Revision Surgery After Cartilage Repair: Data From the German Cartilage Registry (KnorpelRegister DGOU)

Abstract

Background:Various operative strategies have been introduced to restore the integrity of articular cartilage when injured. The frequency of revision surgery after cartilage regenerative surgery remains incompletely understood.Purpose/Hypothesis:The purpose of this study was to identify the reasons for revision surgery after cartilage regenerative surgery of the knee. We hypothesized that in a large patient cohort, revision rates would differ from those in the current literature.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 2659 complete data sets from the German Cartilage Registry were available for analyses. In brief, baseline data were provided by the attending physician at the time of index surgery. Follow-up data were collected using a web-based questionnaire inquiring whether patients had needed revision surgery during follow-up, which was defined as the endpoint of the present analysis.Results:A total of 88 patients (3.3%) reported the need for revision surgery as early as 12 months postoperatively. Among the most common causes were arthrofibrosis (n = 27) and infection (n = 10). Female patients showed a significantly greater complication rate (4.5%) when compared with male patients (2.6%; P = .0071). The majority of cartilage lesions were located at the medial femoral condyle (40.2%), with a mean defect size of 3.5 ± 2.1 cm2. Neither the location nor defect size appeared to lead to an increased revision rate, which was greatest after osteochondral autografts (5.2%) and autologous chondrocyte implantation (4.6%). Revision rates did not differ significantly among surgical techniques. Chi-square analysis revealed significant correlations between the number of previous joint surgeries and the need for revision surgery (P = .0203). Multivariate regression analysis further confirmed sex and the number of previous surgeries as variables predicting the need for early revision surgery.Conclusion:The low early revision rates found in this study underline that today’s cartilage repair surgeries are mostly safe. Although invasiveness and techniques differ greatly among the procedures, no differences in revision rates were observed. Specific factors such as sex and the number of previous surgeries seem to influence overall revision rates and were identified as relevant risk factors with regard to patient safety.

Toward tissue-engineering of nasal cartilages

“…Postoperatively, 13% of patients retained their anatomic nasal deformities [10]. The revision rate associated with rhinoplasty is influenced by this lack of anatomic correction [10] and is, notably, much higher than the revision rate for articular cartilage repair procedures (5.2%) and total knee arthroplasties (0.49%) [12,13]. Despite the evolution of surgical rhinoplasty techniques [14], the frequency of rhinoplasty operations, in combination with their high revision rates, highlights the importance and need for their continued refinement.…”

“…Structural integrity of all cartilaginous nasal structures is key in proper nasal function and airway patency. 12…”

Decision making for concomitant high tibial osteotomy (HTO) in cartilage repair patients based on a nationwide cohort study of 4968 patients

“…On the other hand, the question could also be why not to perform a concomitant HTO in patients with an isolated cartilage defect on the medial femoral condyle. The fear of revision surgery should not be a reason, since the revision rate after concomitant HTO (2,6%) is even a little lower than the general revision rate after cartilage surgery (2,8%) [ 25 ]. Yet, a truly considerable reason which needs to be mentioned in patient consultation is the length of sick leave after high tibial osteotomies.…”

Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

“…Rates of subsequent surgery after microfracture using an awl and hammer technique have demonstrated increasing revision rates over time. 13,[34][35][36] Revision rates within the first postoperative year have been reported to range between 3% and 9%, 36 and 5-year revision rates have been reported to increase to 22% to 42%. 13,34,35 Weber et al 13 retrospectively reviewed outcomes in a cohort of patients receiving microfracture with an awl from the same institution.…”