The epidemiology of failure in total knee arthroplasty

Khan, Mehnaz; Osman, Khabab; Green, G.; Haddad, Fares S.

doi:10.1302/0301-620x.98b1.36293

Cited by 280 publications

(196 citation statements)

References 49 publications

(59 reference statements)

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“…A similar observation was recently reported in a major review study conducted by Khan et al. (2016), where a shift from infection to aseptic loosening occurred 2.5 years after the primary TKA operation.…”

Section: Discussionmentioning

confidence: 99%

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Increased risk of early and medium-term revision after post-fracture total knee arthroplasty

et al. 2017

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Background and purposeTotal knee arthroplasty (TKA) due to posttraumatic fracture osteoarthritis (PTFA) may be associated with inferior prosthesis survival. This study is the first registry-based study solely addressing this issue. Both indications and predictors for revision were identified.Patients and methods52,518 primary TKAs performed between 1997 and 2013 were retrieved from the Danish Knee Arthroplasty Register (DKR). 1,421 TKAs were inserted due to PTFA and 51,097 due to primary osteoarthritis (OA). Short-term (< 1 year), medium-term (1–5 years), and long-term (> 5 years) implant survival were analyzed using Kaplan-Meier analysis and Cox regression after age stratification (< 50, 50–70, and >70 years). In addition, indications for revision and characteristics of TKA patients with subsequent revision were determined.ResultsDuring the first 5 years, TKAs inserted due to PTFA had a higher risk of revision than OA (with adjusted hazard ratio ranging from 1.5 to 2.4 between age categories). After 5 years, no significant differences in the risk of revision were seen between the groups. Infection and aseptic loosening were the most common causes of revision in both groups, but TKA instability was a more frequent indication for revision in the PTFA group. In both groups, the revision rates were higher with younger age and extended duration of primary surgery.InterpretationWe found an increased risk of early and medium-term revision of TKAs inserted due to previous fractures in the distal femur and/or proximal tibia. Predictors of revision such as age <50 years and extended duration of primary surgery were identified, and revision due to instability occurred more frequently in TKAs performed due to previous fractures.

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Section: Discussionmentioning

confidence: 99%

“…The confounders were chosen based on clinical experience and the previous literature (Khan et al. 2016). All covariates fulfilled the assumption of proportional hazards when tested by Schoenfeld residual test.…”

Section: Methodsmentioning

confidence: 99%

Increased risk of early and medium-term revision after post-fracture total knee arthroplasty

et al. 2017

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“…The decreasing trend of revisions due to wear debris clearly indicates that improvements in PE manufacturing, sterilization, and design were key to increasing the device survival [49]. However, this study demonstrates that PE debris in and of itself may not be responsible for the loss of cement-bone interlock in functioning TKAs.…”

Section: Discussionmentioning

confidence: 95%

“…However, this study demonstrates that PE debris in and of itself may not be responsible for the loss of cement-bone interlock in functioning TKAs. Considering the rates of revision are now at ~5% for 10 years post implantation for some devices [49], looking beyond PE debris to other potential causes of aseptic loosening may be necessary to further improve the longevity of TKA. Note that all of implants in this study were unrevised, clinically successful implants at time of death.…”

Section: Discussionmentioning

confidence: 99%

Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties?

Cyndari

Goodheart

Miller

et al. 2017

The Journal of Arthroplasty

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Background Loss of mechanical interlock between cement and bone with in vivo service has been recently quantified for functioning, non-revised, cemented Total Knee Arthroplasties (TKA). The cause of interlocking trabecular resorption is not known. The goal of this study was to quantify the distribution of PE debris at the cement-bone interface and determine if polyethylene (PE) debris is locally associated with loss of interlock. Methods Fresh, non-revised, postmortem-retrieved TKAs (n=8) were obtained en bloc. Lab-prepared constructs (n=2) served as negative controls. The intact cement-bone interface of each proximal tibia was embedded in Spurr’s resin, sectioned, and imaged under polarized light to identify birefringent PE particles. PE wear particle number density was quantified at the cement-bone interface and distal to the interface, then compared to local loss of cement-bone interlock. Results The average PE particle number density for postmortem retrieved TKAs ranged from 8.6 (1.3) to 24.9 (3.1) particles/mm2 (SE) but was weakly correlated with years in service. The average particle number density was twice as high distal (> 5mm) to the interface compared to at the interface. The local loss of interlock at the interface was not related to presence, absence, or particle density of PE. Conclusions PE debris can migrate extensively along the cement-bone interface of well-fixed tibial components. However, the amount of local bone loss at the cement-bone interface was not correlated with the amount of PE debris at the interface, suggesting that the observed loss of trabecular interlock in these well-fixed TKAs may be due to alternative factors.

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“…Despite the relative frequency of this operation, recent research shows over a fifth of patients are left dissatisfied with their post-surgical outcomes [5] and this figure is higher in younger patient age groups. Younger patients undergoing primary TKR are also far more likely to require revision surgery in the future due to increased demands and expectations following surgery [6]. Furthermore, a recent analysis performed by Ferket et al found that current practice on TKR operations leads to minimal changes in quality of life and quality adjusted life years, and is only cost-effective in older patients with severe symptoms [7].…”

Section: Introductionmentioning

confidence: 99%

Intra-articular Injections for Management of Knee Osteoarthritis

Golding¹,

Brock²,

Whiting³

et al. 2017

J Arthritis

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Knee pain is an increasingly common presentation to general practitioners worldwide which is thought to be related to the obesity epidemic, an ageing population and increasingly sedentary lifestyles in more developed nations. Degenerative osteoarthritis (OA) accounts for the majority of presentations in older age groups and this has traditionally been treated with analgesia, lifestyle modifications and adjuncts such as physiotherapy, braces and insoles. All these therapies aim to delay the need of total knee replacement (TKR), which is often the end-point for severe knee OA. However, TKR is associated with poor levels of patient satisfaction, low functional outcomes and has recently been shown to have low levels of cost-effectiveness except in patients with severe disabling OA. Increasingly doctors are turning to intra-articular injections which can provide temporary pain relief such as corticosteroids, hyaluronic acid and platelet rich plasma. This article aims to review the current options for intraarticular injections, comment on their efficacy and suggest areas for future development.

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The epidemiology of failure in total knee arthroplasty

Cited by 280 publications

References 49 publications

Increased risk of early and medium-term revision after post-fracture total knee arthroplasty

Increased risk of early and medium-term revision after post-fracture total knee arthroplasty

Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties?

Intra-articular Injections for Management of Knee Osteoarthritis

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