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J Knee Surg 2022; 35(11): 1204-1208
DOI: 10.1055/s-0040-1722351
Original Article

Revision TKA for Instability: Poorer Outcomes after a Previous Aseptic Revision

Jason D. Tegethoff
1   University of Missouri School of Medicine - School of Medicine, Columbia, Missouri
,
Rafael Walker-Santiago
2   University of Missouri - Orthopaedic Surgery, Columbia, Missouri
,
William M. Ralston
2   University of Missouri - Orthopaedic Surgery, Columbia, Missouri
,
James A. Keeney 
3   Washington University School of Medicine - Orthopaedic Surgery, St. Louis, Missouri
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Abstract

Instability is a common indication for early revision total knee arthroplasty (rTKA). The comparative performance of instability rTKA performed after primary TKA and instability rerevision TKA (rrTKA) performed after a previous rTKA performed for any aseptic indication have not been defined. This study was performed to determine the rate of adverse outcomes for patients undergoing aseptic instability TKA revision following a primary TKA or a previous aseptic any-cause rTKA. After obtaining Institutional Review Board approval, we retrospectively identified 126 rTKA and 28 rrTKA component revision procedures performed for an exclusive instability diagnosis between January 1, 2011 and April 30, 2018. We excluded patients undergoing isolated liner exchange, single component revision for mid-flexion instability, and patients treated with a constrained hinge. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and adverse postrevision outcomes (reoperation, component revision, infection, amputation) were assessed using paired Student's t-test or Fisher's exact test with a p-value < 0.05 used to determine significance. Patients in the rrTKA cohort were more commonly female (57.1 vs. 27.8%, p < 0.01), with no other demographic differences. The rrTKA cohort had higher reoperation (39.3 vs. 18.4%, p = 0.02) and component revision rates (25.0 vs. 8.7%, p = 0.03), with a trend towards early reoperation < 2 years after surgery (25.0 vs. 11.1%, p = 0.07). The rrTKA cohort also had higher adverse outcomes related to infection (14.3 vs. 1.6%, p = 0.01), extensor mechanism failure (14.3 vs. 3.2%, p = 0.04) and above-knee amputation (14.3 vs. 2.4%, p = 0.02). Component revision is beneficial for patients with TKA instability; however, higher adverse outcome rates occur after instability rrTKA performed after a previous aseptic any-cause rTKA. Infection prevention and extensor mechanism protection are important to minimize the most common adverse outcomes identified among patients undergoing aseptic rrTKA for instability.

Keywords

instability - revision - total knee arthroplasty - aseptic - extensor mechanism


Publication History

Received: 28 September 2020

Accepted: 12 November 2020

Article published online:
23 January 2021

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  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 2 Martin KR, Kuh D, Harris TB, Guralnik JM, Coggon D, Wills AK. Body mass index, occupational activity, and leisure-time physical activity: an exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet Disord 2013; 14: 219
    CrossrefPubMedGoogle Scholar
  • 3 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
    CrossrefPubMedGoogle Scholar
  • 4 Le DH, Goodman SB, Maloney WJ, Huddleston JI. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res 2014; 472 (07) 2197-2200
    CrossrefPubMedGoogle Scholar
  • 5 Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 2015; 97 (09) 715-720
    CrossrefPubMedGoogle Scholar
  • 6 Dalury DF, Pomeroy DL, Gorab RS, Adams MJ. Why are total knee arthroplasties being revised?. J Arthroplasty 2013; 28 (8, Suppl): 120-121
    CrossrefPubMedGoogle Scholar
  • 7 Schroer WC, Berend KR, Lombardi AV. et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013; 28 (8, Suppl): 116-119
    CrossrefPubMedGoogle Scholar
  • 8 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty 2014; 29 (09) 1774-1778
    CrossrefPubMedGoogle Scholar
  • 9 Wyles CC, Taunton MJ, Jacobson SR, Tran NV, Sierra RJ, Trousdale RT. Intraoperative angiography provides objective assessment of skin perfusion in complex knee reconstruction. Clin Orthop Relat Res 2015; 473 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 10 Azzam K, Parvizi J, Kaufman D, Purtill JJ, Sharkey PF, Austin MS. Revision of the unstable total knee arthroplasty: outcome predictors. J Arthroplasty 2011; 26 (08) 1139-1144
    CrossrefPubMedGoogle Scholar
  • 11 Cooper HJ, Moya-Angeler J, Bas-Aguilar MA, Hepinstall MS, Scuderi GR, Rodriguez J. Isolated polyethylene exchange with increased constraint is comparable to component revision TKA for instability in properly selected patients. J Arthroplasty 2018; 33 (09) 2946-2951
    CrossrefPubMedGoogle Scholar
  • 12 Fehring TK, Baird III R, Park B, Della Valle C. When polyethylene exchange is appropriate for prosthetic knee instability. J Am Acad Orthop Surg Glob Res Rev 2019; 3 (05) e031
    PubMedGoogle Scholar
  • 13 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
    CrossrefPubMedGoogle Scholar
  • 14 Petrie JR, Haidukewych GJ. Instability in total knee arthroplasty: assessment and solutions. Bone Joint J 2016; 98-B (1, Suppl A): 116-119
    CrossrefPubMedGoogle Scholar
  • 15 Chang MJ, Lim H, Lee NR, Moon YW. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res 2014; 26 (02) 61-67
    CrossrefPubMedGoogle Scholar
  • 16 Luttjeboer JS, Bénard MR, Defoort KC, van Hellemondt GG, Wymenga AB. Revision total knee arthroplasty for instability-outcome for different types of instability and implants. J Arthroplasty 2016; 31 (12) 2672-2676
    CrossrefPubMedGoogle Scholar
  • 17 Leta TH, Lygre SH, Skredderstuen A, Hallan G, Furnes O. Failure of aseptic revision total knee arthroplasties. Acta Orthop 2015; 86 (01) 48-57
    CrossrefPubMedGoogle Scholar
  • 18 Sierra RJ, Cooney IV WP, Pagnano MW, Trousdale RT, Rand JA. Reoperations after 3200 revision TKAs: rates, etiology, and lessons learned. Clin Orthop Relat Res 2004; (425) 200-206
    CrossrefPubMedGoogle Scholar
  • 19 Mortazavi SM, Molligan J, Austin MS, Purtill JJ, Hozack WJ, Parvizi J. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop 2011; 35 (08) 1157-1164
    CrossrefPubMedGoogle Scholar
  • 20 Rosso F, Cottino U, Dettoni F, Bruzzone M, Bonasia DE, Rossi R. Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment. J Orthop Surg Res 2019; 14 (01) 280
    CrossrefPubMedGoogle Scholar
  • 21 Postler A, Lützner C, Beyer F, Tille E, Lützner J. Analysis of total knee arthroplasty revision causes. BMC Musculoskelet Disord 2018; 19 (01) 55
    CrossrefPubMedGoogle Scholar