Survival, functional outcome and satisfaction of first revision total knee arthroplasty at a mean eleven-year follow-up

Abstract

Purpose Providing long-term outcome data after rTKA and compare one- versus two-stage and septic versus aseptic revisions. Methods This study represents a single-center retrospective study of first rTKAs performed for any reason with a final follow-up of a minimum of five years. Outcome parameters included stability assessment ROM, radiologic assessment, HSS score, KSS score, OKS score, EQ-5D-3L and VAS. 44 patients were included in the study. Subgroups analysis of one- versus two-stage revision and septic versus aseptic revision was performed. Results The leading causes of rTKA in this mean 11 year follow-up study were aseptic loosening (36%) and periprosthetic joint infection (27%). At the final follow-up, there was a 89% survivorship of the implants. Patients showed a ROM of 114 ± 13°, HSS score of 78 ± 12, KKS objective score of 77 ± 16, KSS expectation and satisfaction score of 32 ± 11, KSS functional activity score of 50 ± 20, OKS of 30 ± 9, VAS of 53 ± 25 and EQ-5D index of 0.649. Functional outcome scores were not significantly altered in the analyzed subgroups. Conclusions In our 11 years follow-up, we obtained 89% implant survivorship. Measurements regarding functional outcome and pain showed results in the medium range of the respective scores, while patient satisfaction lay in the upper third. No significant differences in outcome scores between one- and two-stage revisions and septic versus aseptic revisions were observed. Level of Evidence Level III, retrospective cohort study.

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

“…Previous studies have reported conflicting results regarding the clinical outcomes after septic and aseptic revision TKAs. Hecker et al reported no significant differences in the Hospital for Special Surgery (HSS) knee score, Oxford Knee Score, Knee Society Score (KSS) subscores, and EuroQol-5 Dimensions (EQ-5D) visual analog scale (VAS) score and index between septic and aseptic revision TKAs 31 . In contrast, Ro et al reported poorer clinical outcomes (range of motion, KSKS, and HSS score) for septic revision TKAs (p < 0.05).…”

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases

“…This is in accordance with the available literature. [4,8,25] The reason for using such implants in primary cases is the complex nature of these cases including severe bone loss, high grade deformities, ligamentous and muscular insufficiency associated with an increased risk of a less favorable outcome [21]. Another proposed indication is a intraarticular fracture in the elderly patient [19].…”

“…[21] Even current generation RHKs such as the one used in this cohort were shown to be associated with high revision rates of 10-20% during the first 2 years when used in revision and complex primary cases. [7,8,22,23] There is an ongoing debate on, whether RHK should be used in complex primary cases. [9] Recent studies showed acceptable survival rates of 80-90% after Abbreviations: ASA American society of anesthesiologists, BMI body mass index, TKA total knee arthroplasty, RHK rotating hinge knee, ROM range of motion.…”

“…A short-term (1-5 years) survival of up to 92% and mid-term (6-10 years) survival of up to 82% has been shown. The most common reasons for revision surgery were infection, aseptic loosening and peri-prosthetic fractures [1,7,8]. When used in revision surgery, the main Local review board that approved the study: Cantonal ethicscommission Bern.…”