medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2025, Number 4

<< Back Next >>

Acta Ortop Mex 2025; 39 (4)

Why are we revising our primary knee arthroplasties? An evaluation of the causes for revision of primary knee arthroplasties over a five-year period (2018-2022)

Sánchez-del SJ, Alcobía-Díaz B, Rizo-de ÁM, García-Crespo R

Language: Spanish
References: 39
Page: 204-211
PDF size: 321.41 Kb.


ABSTRACT

Introduction: the progressive increase in the volume of primary knee arthroplasty surgery is leading in parallel to an increase in revision surgeries, and this trend is expected to continue in the coming decades. Material and methods: a retrospective observational study with 203 interventions in 201 patients with knee arthroplasty revision surgery at our center between 2018-2022, including the variables age, sex, body mass index, primary implant, time until revision surgery, mechanical alignment of the primary implant, cause of revision, revision implant, and need for secondary revision. Results: the average age of the patients was 73.8 years (70% were women). The average time from primary surgery to revision was 58.7 months. The main cause of revision was aseptic loosening (37.9%). Eighty-three (34.9%) patients required an early revision (on average, in 12.7 months), with instability being the main cause in this subgroup (36.1%). Twenty-four (11.8%) patients required an additional revision, also mainly due to instability (33.3%), with a younger average age (66.9 years). The most common surgical approach was complete replacement (70%). Conclusions: knee arthroplasty revision surgery in our environment is determined by different patterns depending on the chronology. Joint stability is the main determinant of revision in the first two years, while aseptic loosening seems to predominate in the long term, with infection in the background. Revision of primary knee arthroplasty remains to be a surgical challenge, as 11.8% of patients required an additional revision surgery, especially in younger patients.


REFERENCES

  1. Ethgen O, Bruyére O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004; 86-A: 963-74.

  2. Jenkins PJ, Clement ND, Hamilton DF, et al. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Joint J. 2013; 95-B: 115-21.

  3. Allepuz A, Serra-Sutton V, Espallargues M, Sarria A. Artroplastías de cadera y rodilla en el Sistema Nacional de Salud. Rev Esp Cir Ortop Traumatol. 2009; 53(5): 290-9.

  4. Khan M, Osman K, Green G, Haddad FS. The epidemiology of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J. 2016; 98-B(1 Suppl A): 105-12.

  5. Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am. 2013; 95(5): 385-92.

  6. Civinini R, Carulli C, Matassi F, Lepri AC, Sirleo L, Innocenti M. The survival of total knee arthroplasty: current data from registries on tribology: Review article. HSS J. 2017; 13(1): 28-31.

  7. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010; 468(1): 52-56.

  8. Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, et al. Comparative epidemiology of revision arthroplasty: Failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res. 2015; 473(6): 2131-8.

  9. Kurtz SM, Mowat F, Ong KL, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2015; 87(7): 1487-97.

  10. Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009; 467(10): 2606-12.

  11. Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: Future projections to 2020-2040 using the National Inpatient Sample. J Rheumatol. 2019; 46(9): 1134-40.

  12. Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weibenberger M, et al. The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc. 2021; 29(10): 3287-3298.

  13. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4): 780-5.

  14. Sabah SA, Knight R, Alvand A, Murray DW, Petrou S, Beard DJ, et al. No exponential rise in revision knee replacement surgery over the past 15 years: an analysis from the National Joint Registry. Osteoarthritis Cartilage. 2022; 30(12): 1670-1679.

  15. Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1,000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006; 452: 28-34.

  16. Lewis PL, Robertsson O, Graves SE, Paxton EW, Prentice HA, W-Dahl A. Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden. Acta Orthop. 2021; 92(2): 182-8.

  17. Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty. 2013; 28(8 Suppl): 116-9.

  18. Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston JI 3rd. Causes of instability after total knee arthroplasty. J Arthroplasty. 2014; 29(2): 360-4.

  19. Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001; 392: 315-8.

  20. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010; 468(1): 45-51.

  21. Le DH, Goodman SB, Maloney WJ, Huddleston JI. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res. 2014; 472(7): 2197-200.

  22. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002; 404: 7-13.

  23. Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am. 2015; 97(9): 715-20.

  24. Mathis DT, Hirschmann MT. Why do knees after total knee arthroplasty fail in different parts of the world? J Orthop. 2020; 23:52-9.

  25. Hamilton DF, Howie CR, Burnett R, Simpson AH, Patton JT. Dealing with the predicted increase in demand for revision total knee arthroplasty: challenges, risks and opportunities. Bone Joint J. 2015; 97-B(6): 723-8.

  26. Jud L, Gautschi N, Moller S, Moller K, Giesinger K. Revision total knee arthroplasty results in financial deficits within the Swiss healthcare system. Knee Surg Sports Traumatol Arthrosc. 2023; 31(12): 5293-8.

  27. Schelker BL, Nowakowski AM, Hirschmann MT. What is the "safe zone" for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2022; 30(2): 419-27.

  28. Critchley RJ, Baker PN, Deehan DJ. Does surgical volume affect outcome after primary and revision knee arthroplasty? A systematic review of the literature. Knee. 2012; 19(5): 513-8.

  29. Hardeman F, Londers J, Favril A, Witvrouw E, Bellemans J, Victor J. Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012; 20(6): 1049-56.

  30. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014; 29(9): 1774-78.

  31. Matassi F, Pettinari F, Frasconá F, Innocenti M, Civinini R. Coronal alignment in total knee arthroplasty: a review. J Orthop Traumatol. 2023; 24(1): 24.

  32. Blight TJ, Choong PFM. No consistent association between patient-reported outcome measures and coronal alignment following total knee arthroplasty: a narrative review. ANZ J Surg. 2022; 92(12): 3176-81.

  33. Aggarwal VK, Goyal N, Deirmengian G, Rangavajulla A, Parvizi, J, Austin MS. Revision total knee arthroplasty in the young patient: is there trouble on the horizon? J Bone Joint Surg Am. 2014; 96(7): 536-42.

  34. Collier MB, Engh CA Jr, McAuley JP, Ginn SD, Engh GA. Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert: findings at five to ten years postoperatively. J Bone Joint Surg Am. 2005; 87(12): 2702-8.

  35. Griffin WL, Fehring TK, Pomeroy DL, Gruen TA, Murphy JA. Sterilization and wear-related failure in first- and second-generation press-fit condylar total knee arthroplasty. Clin Orthop Relat Res. 2007; 464: 16-20.

  36. Luque R, Rizo B, Urda A, Garcia-Crespo R, Moro E., Marco F, López-Duran, L. Predictive factors for failure after total knee replacement revision. Int Orthop. 2014; 38(2): 429-35.

  37. Geary MB, Macknet DM, Ransone MP, Odum SD, Springer BD. Why do revision total knee arthroplasties fail? A single-center review of 1632 revision total knees comparing historic and modern cohorts. J Arthroplasty. 2020; 35(10): 2938-43.

  38. Mortazavi SMJ, Molligan J, Austin MS, Purtill JJ, Hozack WJ, Parvizi J. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop. 2011; 35(8): 1157-64.

  39. Agarwal S, Kabariti R, Kakar R, Lopez D, Morgan-Jones R. Why are revision knee replacements failing? Knee. 2019; 26(3): 774-7.



EVIDENCE LEVEL

III




2020     |     www.medigraphic.com