survivorship of RTKA to be only 87%.…”