Predictors of functional outcome after revision total knee arthroplasty following aseptic failure

Kasmire, Kathryn E.; Mortazavi, Seyed Mohammad Javad; Sharkey, Peter F.; Parvızı, Javad

doi:10.1016/j.knee.2012.10.017

Cited by 36 publications

(23 citation statements)

References 31 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

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“…While preoperative pain is a significant predictor of postoperative pain, pain with activity was not a predictor of functional outcomes 6 months postoperatively . Prior studies show that perceived function after TKA is predicted by BMI, sex, and preoperative function while functional tasks like the six‐minute walk test are predicted by quadriceps strength . Another study suggested that there are differences in steps/day after TKA between sexes .…”

Section: Discussionmentioning

confidence: 95%

“…29 Prior studies show that perceived function after TKA is predicted by BMI, sex, and preoperative function while functional tasks like the six-minute walk test are predicted by quadriceps strength. [30][31][32] Another study suggested that there are differences in steps/day after TKA between sexes. 7 We extend these findings by examining multiple functional outcomes in the same sample and examining potential predictors across multiple domains.…”

Section: Discussionmentioning

confidence: 99%

Predictors of multidimensional functional outcomes after total knee arthroplasty

Cooper

Rakel

Zimmerman

et al. 2017

Journal Orthopaedic Research

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Multiple assessments are used clinically after total knee arthroplasty (TKA) including self-report, performance tasks, and physical activity levels. It is unclear if these different functional assessments are interchangeable or if they measure different constructs. The objective of this study was to characterize different functional measures before and after TKA. We characterized function before and after TKA using perceived function (KOOS ADL), physical performance (gait speed), and daily activity (steps/day via accelerometry); compared function in people undergoing TKA to age-matched healthy controls; and examined characteristics of those undergoing TKA for potential predictors of postoperative function. Prior to TKA, all three functional assessments were significantly lower for participants than those of healthy controls and each measure remained lower for participants than for controls postoperatively. All three functional assessments developed differently over time postoperatively. Each functional outcome had a unique set of predictors. Perceived function was predicted primarily by anxiety and depression, physical performance was most strongly predicted by age, and daily activity was chiefly predicted by BMI. Pressure pain threshold was a common predictor across all models. Functional limitations exist preoperatively and persist postoperatively across different measures in people undergoing TKA when compared to those measures in healthy controls. Functional outcomes after TKA are different depending on the functional measure utilized, implying that different constructs underlie each measure. Multiple functional measures should be assessed to provide a more comprehensive assessment of function after TKA. Further work should assess the impact of interventions designed to treat modifiable predictors of postoperative TKA function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2790-2798, 2017.

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“…Kasmire, et al studied predictors of functional outcome after revision TKA by using various parameters, such as short-form 36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and Knee Society Scores (KSS) [6]. The data was collected preoperatively and at two years follow-up in their 175 revision TKAs done for aseptic failure.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Simultaneous Revision Total Knee Arthroplasty as a Single Staged Procedure: A Case Report and Review of Literature

Vaishya¹,

Agarwal²,

Jaiswal³

et al. 2017

Cureus

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Bilateral revision total knee arthroplasty (TKA) is a surgical procedure, which is rarely done simultaneously as it is a difficult surgery and the safety of simultaneous bilateral single stage surgery remains unknown. We report a case of a 67-year-old woman who presented to us with bilateral painful and unstable TKA (right > left) of six months duration. The primary bilateral TKA were done 14 years ago. Bilateral simultaneous revision TKA was performed, using cemented, constrained, long-stem prostheses. The intraoperative and postoperative periods remained uneventful. At last follow-up at four years, she had a pain-free range of motion of up to 0–115°, and the patient had returned to the activities of daily living. She had stable knees with good function and no evidence of loosening or wear.

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Predictors of functional outcome after revision total knee arthroplasty following aseptic failure

Cited by 36 publications

References 31 publications

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Predictors of multidimensional functional outcomes after total knee arthroplasty

Bilateral Simultaneous Revision Total Knee Arthroplasty as a Single Staged Procedure: A Case Report and Review of Literature

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