Long-Term Survival of Semi-Constrained Total Knee Arthroplasty for Revision Surgery

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

doi:10.1016/j.arth.2013.10.025

Cited by 45 publications

(37 citation statements)

References 7 publications

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“…Furthermore, obesity is associated with a higher risk of postoperative complications and need for revision surgery after primary TKA, particularly in patients with morbid obesity (BMI C 40 kg/m 2 ) [5,11]. Revision TKA for aseptic failure provides reliable and durable improvement in patient pain and function, with long-term implant survival rates between 80% and 94% [2,7,9,12,20,23,25,26]. However, to our knowledge, no studies have specifically reported on survivorship or functional scores after aseptic revision TKA in patients with morbid obesity.…”

Section: Introductionmentioning

confidence: 99%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with obesity are known to have a higher risk of complications after primary TKA; however, there is a paucity of data regarding the effects of obesity with revision TKAs. Questions/purposes We asked the following questions : (1) Are patients with morbid obesity (BMI C 40 kg/m 2 ) at greater risk for repeat revision, reoperation, or periprosthetic joint infection (PJI) compared with patients without obesity (BMI \ 30 kg/m 2 ) after an index revision TKA performed for aseptic reasons? (2) Do patients who are not obese achieve higher Knee Society pain and function scores after revision TKA for aseptic reasons? Methods We used a retrospective cohort study with 1:1 matching for sex, age (± 3 years) and date of surgery (± 1 year) to compare patients with morbid obesity with patients without obesity with respect to repeat revision, reoperation, and PJI. Using our institution's total joint registry, we identified 1291 index both-component (femoral and tibial) aseptic revision TKAs performed during a 15-year period (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Of these, 120 revisions were in patients with morbid obesity (BMI C 40 kg/ m 2 ) and 624 were in patients with a BMI less than 30 kg/ m 2 . We then considered only patients with a minimum 5-year followup, which was available for 77% of patients with morbid obesity and 76% of patients with a BMI less than 30 kg/m 2 (p = 0.84). All patients with morbid obesity who met criteria were included (morbid obesity group: n = 93; average followup, 7.9 years) and compared with a matched cohort of patients with a BMI less than 30 kg/m 2 (nonmorbid obesity group: n = 93; average followup, 7.3 years). Medical records were reviewed to gather details regarding complications and clinical outcomes. Results Overall, patients with morbid obesity had an increased risk of repeat revision (hazard ratio [HR], 3.8; 95% CI, 1.2-16.5; p \ 0.02), reoperation (HR, 2.9; 95% CI, 1.3-7.4; p \ 0.02), and PJI (HR, 6.4; 95% CI, 1.2-119.7; p \ 0.03). Implant survival rates were 96% (95% CI, 92%-100%) and 100% at 5 years, and 81% (95% CI, 70%-92%) and 93% (95% CI, 86%-100%) at 10 years for the patients with morbid obesity and those without morbid obesity, respectively (p = 0.02). At 10 years, The Knee Society pain (90 [95% CI,(88)(89)(90)(91)(92) Conclusion Morbid obesity is associated with increased rates of rerevision, reoperation, and PJI after aseptic revision TKA. As the time-sensitive nature of revision surgery may not always allow for patient or comorbidity optimization, these results emphasize the need for improving our care of patients with morbid obesity earlier on during

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Section: Introductionmentioning

confidence: 99%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

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“…Wilke BK et al in his retrospective review of 234 semi-constrained revision total knee arthroplasty with average follow-up of 9 year, showed 91% 5-year and 81% 10-year survival. 22 At 10 years the average range of motion, pain level, and knee society score improved significantly (p< 0.001). Hinged prostheses were first designed for knee reconstruction following tumour resection.…”

Section: Discussionmentioning

confidence: 96%

“…Although, there is theoretical disadvantage of increase mechanical stresses leading to early osteolysis, loosening and failure; long term result of CCK in difficult primary and revision procedures are encouraging. [20][21][22] Cholewinski P et al reported on longterm follow-up of CCK in primary TKA. 21 Their indications were severe deformity, pre-operative laxity, and failure to achieve intra-operative balancing.…”

Section: Discussionmentioning

confidence: 99%

Constraints in total knee arthroplasty: current status and review of literature

2017

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Appropriate selection of prosthesis is critical for success of total knee arthroplasty. It is a daunting task of arthroplasty surgeon to choose from a wide array of implant design for a given situation to confer optimal stability, which translates into satisfactory outcome. Contemporary evolution of prosthetic design with various levels of constraints has revolutionized the approach to total knee arthroplasty. This paper deals with the succinct review of the level of constrained prosthesis available for knee arthroplasty.

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“…Wilke et al 33 recently reported long-term outcome data for semi-constrained TKA used in revision surgery. Survival was 91% at 5 yr, 81% at 10 yr. At 10 yr there was significant improvement in average Knee Society Score, range of motion, and pain (P < 0.001).…”

Section: Surgical Techniquesmentioning

confidence: 98%

Revision total knee arthroplasty

Wiley

Brown

Huo³

et al. 2015

Current Orthopaedic Practice

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Total knee arthroplasty (TKA) is one of the most frequently preformed orthopaedic operations in the world. As the demand for TKA continues to increase, so will the need for revision TKA. This review focuses on revision TKAs, highlighting recent, key articles exploring the epidemiology, complications, blood loss, methods of pain control and patient-perceived outcomes from revision TKA. Surgical techniques aimed at addressing specific challenges including bone loss, exposure and implant choices are also discussed.

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Long-Term Survival of Semi-Constrained Total Knee Arthroplasty for Revision Surgery

Cited by 45 publications

References 7 publications

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Constraints in total knee arthroplasty: current status and review of literature

Revision total knee arthroplasty

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