Introduction. Revision type arthroplasties for the treatment of knee osteoarthritis is an effective and secure procedure. It has different indications, but the most relevant is the revision of a failured primary arthroplasty. In our study, we reviewed the results of another indication, the implantation of a revision type arthroplasty as a primary procedure in cases of severe deformities. Objectives. To assess the radiological, clinical and functional situation and the quality of life of those patients in whom a revision knee arthroplasty had been implanted in the past years. Materials and Methods. We did a retrospective study of 108 knee arthroplasties (80% women) implanted between 1999 and 2005 with a mean follow up of 7.8 years. The mean age of the patients at the time of surgery was 75 years old (60–87). The most frequent indication for a revision type arthroplasty was an important valgum deformity osteoarthritis. We assess the functional and clinical situation using the Knee Society Score, both clinical and functional; the radiological situation using the Knee Society Roentgenographic evaluation and the quality of life using the Short Form 12 (SF12). We have analyzed the survivorship rate of our arthroplasties as well. Results. We could contact 75 patients. 20 had died in the past years without any new surgeries in the knee; we could not contact 13 patients due to lost of follow up. The survivalship rate of the arthroplasties is 91% at the time of follow up. In the cases of severe valgum or varum malalignment, a phisiological valgum angle (5.47°) was achieved in all of the patients. 77.4% of the patients declared themselves as satisfied or very satisfied in the last follow up. The results of the KSS-Clinical were excellent or good in 87.1% of the patients while in the KSS- Functional was 77.5%. The mean SF12 score was 20.68 out of 60 points. Conclusions. The clinical and functional results are overall good or very good, as well as the quality of life, in those patients in which a revision arthroplasty had been implanted instead of a conventional primary arthroplasty, when it was correctly indicated. So a revision type arthroplasty should be considered for the treatment of knee osteoarthritis in cases of severe bone deformities or severe malalignment

Adverse spinopelvic mobility (SPM) has been shown to increase risk of dislocation of primary total hip arthroplasty (THA). In patients undergoing THA, prevalence of adverse SPM has been shown to be as high as 41%. Stiff lumbar spine, large posterior standing pelvic tilt and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Dislocation rates for dual mobility articulations have been reported to be 0% to 1.1%. The aim of this study was to determine the early survivorship from the Australian National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a dual mobility articulation. A multicentre study was performed using data from 229 patients undergoing primary THA, enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameters had a dual mobility articulation inserted at the time of their surgery. Average age was 76 (22 to 93) years and 63% were female. At a mean of 2.1 (1 – 3.3) years post-op, the AOANJRR was analysed for follow-up. Reasons for revision and types of revision were identified. The AOANJRR reported two revisions. One due to infection and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan Meier survival was 99.3% (CI 98.3% − 100%) at 2 years. DM bearings reduce the risk of dislocation of primary THA in patients with adverse spine and pelvic mobility

Aims

In metal-on-metal (MoM) hip arthroplasties and resurfacings, mechanically induced corrosion can lead to elevated serum metal ions, a local inflammatory response, and formation of pseudotumours, ultimately requiring revision. The size and diametral clearance of anatomical (ADM) and modular (MDM) dual-mobility polyethylene bearings match those of Birmingham hip MoM components. If the acetabular component is satisfactorily positioned, well integrated into the bone, and has no surface damage, this presents the opportunity for revision with exchange of the metal head for ADM/MDM polyethylene bearings without removal of the acetabular component.

Aims

The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry.

Aims

To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability.

Introduction. Computer-assisted hip navigation offers the potential for more accurate placement of hip components, which is important in avoiding dislocation, impingement, and edge-loading. The purpose of this study was to determine if the use of computer-assisted hip navigation reduced the rate of dislocation in patients undergoing revision THA. Methods and Materials. We retrospectively reviewed 72 patients who underwent computer-navigated revision THA [Fig. 1] between January 2015 and December 2016. Demographic variables, indication for revision, type of procedure, and postoperative complications were collected for all patients. Clinical follow-up was performed at 3 months, 1 year, and 2 years. Dislocations were defined as any episode that required closed or open reduction or a revision arthroplasty. Data are presented as percentages and was analyzed using appropriate comparative statistical tests (z-tests and independent samples t- tests). Results. All 72 patients (48% female; 52% male) were included in the final analysis [Fig. 2]. Mean age of patients undergoing revision THA was 70.4 ± 11.2 years. Mean BMI was 26.4 ± 5.2 kg/m. 2. The most common indications for revision THA were instability (31%), aseptic loosening (29%), osteolysis/eccentric wear (18%), infection (11%), and miscellaneous (11%). During revision procedure, polyethylene component was most commonly changed (46%), followed by femoral head (39%), and acetabular component (15%). At 3 months, 1 year, and final follow-up, there were no dislocations among all study patients (0%). Compared to preoperative dislocation values, there was a significant reduction in the rate of dislocation with the use of computer-assisted hip navigation (31% vs. 0%; p<0.05). Discussion. Our study demonstrates a significant reduction in the rate of dislocation following revision THA with the use of computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer-assisted surgery may help to curtail femoral and acetabular malalignment in revision THA

Aims

One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations. In an existing implant system, the tibial component was modified by adding cement pockets. The aim of this experimental in vitro study was to investigate whether additional cement pockets on the underside of the tibial component could improve implant stability. The relative motion between implant and bone, the maximum pull-out force, the tibial cement mantle, and a possible path from the bone marrow to the metal-cement interface were determined.

As the number of patients who have undergone total hip arthroplasty rises, the number of patients who require surgery for a failed total hip arthroplasty is also increasing. Reconstruction of the failed femoral component in revision total hip arthroplasty can be challenging from both a technical perspective and in preoperative planning. With multiple reconstructive options available, it is helpful to have a classification system which guides the surgeon in selecting the appropriate method of reconstruction. We have developed a classification of femoral deficiency and an algorithmic approach to femoral reconstruction is presented. Type I: Minimal loss of metaphyseal cancellous bone with an intact diaphysis. Often seen when conversion of a cementless femoral component without biological ingrowth surface requires revision. Type II: Extensive loss of metaphyseal cancellous bone with an intact diaphysis. Often encountered after the removal of a cemented femoral component. Type IIIA: The metaphysis is severely damaged and non-supportive with more than four centimeters of intact diaphyseal bone for distal fixation. This type of defect is commonly seen after removal of grossly loose femoral components inserted with first generation cementing techniques. Type IIIB: The metaphysis is severely damaged and non-supportive with less than four centimeters of diaphyseal bone available for distal fixation. This type of defect is often seen following failure of a cemented femoral component that was inserted with a cement restrictor and cementless femoral components associated with significant distal osteolysis. Type IV: Extensive meta-diaphyseal damage in conjunction with a widened femoral canal. The isthmus is non-supportive

Aims

The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing.

As the number of patients who have undergone total hip arthroplasty rises, the number of patients who require surgery for a failed total hip arthroplasty is also increasing. It is estimated that 183,000 total hip replacements were performed in the United States in the year 2000 and that 31,000 of these (17%) were revision procedures. Reconstruction of the failed femoral component in revision total hip arthroplasty can be challenging from a technical perspective and in pre-operative planning. With multiple reconstructive options available, it is helpful to have a classification system which guides the surgeon in selecting the appropriate method of reconstruction. A classification of femoral deficiency has been developed and an algorithmic approach to femoral reconstruction is presented. Type I:. Minimal loss of metaphyseal cancellous bone with an intact diaphysis. Often seen when conversion of a cementless femoral component without biological ingrowth surface requires revision. Type II: Extensive loss of metaphyseal cancellous bone with an intact diaphysis. Often encountered after the removal of a cemented femoral component. Type IIIA: The metaphysis is severely damaged and non-supportive with more than 4cm of intact diaphyseal bone for distal fixation. This type of defect is commonly seen after removal of grossly loose femoral components inserted with first generation cementing techniques. Type IIIB: The metaphysis is severely damaged and non-supportive with less than 4cm of diaphyseal bone available for distal fixation. This type of defect is often seen following failure of a cemented femoral component that was inserted with a cement restrictor and cementless femoral components associated with significant distal osteolysis. Type IV: Extensive meta-diaphyseal damage in conjunction with a widened femoral canal. The isthmus is non-supportive. An extensively coated, diaphyseal filling component reliable achieves successful fixation in the majority of revision femurs. The surgical technique is straightforward and we continue to use this type of device in the majority of our revision total hip arthroplasties. However, in the severely damaged femur (Type IIIB and Type IV), other reconstructive options may provide improved results. Type IIIB:. Based on the poor results obtained with a cylindrical, extensively porous coated implant (with 4 of 8 reconstructions failing), our preference is a modular, cementless, tapered stem with flutes for obtaining rotational stability. Excellent results have been reported with this type of implant and by virtue of its tapered design, excellent initial axial stability can be obtained even in femurs with a very short isthmus. Subsidence has been reported as a potential problem with this type of implant and they can be difficult to insert. However, with the addition of modularity to many systems that employ this concept of fixation, improved stability can be obtained by impaction of the femoral component as far distally as needed while then building up the proximal segment to restore appropriate leg length. Type IV:. The isthmus is completely non-supportive and the femoral canal is widened. Cementless fixation cannot be reliably used in our experience, as it is difficult to obtain adequate initial implant stability that is required for osseointegration. Reconstruction can be performed with impaction grafting if the cortical tube of the proximal femur is intact. However, this technique can be technically difficult to perform, time consuming and costly given the amount of bone graft that is often required. Although implant subsidence and peri-prosthetic fractures (both intra-operatively and post-operatively) have been associated with this technique, it can provide an excellent solution for the difficult revision femur where cementless fixation cannot be utilised. Alternatively, an allograft-prosthesis composite can be utilised for younger patients in an attempt to reconstitute bone stock and a proximal femoral replacing endoprosthesis used for more elderly patients

As the number of patients who have undergone total hip arthroplasty rises, the number of patients who require surgery for a failed total hip arthroplasty is also increasing. Reconstruction of the failed femoral component in revision total hip arthroplasty can be challenging from both a technical perspective and in pre-operative planning. With multiple reconstructive options available, it is helpful to have a classification system which guides the surgeon in selecting the appropriate method of reconstruction. Type I: Minimal loss of metaphyseal cancellous bone with an intact diaphysis. Often seen when conversion of a cementless femoral component without biological ingrowth surface requires revision. Type II: Extensive loss of metaphyseal cancellous bone with an intact diaphysis. Often encountered after the removal of a cemented femoral component. Type IIIA: The metaphysis is severely damaged and non-supportive with more than 4 cm of intact diaphyseal bone for distal fixation. This type of defect is commonly seen after removal of grossly loose femoral components inserted with first generation cementing techniques. Type IIIB: The metaphysis is severely damaged and non-supportive with less than 4 cm of diaphyseal bone available for distal fixation. This type of defect is often seen following failure of a cemented femoral component that was inserted with a cement restrictor and cementless femoral components associated with significant distal osteolysis. Type IV: Extensive meta-diaphyseal damage in conjunction with a widened femoral canal. The isthmus is non-supportive. Based on our results, the following reconstructive algorithm is recommended for femoral reconstruction in revision total hip arthroplasty. An extensively coated, diaphyseal filling component reliably achieves successful fixation in the majority of revision femurs and the surgical technique is straightforward. However, in the severely damaged femur (Type IIIB and Type IV), other reconstructive options may provide improved results. Type I: Cemented or cementless fixation can be utilised. If cemented fixation is selected, great care must be taken in removing the neo-cortex often encountered to allow for appropriate cement intrusion into the remaining cancellous bone. Type II: In this cohort of patients, successful fixation was achieved using a diaphyseal fitting, extensively porous coated implant. However, as the metaphysis is supportive, a cementless implant that achieves primary fixation in the metaphysis can be utilised. Type IIIA: An extensively coated stem of adequate length is utilised to ensure that more than 4 cm of scratch fit is obtained in the diaphysis. Type IIIB: Our present preference is a modular, cementless, tapered stem with flutes for obtaining rotational stability. Type IV: Cementless fixation cannot be reliably used in our experience, as it is difficult to obtain adequate initial implant stability that is required for osseointegration. Reconstruction can be performed with impaction grafting if the cortical tube of the proximal femur is intact. However, this technique can be technically difficult to perform, time consuming and costly given the amount of bone graft that is often required. Although implant subsidence and peri-prosthetic fractures (both intra-operatively and post-operatively) have been associated with this technique, it can provide an excellent solution for the difficult revision femur where cementless fixation cannot be utilised. Alternatively, an allograft-prosthesis composite can be utilised for younger patients in an attempt to reconstitute bone stock and a proximal femoral replacing endoprosthesis used for more elderly patients

Aims

The main advantage of 3D-printed, off-the-shelf acetabular implants is the potential to promote enhanced bony fixation due to their controllable porous structure. In this study we investigated the extent of osseointegration in retrieved 3D-printed acetabular implants.

Limb deformity is common in patients presenting for knee arthroplasty, either related to asymmetrical wear patterns from the underlying arthritic process (intra-articular malalignment) or less often major extra-articular deformity due to prior fracture malunion, childhood physical injury, old osteotomy, or developmental or metabolic disorders such as Blount's disease or hypophosphatemic rickets. Angular deformity that is above the epicondyles or below the fibular neck may not be easily correctable by adjusted bone cuts as the amount of bone resection may make soft tissue balancing impossible or may disrupt completely the collateral ligament attachments. Development of a treatment plan begins with careful assessment of the malalignment which may be mainly coronal, sagittal, rotational or some combination. Translation can also complicate the reconstruction as this has effects directly on location of the mechanical axis. Most intra-articular deformities are due to the arthritic process alone, but may occasionally be the result of intra-articular fracture, periarticular osteotomy or from prior revision surgery effects. While intra-articular deformity can almost always be managed with adjusted bone cuts it is important to have available revision type implants to enhance fixation (stems) or increase constraint when ligament balancing or ligament laxity is a problem. Extra-articular deformities may be correctable with adjusted bone cuts and altered implant positioning when the deformity is smaller, or located a longer distance from the joint. The effect of a deformity is proportional to its distance from the joint. The closer the deformity is to the joint, the greater the impact the same degree angular deformity will have. In general deformities in the plane of knee are better tolerated than sagittal plane (varus/valgus) deformity. Careful pre-operative planning is required for cases with significant extra-articular deformity with a focus on location and plane of the apex of the deformity, identification of the mechanical axis location relative to the deformed limb, distance of the deformity from the joint, and determination of the intra-articular effect on bone cuts and implant position absent osteotomy. In the course of pre-operative planning, osteotomy is suggested when there is inability to correct the mechanical axis to neutral without excessive bone cuts which compromise ligament or patellar tendon attachment sites, or alternatively when adequate adjustment of cuts will likely lead to excessive joint line obliquity which can compromise ability to balance the soft tissues. When chosen, adjunctive osteotomy can be done in one-stage at the time of TKA or the procedures can be done separately in two stages. When simultaneous with TKA, osteotomy fixation options include long stems added to the femoral (or tibial) component for intramedullary fixation, adjunctive plate and screw fixation, and antegrade (usually locked) nailing for some femoral osteotomies. Choice of fixation method is often influenced by specific deformity size location, bone quality and amount, and surgeon preference. Surgical navigation, or intra-operative x-ray imaging methods (or both) have both been used to facilitate accurate correction of deformity in these complex cases. When faced with major deformity of the femur or tibia, with careful planning combined osteotomy and TKA can result in excellent outcomes and durable implant fixation with less constraint, less bone loss, and better joint kinematics than is possible with modified TKA alone

Introduction/Aims. The Exeter Stem can be used with metal femoral head that are made of either cobalt chrome, or stainless steel. The aim of this study was to compare the rates of revision of these two metal femoral head types when used with this femoral component. Method. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) Data from September 1999 until December 2015 for all primary THRs using an Exeter or an Exeter v40 stem with the diagnosis of osteoarthritis were analysed. Only bearing couples that used a metal head with polyethylene were included. The cumulative percent revision (CPR) calculated using Kaplan-Meier estimates were compared for the two metal head types. CPR were further analysed by age, polyethylene type and head size. Reasons for revision and types of revision were assessed. Results. There were 51666 THR that used Exeter or Exeter v40 stems of which 12554 had femoral heads made of cobalt chrome and 39112 had heads made of stainless steel. There was no difference in the rate of revision overall when head types were compared. There was also no difference in CPR between the two head types with age. Hips that used cobalt chrome heads had a higher CPR than stainless steel heads when these were used against non-crosslinked polyethylene. When heads with a diameter of 32mm or greater were compared, those made of cobalt chrome had a higher rate of revision than stainless steel HR 1.38 (1.15, 1.66) P<0.001). Conclusion. There was no difference comparing cobalt chrome or stainless-steel heads, except where non-crosslinked polyethylene was used, or where the heads size was 32mm or greater. In these comparisons, heads made from cobalt chrome had a higher rate of revision

Pre-operative planning in revision total knee replacement is important to simplify the surgery for the implant representative, operating room personnel and the surgeon. In revision knee arthroplasty, many implant options can be considered. This includes cemented and cementless primary and revision tibial and femoral components, with posterior cruciate retention or resection, and either with no constraint, varus/valgus constraint, or with rotating hinge bearings. One may also need femoral and tibial spacers or bulk allograft. It is important to pre-operatively determine which of these implants you may need. If I ask my implant representative to “bring everything you've got, just in case,” I will get 23 pans of instruments, 24 bins of implants composed of 347 boxes of sterile implants, and chaos for everyone. Occasionally, one may not need to revise all components, so the surgeon needs to be familiar with the implants they are revising. Consider having some or all compatible components available. Most revision knee implants can be conservatively cemented with diaphyseal engaging press-fit stems. Most importantly, pre-operative physical examination and radiographs are used to determine the status of the collateral ligaments, so that the appropriate constrained implants will be available at surgery. Radiographs will also show the amount and location of bone loss. This will determine if revision type implants, spacers or bone graft will be needed. Radiographically, one can determine the appropriate joint line position relative to the existing femoral component to simplify the surgery. Excellent pre-operative planning will minimises the need to bring in an excessive number of instruments and implants. It will help assure that the patient has a stable revision knee and simplify the surgery for all participants

Aim. To assess the survival of revision knee replacements at our institution and to identify prognostic factors that predict failure in revision knee surgery. Materials and methods. This was a retrospective review of 52 patients who had undergone revision knee surgery as identified by hospital clinical coding. Patient demographics, physiological parameters, reason for revision, type of revision implant and last date of follow up were recorded from the medical records. Implant survival was analysed both from the index primary procedure to revision and from definitive reconstruction at revision to re-operation for any cause. Results. The median time from index primary to first revision was 1428 days (331-5000). A P value of 0.05 was set as the significance level. Patients with a diagnosis of inflammatory arthropathy had a significantly shorter time to revision compared to those with osteoarthritis. Time to revision was not significantly different for those being revised for infection and those not infected. Following reconstruction, there was no significant difference in the reoperation rates for infected vs non-infected implants. The 5-year implant survival for all revision knee replacements with re-operation for any cause as the end point was 72.2% (95%CI 52.3-87.9). At 5 years there was no significant difference in implant survival of infected and non-infected revisions. Conclusion. The implant survival of revision knee replacements for all causes in our institute was 72.2% at 5 years. There was no significant difference in 5-year survival between infected and non-infected revisions. Patients with an inflammatory arthropathy had a significantly shorter time to revision compared to those with osteoarthritis

This study reviewed the revision rate of fully cemented, hybrid and cementless primary total knee replacements (TKR) registered in the New Zealand Joint Registry from 1999 to May 2008 to determine whether there was any significant difference in the survival and reason for revision with these different types of fixation. The percentage rate of revision was calculated per 100 person years (HPY) and compared to the reason for revision, type of fixation and the patient’s age. Of the 28707 primary TKR registered, 522 underwent revision procedures requiring change of at least one component with a survival rate of 0.44 HPY (1.8%). The majority of revisions were for pain (153) followed by deep infection (133) followed by loosening of the tibial component (98). Overall the rate of tibial loosening was 0.07 HPY (0.3 %) in the cemented group vs 0.25 HPY (1%) in the cementless group (p < 0.001). There was no significant difference in the type of fixation used for the femoral component, but there was a significant difference in the different types of fixation when revised for pain, with the uncemented tibia performing the poorest. There was no significantly difference in the younger patient (< 55 years) with respect to tibial loosening (p=0.92). Failure of the uncemented total knee replacement was due to pain and tibial loosening although the results in patients under 55 years were similar in all fixation groups. There was no difference in the fixation method of the femoral component

Objective. To evaluate the volume of cases, causes of failure, complications in patients with a failed Thompson hemiarthroplasty. Methods. A retrospective review was undertaken between 2005–11, of all Thompson implant revised in the trust. Patients were identified by clinical coding. All case notes were reviewed. Data collection included patients demographic, time to revision, reason for revision, type of revision implant, surgical time and technique, transfusion, complications, HDU stay, mobility pre and post revision,. Results. 23 patients were identified, age 81 years (range 76–90). male to female ratio was 2:21, 11 right and 12 left hip. Mean time to failure was 50 months (1–104 m) range, mean follow up post revision surgery 26 months (3–77). Reason for revision was dislocation in 3 patients (13%), femoral loosening 5 (21%), peri-prosthetic fracture 3 (13%), Infection 6 (26%) and acetabular erosion 6 (26%). There were six infected cases in the study which was all aspirated preoperatively off which only 4 were positive. All infected cases grew an organism from intra-operative specimens. (80% cases) were coagulase negative Staphylococcus aureus. 35% only positive on enrichment cultures. 4 infected Thompsons were revised successfully with 2 stage revisions. One patient died after 1. st. stage and another was able to mobilise after the first stage with a cement spacer and refused further surgery. Mean surgical time was 3.5 hours (range 2.5–5.5). HDU stay 1.3 days (range 0–6). 6 deaths in total, 3 unrelated, 3 post operative. Complications included 1 fracture requiring revision, 1 dislocation, 1 foot drop and 4 chest infection of which two patients died from this. Conclusion. We identified a revision rate of 1.2%, complication occurred in 43% of cases with a one year mortality of 26%. Failed Thompson revision surgery is rare, challenging and patient selection is important to reduce postoperative morbidity and mortality

Infection of total knee replacement (TKR) is considered a devastating complication, which necessitates complete removal and thorough debridement of the site. Usually long term antibiotic treatment and a multitude of surgical interventions within a period of several months are required until a definitive supply can be achieved. Osseous defects are common in such conditions and need to be addressed during re-implantation. Managing removal, debridement, reconstruction and re-implantation within a single operation is the ideal solution, both for the patient and the treating team, but rarely executed due to the fear of re-infection. Allograft bone may be impregnated with high loads of antibiotics using a special incubation technique. The resulting antibiotic bone compound (ABC) provides high and long lasting antibiotic levels at the site of infection and is likely to restore bone stock. We have investigated the results of one-stage exchange of infected TKR using ABC together with uncemented implants. Between 1998 and 2004 nineteen exchange procedures of infected TKRs were performed in a single stage, all of them without the use of bone cement. After removal of the implants and radical debridement bone voids were filled with ABC using a modified impaction technique. Consequently, new uncemented implants were inserted. We mainly used the revision type of the LCS knee (DePuy, J& J) as long as ligamentary stability was considered sufficient. Otherwise, we used a custom-made uncemented version of the LINK Rotational Endo Model. Joints were drained and closed immediately; rehabilitation did not differ from uninfected revision. One knee required re-revision because of persisting infection. The remaining 18 patients stayed infect-free for a period between 2 and 8 years after surgery. In two knees loosening was found after one year, once of the tibial and once of the femoral component. Both were found infect-free at the time of re-revision. All could be successfully revised using the same technique again. No adverse side effects could be found. Incorporation appeared as after grafting with unimpregnated bone grafts. Using antibiotic-impregnated allografts eradication of pathogens, grafting of defects and re-insertion of an uncemented prosthesis may be accomplished in a one-stage procedure. Since the graft gradually is replaced by healthy own bone, improved long-term results may be expected as well as improved conditions in the case of another revision

Methodology: A retrospective review based on a prospective database was performed on 146 consecutive revision TKA’s. An independent observer measured clinical outcomes using the Knee Society Knee (KS) and Function Score (FS). X-ray evaluation, including rating of radiolucent lines, tibiofemoral and patellofemoral alignment, was carried out by an independent radiologist. ANOVA was used for statistical analysis, with significance set at p≤0.05 (SPSS version 15.0). Post-hoc Bonferroni testing was carried out for single variables including primary cause of failure, age at revision surgery, time span between index operation and revision, type of index operation, partial or total revision and the performance of a tuberosity osteotomy. Results: 146 files were available in 135 patients. 16 patients deceased (17 knees) during the follow-up period and 2 patients (2 knees) were lost to follow-up. 117 patients (127 knees) were available for evaluation. Age at revision surgery averaged 67.7 years (range 32.3–88.1). Mean follow-up time was 4.5 years (range 1–14). Patients had revision TKA between 51 days and 16.1 years (average 4.7 years) after the index TKA. 54% of the early revisions were due to infection and instability, 55% of late revisions were caused by polyethylene-wear and loosening. The mean postoperative KS was 70.8 with a mean improvement of 43.2 points as compared to pre-operative. The mean postoperative FS was 52.9 with a mean improvement of 25.4 points. Grouping outcomes according to cause of failure of the index TKA gave the following ranking from better to worse, without being significant: wear (n=15; KS 80.8; range 43–99, SD 17.5), loosening (n=44; KS 75.8; range 15–100, SD=21.2), malalignment (n=19; KS 70.0; range 9–95, SD 25.9), instability (n=33; KS 68.2; range 5–100, SD 24.1), others (n=16; KS 66.7; range 10–100, SD 25.9), and infection (n=21; KS 64.2; range 3–100, SD 31.7). Survivorship at 5 years was 90.0% (CI 86.4% –93.6%), at 10 years 84,6% (CI 77.0% –92.3%) and at 14 years 84,6% (CI 37.7% –131.6%). Significant better outcomes were seen with late revisions, index operation being partial knee replacement and older age at revision. More failures (p=0.002) were seen with early revisions. In 32.6% of the patients radiolucent lines of ≥1 mm were observed. Points were granted with the use of a Radiolucency Scoring Scheme. Patients with less than 4 points (n=87, mean KS 71.2) had better outcomes than patients with 4 or more points (n=8, mean KS 56.4). 87% of patients were aligned within 4° of mechanical axis. Conclusion:. Outcomes of revision TKA are inferior to primary TKA. Early failures were mainly caused by infection, instability, malalignment. Grouping revision TKA’s to etiology of failure did not lead to significant differences in outcomes. Significant better outcomes were reported for late revisions, patients with older age at revision surgery and partial knee replacement. Survivorship analysis was significally better for late than for early revisions