The Chitranjan Ranawat Award: Long-term Survivorship and Failure Modes of 1000 Cemented Condylar Total Knee Arthroplasties

Abstract

We examined factors affecting survivorship, and reasons for reoperation and revision of a cemented modular condylar total knee arthroplasty (TKA). One thousand and eight consecutive primary cemented cruciate-retaining TKAs performed at one institution were studied. At the time of review, 411 patients (562 knees) had died, 43 patients (45 knees) had their knee components revised or removed, and 47 patients (62 knees) were lost to followup. Mean followup of living patients with their TKA components in situ (244 patients, 331 knees) was 15.7 years. Survivorship at 15 years for revision for any reason, revision for mechanical failure, and revision for aseptic loosening were 95.9%, 97.0%, and 98.8% respectively. Survivorship was poorer among patients aged less than 60. Forty-five knees had components removed or revised; approximately one-third were removed for infection, one-third for aseptic loosening or tibial polyethylene wear, and one-third for other causes. Mechanical implant failures accounted for less than one-half of the reoperations and revisions, while infection and periprosthetic fractures accounted for a substantial portion of revisions and reoperations. Because mechanical arthroplasty failures have become less common, other complications related to arthroplasty have become proportionately more frequent.

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

“…Likewise, our revision TKA findings differ from those of prior reports implicating aseptic etiologies, including polyethylene wear, prosthetic loosening, and instability as the primary mechanisms for failed TKA [16,36,37,41,51,52]. Other studies have reported that periprosthetic joint infection is a primary indication for revision TKA [14,56]. Population and other regional differences might exist that may explain differing results in international registry data.…”

“…These differences carry implications for guiding care and resource allocation. New approaches to capturing the diagnoses and procedures that physicians and hospitals code as part of the billing process, such as the those used by the Nationwide Inpatients Sample (NIS), allow for larger-scale evaluations of the epidemiology of revision total joint arthroplasties than previously could be performed [13,14,17,37,51,56]. Prior studies [7,8] have been done that investigated the revised coding scheme in a national sample [1] to more clearly identify the indications for revision, procedure frequencies, and degree of adoption of the new diagnosis and procedure codes.…”

Prevention of Periprosthetic Joint Infection

“…Infection is the leading cause of revision after TKA and the third most common reason for revision THA in the Medicare population. PJI can occur any time after the surgery, and there is no "gold standard" for diagnosis (2)(3)(4)(5)(6)(7)(8). PJI has a huge financial impact on the healthcare system.…”

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…Studies have shown that 6.6% to 38% of RTKAs are attributable to prosthetic knee infections [5,11,23,24,31,41,43,55,58,76,95,96]. Although some [56,63] prefer it, a two-stage procedure for chronic prosthetic knee infection requires temporary cement spacers to preserve limb length and reduce soft tissue retraction.…”