Long-Term Survival of a Semi-Constrained Implant Following Revision for Infection

Wilke, Benjamin K.; Wagner, Eric R.; Trousdale, Robert T.

doi:10.1016/j.arth.2014.10.037

Cited by 13 publications

(17 citation statements)

References 11 publications

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“…This series demonstrated a satisfactory functional improvement in the metal sensitive group where no obvious clinical condition which could explain their pain was present. While not ordinarily considered an impressive outcome, this series compares favorably with many authors’ findings of patients with unexplained knee pain (Caicedo et al 2013 ; Cherian et al 2016 ; Elmallah et al 2016 ; Hitt et al 2015 ; McNabb et al 2015 ; Meneghini et al 2015 ; Petersen et al 2015 ; Schroer et al 2013 ; Siqueira et al 2015 ; Watters et al 2010 ; Wilke et al 2015 ), particularly knee pain that cannot be explained radiographically (Mont et al 1996 ). This series demonstrates that the influence of metal sensitization was apparent and was subsequently corrected by removal of the antigenic byproducts of wear.…”

Section: Discussionsupporting

confidence: 79%

What role does metal allergy sensitization play in total knee arthroplasty revision?

Lionberger¹,

Samorajski

Wilson

et al. 2018

J EXP ORTOP

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BackgroundClinicians are often faced with the decision whether to revise a painful total knee replacement in patients who have chronic vague pain with no apparent explanation. A sensitive metal testing assay called the lymphocyte stimulation test has been used to detect nickel sensitization in patients with orthopedic implants. We hypothesize that nickel sensitization plays a role in the pathology of failed joint arthroplasty in patients with unexplained dissatisfaction.Methods32 patients with symptomatic total knee arthroplasty without obvious mechanical findings were tested prior to revision surgery. 19 nickel-sensitized and 13 non-sensitized patients were compared by cell counts of synovium surgical specimens for CD4+ and CD8+ cell lines. Patients were then revised with ceramic-coated implants. Secondary evaluation of functional outcomes, range of motion, and pain relief were assessed.ResultsNickel-sensitive patients showed a statistical increase in CD4+ reactivity compared to CD8+ reactivity. The ratio of CD4+/CD8+ T lymphocytes was 1.28 in nickel-sensitive patients versus 0.76 in the control (p = 0.009). There was no difference in functional scores, clinical scores, or range of motion after revision.ConclusionsThis study provides objective data via histological analysis in support of a nickel allergic sensitization in failed arthroplasties where clinical and/or radiographic abnormalities may not be apparent. Biopsy for CD4+/CD8+ cell counts may provide further proof of the existence of nickel sensitization in lymphocyte stimulation test positive patients, and more importantly, may implore the surgeon to consider low nickel implant design in these patients.

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Section: Discussionsupporting

confidence: 79%

What role does metal allergy sensitization play in total knee arthroplasty revision?

Lionberger¹,

Samorajski

Wilson

et al. 2018

J EXP ORTOP

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“…The re-revision rate ranged from 0 to 29%, depending on the inclusion criteria of the index revision TKAs and follow-up durations. [2][3][4][5][6][7] In our series, the overall complication rate was 18.9% (7/37): delayed infection was the most common cause of reoperations (mean occurrence: 40.4 months after the index revision TKA). Two patients had undergone additional surgeries because of dislocations.…”

Section: Discussionmentioning

confidence: 59%

“…Revision knee arthroplasties with a PS or CCK articular surface have been reported in series with satisfactory clinical results and implant survival, with a mean follow-up time ranged from 7 to 14.6 years. [1][2][3][4][5][6] Haas et al 1 reported the satisfactory clinical results of 57 patients who had undergone a revision TKA using a PS articular surface (mean follow-up: 3.5 years). Whaley et al 2 reported 38 revision TKAs using a PS articular surface with cemented extension stems (mean follow-up: 10.1 years; mean ROM: 100 degrees; mean KSS: 51 points; mean KSS-F: 56.9 points; 10-year implant survival rate: 96.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Constrained condylar designs are indicated for significant valgus-varus instability and for excessive flexion gaps. [4][5][6] Kim and Kim 4 reported the satisfactory results of 114 revision TKAs using a CCK articular surface with a mean followup of 7.2 years (range: 5-10 years) (mean ROM: 106 degrees; Reinfection was the major indication of the re-revision surgeries (n ¼ 18, 23%). Notably, implant survival for these patients was worse than that for other series.…”

Section: Discussionmentioning

confidence: 99%

“…They both were low-function-demand patients. Based on the good-toexcellent implant survival of revision TKA using a CCK articular surface, [4][5][6] theoretically superior implant survival of revision TKA using a PS articular surface resulting from less constraint might not be a consideration for this population. In other words, a CCK articular surface might result in better stability with a taller tibial post to prevent the "jump out" of the femoral cam.…”

Section: Discussionmentioning

confidence: 99%

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Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis Combined with a Posterior Stabilized Articular Surface

Tsai

Chen

et al. 2017

J Knee Surg

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Intraoperative assessment of valgus-varus stability is crucial for choosing articular surfaces with different levels of constraint. Legacy constrained condylar knee (CCK) prostheses are readily available to assemble and use with a CCK articular surface or a posterior stabilized (PS) articular surface in revision knee arthroplasty surgeries. We wanted to validate outcomes of revision total knee arthroplasty (TKA) using legacy CCK prostheses combined with a PS articular surface. Thirty-seven patients were enrolled and followed up for more than 2 years. Range of motion (ROM), the Knee Society score (KSS), the Knee Society functional score (KSS-F), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to evaluate outcomes. Follow-up was a mean of 86.5 months (range: 28-152 months). The mean age of the participants was 69.8 years (range: 31-86 years). The mean ROM was 110.5 degrees, the KSS was 86.2 points, the KSS-F was 68.3 points, and the WOMAC score was 22.6 points. Seven participants had implant failures: five because of delayed infections and two because of posterior dislocations. In conclusion, revision TKA using a CCK prosthesis combined with a PS articular surface might provide satisfactory mid-term outcomes. Delayed infection was the most common cause of implant failure. Dislocation might occur in middle-old or older patients despite careful intraoperative examination of valgus-varus stability, extension-flexion gap balancing, and signs of recurvatum.

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Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Goud

Harlianto

Ezzafzafi

et al. 2021

Arch Orthop Trauma Surg

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Purpose Revisions for periprosthetic joint infection of knee and hip arthroplasty can be performed following one- or two-stage treatment protocols. Current literature is inconclusive whether one protocol is superior to the other, as prior literature reported similar reinfection rates for both treatment options. We aimed to provide a systematic review and meta-analysis of current literature on septic arthroplasty revisions. Methods Between April 2015 and December 2020, Medline, Embase, and The Cochrane Library were searched for studies reporting reinfection outcomes in patients treated with one-stage and two-stage knee or hip revision arthroplasty. Two reviewers independently extracted data and disagreements were resolved by a third investigator. We utilized a double arcsine transformation, prior to pooling using a random-effects model. Results For hip revision arthroplasty, we identified 14 one-stage studies (n = 1237) with a pooled reinfection rate of 5.7% (95% CI 3.7–8.1%), and 46 two-stage studies (n = 5009) with a reinfection rate of 8.4% (95% CI 6.9–9.9%). For knee revision arthroplasty, 6 one-stage studies (n = 527) and 48 two-stage studies (n = 4344) were identified with reinfection rates of 12.7% (7.0–19.7%) and 16.2% (13.7–19.0%), respectively. Overall, reinfection rates did not vary substantially after subgroup analysis. Limitations of our study are the limited amount of one-stage studies that introduce a potential bias. Conclusion The reinfection rates following one- and two-stage hip and knee arthroplasty revisions were similar. Knee reinfection rates have increased compared to the previous analysis. Individual patient characteristics and adequate treatment algorithms are needed for a more individual selection approach, until a randomized trial is performed.

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Long-Term Survival of a Semi-Constrained Implant Following Revision for Infection

Cited by 13 publications

References 11 publications

What role does metal allergy sensitization play in total knee arthroplasty revision?

What role does metal allergy sensitization play in total knee arthroplasty revision?

Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis Combined with a Posterior Stabilized Articular Surface

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

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