Why Are Total Knees Failing Today? Etiology of Total Knee Revision in 2010 and 2011

Schroer, William C.; Berend, Keith R.; Lombardi, Adolph V.; Barnes, C. Lowry; Bolognesi, Michael P.; Berend, Michael E.; Ritter, Merrill A.; Nunley, Ryan M.

doi:10.1016/j.arth.2013.04.056

Cited by 357 publications

(242 citation statements)

References 32 publications

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“…One of the most devastating reasons for revision TKA is PJI, which has been found responsible for 16% to 27% of all revision TKAs in recent investigations [2,17,21,22]. PJI has also been implicated as the primary culprit in early revision (\2 years) [13,17,22].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most devastating reasons for revision TKA is periprosthetic joint infection (PJI), representing 16% to 27% of all revision TKAs in recent series [2,4,6,16,17,21,22]. Although various surgical approaches for eradicating infection are used around the world, two-stage exchange arthroplasty is the gold standard for treating TKA PJI in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication. Questions/purposes The purposes of this study were (1) to determine the ultimate range of motion; and (2) to determine the proportion of patients who remained free of infection at a minimum 2 years after treatment with static antibiotic spacers as part of a two-stage revision TKA for the treatment of periprosthetic joint infection. Methods Between 1999 and 2011, we treated 121 patients with chronically infected TKAs, of whom three had medical comorbidities precluding a two-stage exchange, four had died before 2-year followup for reasons other than the surgical intervention, and seven were lost to followup. The remaining 107 patients (109 knees; 53 men and 54 women) were treated using a two-stage approach with static spacers and are evaluated here at a mean of 3.7 years (range, 2.0-9.8 years); no patients were treated with articulating spacers during this study period. Twenty-five percent (27 of 109) of the organisms isolated the first-stage procedure were resistant to methicillin and/or vancomycin. Median age at the time of reimplantation was 67 years (range, 42-89 years). Range of motion was measured by an independent physical therapist with a standard goniometer. Knee Society knee and function scores were calculated before the first stage and at the 2-year mark. Because many of these patients were treated before consensus definitions Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Stanford University Medical Center, Stanford, CA, USA. of infection were established, we made ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Despite the clinical success of the arthroplasties, aseptic loosening is one of the major causes of failure [29,45]. Aseptic loosening has been reported to be one of the most common causes for revisions, accounting for almost 55% of hip [47] and 31% of knee [49] revisions. As such, it is imperative to optimize primary outcomes in total joint arthroplasties and to avoid the difficulties and complication rates that can be found with revisions.…”

Section: Introductionmentioning

confidence: 99%

What Host Factors Affect Aseptic Loosening After THA and TKA?

Cherian

Jauregui

Banerjee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

174

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Background Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening. Questions/purpose We performed a systematic review to determine which host factors play a role in the development of clinical and/or radiographic failure from aseptic loosening after (1) THA and (2) TKA. Methods Two searches on THA and TKA, respectively, using four electronic databases (EMBASE, CINAHL Plus, PubMed, and Scopus) were conducted. We identified a total of 209 reports that encompassed nine potential host factors affecting aseptic loosening. Inclusion criteria for consideration of scientific clinical reports were that 20 or more patients were involved, with more than 1-year followup, with at least three studies pertaining to each factor, and at least six of the Methodological Index for Non-randomized Studies criteria met, and with raw data for odds ratio (OR) calculations. Twenty-one studies (16 THA studies with 45,779 hips and five TKA studies with 288 knees, respectively) were used to calculate weighted OR and CIs (using the random effects theory) and study heterogeneity for four different host factors in THAs (male sex, high activity level, obesity defined as BMI C 30 kg/m 2 , and current or former tobacco use) and one factor in TKA (BMI C 30 kg/m 2 ), which were placed in a forest plot. Results For THA, male sex (OR, 1.39; 95% CI, 1.22-1.58; p = 0.001) and high activity level (University of California Los Angeles [UCLA] activity score C 8 points; OR, 4.24; 95% CI, 2.46-7.31; p = 0.001) were associated with aseptic loosening. However, obesity (OR, 1.01; 95% CI, 0.73-1.40; p = 0.96), and tobacco use (OR, 1.96; 95% CI, 0.43-8.97; p = 0.39) were not associated with an increased risk of aseptic loosening after THA with the numbers available. For TKA, we found no host factors associated with loosening. In particular, obesity (BMI C 30 kg/m 2

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“…More importantly, however, polyethylene sterilization carried out in an oxygen-free environment prevents complications related to oxidative degradation, free radical production, and excessive osteolysis [30]. Despite the fact that the incidence of severe osteolysis has been significantly reduced since the advent of these new technologies, Schrorer et al reported that 10 % of their TKA revisions were related to issues with polyethylene wear and bone loss, particularly around the tibial baseplate [31]. The diagnosis of polyethylene wear can be often be made on serial radiographs of the knee, and is characterized by loss of polyethylene liner height over time, the accompanying resorption of bone surrounding the implants, and possible associated subsidence of the implant components.…”

Section: Aseptic Looseningmentioning

confidence: 99%

Towards an understanding of the painful total knee: what is the role of patient biology?

Preston

Petrera

Kim

et al. 2016

Curr Rev Musculoskelet Med

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Total knee arthroplasty (TKA) remains the treatment of choice for end-stage osteoarthritis of the knee.With an aging population, the demand for TKA continues to increase, placing a significant burden on a health care system that must function with limited resources. Although generally accepted as a successful procedure, 15-30 % of patients report persistent pain following TKA. Classically, pain generators have been divided into intra-articular and extra-articular causes. However, there remains a significant subset of patients for whom pain remains unexplained. Recent studies have questioned the role of biology (inflammation) in the persistence of pain following TKA. This article aims to serve as a review of previously identified causes of knee pain following TKA, as well as to explore the potential role of biology as a predictor of pain following knee replacement surgery.

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Why Are Total Knees Failing Today? Etiology of Total Knee Revision in 2010 and 2011

Cited by 357 publications

References 32 publications

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

What Host Factors Affect Aseptic Loosening After THA and TKA?

Towards an understanding of the painful total knee: what is the role of patient biology?

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