AN ASSESSMENT OF THE USE OF THE REVISION TOTAL KNEE REPLACEMENT PROSTHESIS FOR COMPLEX PRIMARY SURGERY

Abstract

Complex primary total knee replacements have been poorly reported in the literature We review all complex primary total knee replacement procedures at Stepping Hill Hospital. Patients underwent knee examination, knee scores, notes review and pre- and post-operative radiograph review. There were 29 patients with 36 knees that had a complex primary total knee replacement. Most frequent indications for surgery were osteoarthritis, rheumatoid arthritis or following trauma. Mean age at surgery 70 years. The prosthesis used were : 3 Stryker Kinemax; 32 De Puy PFC and one rotating hinge. Complex Primary Oxford knee score; preoperative mean 45 (range 33 to 57); postoperative mean 26 (range 14 to 53). NJR Total Knee Replacement Oxford knee score postoperative mean 30. Mean visual analogue scores; pain in the knee, mean 19; knee function, mean 77; outcome of the operation 76; satisfaction with the surgery 87. Mean length of hospital stay 13 days.

Using the Knee Society Radiographic Scoring System, there were no signs that need to be monitored or signify failure. Seven patients were transfused postoperatively, four patients had minor wound problems, three required further surgery, two to washout the knee and exchange the polyethylene liner, one femoral plating to stabilise an osteotomy site. Long term complications : one above knee amputation for infection, one foot drop.

Revision implants can be used in complex primary knee replacements, and pose technical difficulties but address various pathologies. The surgery is associated with an increased risk of complications and transfusion. Clinical scores at least match scores for routine total knee replacements, patient satisfaction is excellent.