Recent trends in revision knee arthroplasty in Germany

Rupp, Markus; Walter, Nike; Lau, Edmund; Worlicek, Michael; Kurtz, Steven M.; Alt, Volker

doi:10.1038/s41598-021-94988-7

Cited by 21 publications

(11 citation statements)

References 24 publications

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“…TKAs, like any surgery, are susceptible to complications and reoperations. A study by Rupp et al of all TKAs performed in Germany in 2018 concluded that 12.6% of them required revision surgery, 16 which is slightly higher than in our cohort. The main causes of revision TKA described in literature are aseptic loosening (20.3-23.1%), infection (18.4-20.4%), bearing surface wear (3.2-18.1%), instability (17.7%), and pain or stiffness (9.3%).…”

Section: Discussioncontrasting

confidence: 68%

Complications of Bicruciate-Retaining Total Knee Arthroplasty: The Importance of Alignment and Balance

2023

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Introduction: Bicruciate-retaining total knee arthroplasty (BCR TKA) results in kinematics closer to the native knee and in greater patient satisfaction but information concerning its outcome and complications is lacking. The goal of this study is to report the clinical and radiological outcomes of BCR prothesis implanted using a spacer-based gap balancing technique and to assess if some preoperative factors are associated with a worse prognosis. Methods: A cohort of 207 knees in 194 patients who underwent BCR TKA, with a minimum one-year follow-up, was retrospectively analyzed. Patients were followed at six weeks, six months, one year, and then every following year post-operatively, and filled questionnaires (Knee Society and KOOS) at every visit. Clinical and radiological assessments included ROM, knee alignment, pain, and complications as defined by the Knee Society’s Standardized list and definition of Complication of Total Knee Arthroplasty. Results: Forty-three knees (20.8%) suffered major complications. Twenty-one knees (10.1%) underwent revision at an average of 32.1 months after the index procedure. Revision-free survival at 100 months was 85.7%. Revision was performed for aseptic tibial loosening in eight knees (3.9%) and stiffness in five knees (2.4%). There were twenty-nine reoperations other than revision (14.0%), the most frequent procedure being manipulation under anesthesia (MUA) in 14 knees (6.8%). Minor complications included tendonitis (20.8%), persistent synovitis (6.8%), and superficial wound infections (6.3%). All outcomes scores were greatly improved at the one-year follow-up compared to preoperatively (p<0.001). However, maximum flexion at the last follow-up was significantly reduced compared to preoperatively (mean maximum flexion ± standard deviation: 119.9 ± 15.6 vs 129.9 ± 14.4, p<0.001). Aseptic tibial loosening was associated with a hypercorrection in varus of preoperative valgus knees (p=0.012). Conclusion: BCR TKA can give functional results similar to other types of protheses but involves a substantial risk of complications. Important factors that can explain failed BCR TKA and guide its use were identified, more particularly knee alignment and its role in aseptic tibial loosening.

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Section: Discussioncontrasting

confidence: 68%

Complications of Bicruciate-Retaining Total Knee Arthroplasty: The Importance of Alignment and Balance

2023

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“…Interestingly, our analysis revealed substantially lower revision rates due to PJI after UKA compared to revision due to PJI after TKA, which has been reported to be around 20–30% [ 12 – 15 ]. Reason for lower PJI revision rates in UKA might be the key drivers for aseptic revision surgery after UKA which have been described as osteoarthritis of another compartment and aseptic loosening after UKA [ 10 ].…”

Section: Discussionmentioning

confidence: 64%

Revision arthroplasty after unicompartimental knee arthroplasty

et al. 2021

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Background Unicompartimental knee arthroplasty (UKA) is a promising and increasing application to treat unicompartimental knee osteoarthritis. However, revision arthroplasty numbers after UKA are unknown. Therefore, aim of this study was to determine the nationwide burden of revision after UKA by answering the following questions: (1) How did numbers of revision UKA procedures developed over the last decade as a function of age and gender? (2) How high is the percentage of revision UKA procedures due to infection? (3) Which therapy strategy was chosen for surgical treatment of aseptic revision UKA? Methods Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Over the last decade, revision UKA increased by 46.3% up to 3105 procedures in 2018. A trend towards higher numbers in younger patients was observed. Septic interventions constituted 5.7% of all revisions, whereby total procedures increased by 67.1% from 2008 through 2018. The main treatment strategy was an exchange to a bicondylar surface replacement prosthesis, which was done in 63.70% of all cases, followed by exchange to a femoral and tibial shaft-anchored (16.2% of all revisions). Conclusion The increasing number of revision arthroplasty after UKA in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies beyond UKA to delay primary arthroplasty and avoid periprosthetic joint infection.

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“…Despite continuous improvements in the pre-, peri- and postoperative treatment of fractures and joint replacements, we are experiencing a steadily increasing rate of infections after surgery [ 3 , 7 ]. The demographic change, the annually growing proportion of patients with metabolic syndrome, further comorbidities and sequelae are potential explanations for this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…An increasing rate of almost 25% for total knee arthroplasties performed in Germany was reported in the last decade. Likewise, septic revisions due to PJI increased by over 50% within the last decade [ 6 , 7 ]. Similarly, an incidence of PJI between 23.5 and 27.8 per 100,000 inhabitants in Germany was detected and showed constant growth [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

Szymski

Walter

Alt

et al. 2022

JCM

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Introduction: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) represent a major challenge in orthopedic surgery. Incidence of both entities is annually growing. Comorbidities play an important role as an influencing factor for infection and thus, for prevention and treatment strategies. The aims of this study were (1) to analyze the frequency of comorbidities in FRI and PJI patients and (2) to evaluate comorbidities as causative risk factor for PJI and FRI. Methods: This retrospective cohort study analysed all ICD-10 codes, which were coded as secondary diagnosis in all in hospital-treated FRI and PJI in the year 2019 in Germany provided by the Federal Statistical Office of Germany (Destatis). Prevalence of comorbidities was compared with the prevalence in the general population. Results: In the year 2019, 7158 FRIs and 16,174 PJIs were registered in Germany, with 68,304 comorbidities in FRI (mean: 9.5 per case) and 188,684 in PJI (mean: 11.7 per case). Major localization for FRI were infections in the lower leg (55.4%) and forearm (9.2%), while PJI were located mostly at hip (47.4%) and knee joints (45.5%). Mainly arterial hypertension (FRI: n = 3645; 50.9%—PJI: n = 11360; 70.2%), diabetes mellitus type II (FRI: n = 1483; 20.7%—PJI: n = 3999; 24.7%), obesity (FRI: n = 749; 10.5%—PJI: n = 3434; 21.2%) and chronic kidney failure (FRI: n = 877; 12.3%—PJI: n = 3341; 20.7%) were documented. Compared with the general population, an increased risk for PJI and FRI was reported in patients with diabetes mellitus (PJI: 2.988; FRI: 2.339), arterial hypertension (PJI: 5.059; FRI: 2.116) and heart failure (PJI: 6.513; FRI: 3.801). Conclusion: Patients with endocrinological and cardiovascular diseases, in particular associated with the metabolic syndrome, demonstrate an increased risk for orthopedic implant related infections. Based on the present results, further infection prevention and treatment strategies should be evaluated.

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Recent trends in revision knee arthroplasty in Germany

Cited by 21 publications

References 24 publications

Complications of Bicruciate-Retaining Total Knee Arthroplasty: The Importance of Alignment and Balance

Complications of Bicruciate-Retaining Total Knee Arthroplasty: The Importance of Alignment and Balance

Revision arthroplasty after unicompartimental knee arthroplasty

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

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