Observational Study of Total Knee Arthroplasty in Aseptic Revision Surgery: Clinical Results

Abstract

Objective To review the long‐term clinical results after revision surgery and the relationship between the different clinical variables involved with a failed total knee arthroplasty (TKA) and its evolution to provide a better understanding of the current treatment methods. Methods The present study involved 89 subjects with a failed knee arthroplasty that ended up requiring revision surgery and component replacement between 2011 and 2015. The study included patients with pain remaining after TKA and indication from the knee unit surgeon to review the implant, without presenting with thromboembolic or neurological changes that could bias the results. The demographic data, surgical information, type of implant, and causes of failure were analyzed. The patients subjected to replacement surgery were specifically asked to fill out clinical and satisfaction questionnaires (Lysholm and KOOS). The mean follow‐up was 5.6 years (range, 3–11 years) and the analysis was divided into early revision (<5 years) and late revision (>5 years). The R statistical package version 3.2.5 for Windows was used, with significance less than 0.05 Cohort observational study. Results The results indicated that implant revisions accounted for 5.57% of total primary implants, with a mean survival of 6 years for primary prosthesis failure. The mean revision surgery result on the Lysholm knee scoring scale was 68.73 out of 100 points. A better score was obtained for revisions undertaken on TKA with over 5 years' survival and there were no significant differences in terms of the type of implant used. The causes of TKA failure were aseptic loosening (77.38%), instability (9.52%), and painful prosthesis (13.10%). The results were statistically significant when isolated revisions were performed on one component. Rating worse on most of the questionnaire subscales. Conclusion The clinical results were better in primary implant replacements with at least 5 years' survival. The replacement of only one of the components (tibial or femoral) provided worse clinical results than total replacement.

Personality Traits Affect the Cost‐Effectiveness of Total Knee Arthroplasty

“…Extroversion represents sociability, liveliness, and surgency; neuroticism represents emotional instability and anxiousness 10 . Previous studies have demonstrated that patients who are talkative, easygoing, cooperated, and sociable tend to actively perform functional exercise with good and continued adherence to treatment and training tasks from doctors and rehabilitation practitioners 14,18–22 . In contrast, those who were passive, controlled, depressive, and even pessimistic are inclined to be depressed and catastrophizing and thus need longer times to achieve postoperative functional targets such as 90° flexion 5,18,23 .…”

“…To account for the time‐dependent loss in the primary clinical benefit as assessed shortly after surgery, the overall benefit estimate was discounted at an annual discounting rate of 3% 12 . Also, we assumed that 5% of the patients per 10 years would accept the revision, as there was a 10‐year revision rate of around 5%–10% after TKA 13,14 .…”

Isolated Partial Femoral Avulsion Fracture of the Posterior Cruciate Ligament in Adults

“…The specificity and sensitivity of the Lysholm knee scoring scale have been confirmed by clinical trials. The total score of the Lysholm knee scoring scale is 100 15 . If the score is less than 70, this means that the knee function has been significantly affected and effective treatment should be taken as soon as possible.…”

Early Failures of Total Knee Patients with Nickel Allergies Secondary to Carbon Fiber Debris

“…For example, the American Association of Hip and Knee Surgeons (AAHKS) recommends annual clinical and radiographic follow-up on asymptomatic patients, assuming patients with problematic symptoms will present earlier [6]. Optimization and patient satisfaction with the primary TKA is vitally important because TKA revision procedures yield less than ideal results [7]. In comparison to a primary TKA, the survivorship of TKA revisions is as low as 60%, in addition to lower satisfaction rates and worse functional scores [7].…”

“…Optimization and patient satisfaction with the primary TKA is vitally important because TKA revision procedures yield less than ideal results [7]. In comparison to a primary TKA, the survivorship of TKA revisions is as low as 60%, in addition to lower satisfaction rates and worse functional scores [7]. Although patient dissatisfaction alone is not an indication for TKA revision, indications for such revision can be classified based on acute and chronic factors [2].…”