Bone loss in aseptic revision total knee arthroplasty: management and outcomes

Bieganowski, Thomas; Buchalter, Daniel B.; Singh, Rajesh; Mercuri, John J; Aggarwal, Vinay K.; Rozell, Joshua C.; Schwarzkopf, Ran

doi:10.1186/s43019-022-00158-y

Cited by 7 publications

(5 citation statements)

References 63 publications

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“…The main purpose of TKA is to relieve the patient’s pain and restore function for a long time [ 37 ]. It is well known as the most effective and satisfactory surgical treatment in the field of orthopedic surgery and has a very good survival rate [ 38 , 39 , 40 , 41 , 42 ]. The 15-year survival rate is 93.0%; the 20-year survival rate is 90.1%; and the 25-year survival rate is reported to be 82.3% [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

et al. 2023

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(1) Background: The purpose of this study was to investigate whether the loosening of total knee arthroplasty (TKA) implants could be detected accurately on plain radiographs using a deep convolution neural network (CNN). (2) Methods: We analyzed data for 100 patients who underwent revision TKA due to prosthetic loosening at a single institution from 2012 to 2020. We extracted 100 patients who underwent primary TKA without loosening through a propensity score, matching for age, gender, body mass index, operation side, and American Society of Anesthesiologists class. Transfer learning was used to prepare a detection model using a pre-trained Visual Geometry Group (VGG) 19. For transfer learning, two methods were used. First, the fully connected layer was removed, and a new fully connected layer was added to construct a new model. The convolutional layer was frozen without training, and only the fully connected layer was trained (transfer learning model 1). Second, a new model was constructed by adding a fully connected layer and varying the range of freezing for the convolutional layer (transfer learning model 2). (3) Results: The transfer learning model 1 gradually increased in accuracy and ultimately reached 87.5%. After processing through the confusion matrix, the sensitivity was 90% and the specificity was 100%. Transfer learning model 2, which was trained on the convolutional layer, gradually increased in accuracy and ultimately reached 97.5%, which represented a better improvement than for model 1. Processing through the confusion matrix affirmed that the sensitivity was 100% and the specificity was 97.5%. (4) Conclusions: The CNN algorithm, through transfer learning, shows high accuracy for detecting the loosening of TKA implants on plain radiographs.

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Section: Discussionmentioning

confidence: 99%

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

et al. 2023

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“…However, as the number of primary TKAs increases, the number of revision TKAs also gradually increases 4 . The clinical outcomes and survivorship of revision TKA are good, but they are not as satisfactory as those of primary TKA because of the greater surgical complexity, use of more constrained implant types, and poorer general patient condition 15,29 . Analyses of the mechanisms of primary and revision TKA failure show infection to be one of the main causes; it is also the most devastating complication 11,12 .…”

Section: Discussionmentioning

confidence: 99%

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Lee,

Kim,

Park

et al. 2023

Journal of Bone and Joint Surgery

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Background: The causes of primary total knee arthroplasty (TKA) failure can be divided into septic and aseptic etiologies. It is unclear whether the etiology affects the infection rate after revision TKA. This systematic review was conducted to evaluate whether there is a difference in infection rates between septic and aseptic revision TKA. We hypothesized that infection rates would be higher after septic revision TKA. Methods: The PubMed and Embase databases and the Cochrane Library were searched to find studies evaluating infection rates following septic and aseptic revision TKA. We included studies that compared the postoperative infection rates of a group that received revision TKA for aseptic failure and a group that received 1- or 2-stage revision TKA for septic failure. Studies on re-revision TKA and on revision surgery after partial knee arthroplasty were excluded, as were studies of debridement, antibiotics, and implant retention (DAIR). Results: Twelve studies were included in this systematic review. In studies in which 1- or 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (odds ratio [OR], 6.83; 95% confidence interval [CI], 1.54 to 30.33; p = 0.01). Similarly, in studies in which 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (OR, 4.14; 95% CI, 2.33 to 7.36; p < 0.00001). In the comparison of revision TKA for aseptic loosening and septic revision TKA, septic revision TKA had a higher infection rate than aseptic revision TKA (OR, 4.45; 95% CI, 2.28 to 8.70; p < 0.0001). Conclusions: Overall, septic revision TKA had a higher infection rate than aseptic revision TKA. Even when 2-stage revision TKA was performed for septic failure, the infection rate was higher after septic revision TKA than after aseptic revision. Surgeons should explain the relatively high infection rates to patients undergoing revision TKA for septic failure of their primary joint replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…While the literature suggests that cones and sleeves might be used interchangeably in smaller defects, we have specifically opted for the use of custom-made sleeves and not cones in our collective due to several factors. The implantation of a CMS should only be indicated when sufficient epiphyseal fixation is no longer possible and metaphyseal fixations are highly compromised [8,19]. In these cases, long-term implant survival can only be achieved by osteointegrative fixation in zones II and III [5].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, metaphyseal augmentation acquired by the usage of cones and sleeves has become "state of the art" [6,7]. Looking at the literature, cones are most useful for defect filling and implant fixations, while sleeves focus more on implant stability and central zone 2 fixation [8]. However, both reconstruction options seem to be superior in terms of implant survival compared to isolated cemented fixation, and the decision depends on the surgeon s preference in most defects [6,9].…”

Section: Introductionmentioning

confidence: 99%

Custom-Made Metaphyseal Sleeves in “Beyond” AORI III Defects for Revision Knee Arthroplasty—Proof of Concept and Short-Term Results of a New Technique

Hanusrichter

Gebert

Dudda

et al. 2023

JPM

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Background: While off-the-shelf cones and sleeves yield good results in AORI type 2 and 3 defects in revision knee surgery, massive longitudinal defects may require a proximal tibia replacement. To achieve the best anatomical as well as biomechanical reconstruction and preserve the tibial tuberosity, we developed custom-made metaphyseal sleeves (CMSs) to reconstruct massive defects with a hinge knee replacement. Methods: Between 2019 and 2022, 10 patients were treated in a single-center study. The indication for revision was aseptic loosening in five cases and periprosthetic joint infection in five cases. The mean number of previous revisions after the index operations was 7 (SD: 2; 4–12). A postoperative analysis was conducted to evaluate the functional outcome as well as the osteointegrative potential. Results: Implantation of the CMS in rTKA was carried out in all cases, with a mean operation time of 155 ± 48 (108–256) min. During the follow-up of 23 ± 7 (7–31) months, no CMS was revised and revisions due to other causes were conducted in five cases. Early radiographic evidence of osseointegration was recorded using a validated method. The postoperative OKS showed a significant increase (p < 0.001), with a mean score of 24 (SD: 4; range: 14–31). Conclusion: Custom-made metaphyseal sleeves show acceptable results in extreme cases. As custom-made components become more and more common, this treatment algorithm presents a viable alternative in complex rTKA.

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Bone loss in aseptic revision total knee arthroplasty: management and outcomes

Cited by 7 publications

References 63 publications

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Custom-Made Metaphyseal Sleeves in “Beyond” AORI III Defects for Revision Knee Arthroplasty—Proof of Concept and Short-Term Results of a New Technique

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