Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA

Abstract

Background and purpose: Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses.Patients and methods: We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach.Results: We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4–2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1–2.5), for fracture were female sex (OR 3.2; CI 2.2–4.8), age ≥ 65 years (OR 2.8; CI 1.9–4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3–3.5), for infection were male sex (OR 1.9; CI 1.7–2.0) and PS (OR 1.5; CI 1.2–1.8), for instability were age < 65 years (OR 1.5; CI 1.3–1.8) and MB (OR 1.5; CI 1.1–2.2), for loosening were PS (OR 1.5; CI 1.4–1.6), MB (OR 2.2; CI 1.6–3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8–2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1–87.2) and MB (OR 2.0; CI 1.2–3.3) and for wear was cementless fixation (OR 4.9; CI 4.3–5.5).Interpretation: Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

“…It is one of Europe and North America’s most widely performed elective orthopedic procedures [ 1 , 2 ]. Despite an optimal implant survival of more than 90% after 15 years, according to long-term studies and registry data [ 3 , 4 ], one in five patients is dissatisfied with surgical treatment [ 5 , 6 ]. There may be multiple reasons behind these results.…”

Assessment of human gait after total knee arthroplasty by dynamic time warping algorithm

“…A comparison of previous studies reported preoperative and postoperative outcome scores for patients of TKR showed that the procedure was effective [20]. The mentioned studies included patients of various ages and used a variety of prostheses and techniques to implant the device [21,22]. TKR was effective in all of the studies [21][22].…”

“…The mentioned studies included patients of various ages and used a variety of prostheses and techniques to implant the device [21,22]. TKR was effective in all of the studies [21][22]. Furthermore, unicompartmental knee replacement (UKR) surgery seems to be as effective as TKR surgery for people who have the indications for it.…”

Novel Tuning of PMMA Orthopedic Bone Cement Using TBB Initiator: Effect of Bone Cement Extracts on Bioactivity of Osteoblasts and Osteoclasts

“…Artificial joint implants can be fixed with cement to bind the bone to the implant through mechanical interlocking, or alternatively cementless surgery is applied expecting implants to generate bone at the implant surface to stabilize the implant. A randomized controlled trials and the registry studies indicated that cemented implants reduce postoperative pain and provide better joint function than cementless implants, thus improving the quality of life for the patients in the areas of hip, knee, and shoulder joints [ 1 , 2 , 3 , 4 , 5 ]. However, the use of bone cement carries a risk of adverse events, with hypotension and shock widely reported in the literature [ 6 , 7 ].…”