Why Reintervention After Total Knee Arthroplasty Fails? A Consecutive Cohort of 1170 Surgeries

Abstract

Background: The aim of this study was to analyze why contemporary reintervention after total knee arthroplasty (RiTKA) fails. Methods: Between January 2006 and December 2010, from a multicenter cohort of 1170 RiTKAs, we assessed all failures of RiTKA requiring additional surgery. All indications for the index reintervention were included. The minimum follow-up period was 3 years. Results: A total of 192 (16.4%) patients required additional surgery after RiTKA (re-reintervention). The mean follow-up period was 7.7 years. Mean age was 69.2 years. The mean time to re-reintervention was 9.6 months with 90.1% of rTKA failure occurring within the first two years. Infection was the main cause of new surgery after RiTKA (47.9%; n ¼ 92/192). Other causes included extensor mechanism pathology (14.6%), stiffness (13.5%), pain (6.8%), aseptic loosening (5.2%), laxity (5.2%), periprosthetic fracture (3.6%), and wound pathology (3.1%). In four groups, the main indication for re-reintervention was recurrence of the pathology leading to the first reintervention: RiTKA for infection (59/355, 16.6%, P < .05), stiffness (18/ 174, 10.3%, P < .05), extensor mechanism failure (9/167, 5.4%, P < .05), and RiTKA for pain (4/137, 2.9%, P ¼ .003). Global survival curve analysis found 87.9% survivorship without re-reintervention at one year and 83% at eight years. Conclusion: Contemporary RiTKA failures mainly occur in the first two postoperative years. Infection is the main cause of failure in RiTKA. Recurrence of the initial pathology occurs in four groups of RiTKA and is the main indication for re-reintervention in these groups; infection (16.6%), stiffness (10.3%), extensor mechanism failure (5.4%), and pain (2.9%).

Recent trends in revision knee arthroplasty in Germany

“…Bozic and coworkers analyzed reasons for rTKA in the US between 2005 and 2010 and reported PJI as reason for surgical revision to be 25% 12 . Other studies assessing reasons for reinterventions after primary TKA reported infection to be reason for rTKA in 30.3% 15 and 20.3% of the cases, respectively 16 . An analysis from two orthopedic centers in Germany reported PJI accounting for rTKA from 14.5% through 26.8%, depending on time after index total knee arthroplasty 17 , which corresponds with reported higher incidence rates of rTKA due to PJI compared to aseptic loosening early after index TKA 10,18 .…”

Antibiotics in Bone Cements Used for Prosthesis Fixation: An Efficient Way to Prevent Staphylococcus aureus and Staphylococcus epidermidis Prosthetic Joint Infection

“…With aseptic loosening, infection is a major cause for arthroplasty revision, especially in early failures after TKA (2). In a recent French study on a cohort of 1,170 reinterventions after TKA, prosthetic joint infection (PJI) accounts for almost 50% of total revision (3). PJIs occur after 1-7% of TJA (4).…”

Kinematic Alignment of Failed Mechanically Aligned Total Knee Arthroplasty Restored Constitutional Limb Alignment and Improved Clinical Outcomes: A Case Report of 7 Patients

“…With respect to resolving stiffness and MFI, our report suggests that revision into KA resolves these complications, at least in part. rTKA performed for stiffness using traditional techniques is complicated by recurrence of stiffness with reported rates between 7.1% and 49% [1,[24][25][26][27][28]. In all these prior studies, however, revision TKA was performed according to MA principles.…”

“…Recent studies have found that the etiologies for revision total knee arthroplasty (rTKA) are infection, aseptic loosening, instability and stiffness [1]. In particular, rTKA for stiffness or instability is a complex procedure and often results in unreliable clinical outcomes with a high rate of complications including recurrence of stiffness and inferior survival rates compared to primary TKA [2,3].…”