Revision Total Knee Arthroplasty in the Young Patient: Is There Trouble on the Horizon?

How are we addressing ligament balance in TKA? A literature review of revision etiology and technological advancement

“…7 However, TKA components in younger patients are more inclined to wear, at an accelerated pace, because of increased activity and impact. [26][27][28][29] This may lead to an increased demand of complex, costly revision procedures. One study predicted that by 2020 the demand for orthopedic procedures will increase by 23%, while the supply of orthopedic surgeons will increase by only 2%.…”

“…4 Young patients place a greater demand on their prosthetics due to greater activity levels, and are more likely to develop component wear and failure secondary to aseptic loosening. [26][27][28][29] The biomechanics of a balanced joint state are likely associated with a cascade of effects. Decreased post-operative pain likely leads to greater participation in physical therapy, therefore accelerated activity levels, and improved overall patient satisfaction.…”

Revision total knee arthroplasty

“…3,4 Infection, instability, malalignment, arthrofibrosis, and stiffness are other common causes of failures in TKAs. 3,4 Aggarwal et al 5 retrospectively analyzed implant failure in a cohort of patients younger than 50 yr of age and compared the results to a matched cohort of older patients older than 60 yr of age. Their data demonstrated that the most common mode of failure in the younger patients was aseptic loosening (27%, 95% CI ¼ 19-38%).…”

“…The most common mode of failure for patients who had undergone revision TKAs was infection in both age cohorts. 5 Namba et al 6 identified younger age (P < 0.001), black race (P < 0.001), diabetes mellitus (P ¼ 0.014), body mass index greater than 35 kg/m 2 (P ¼ 0.02), bilateral procedures (P ¼ 0.03), high-flexion implants (P <0.001), and rotating platform lowcontact stress implants (P < 0.001) as risk factors for aseptic revision in a large institution-based registry of TKA patients. Sex, American Society of Anesthesiologist (ASA) designation, surgeon training, surgeon volume, hospital volume, and fixation were not associated with an increased risk of aseptic revision.…”

Custom-made lateral femoral hemiarthroplasty for traumatic bone loss: A case report

“…Knee arthrodesis allows the patient to remain active, though the functional limitations are poorly tolerated by many [6]. Total knee arthroplasty is associated with several disadvantages in young and active patients, such as additional bone resections and the possibility for multiple anticipated revisions [7]. Patient satisfaction is usually lower in these patients as well [8,9].…”