This study aims to determine the lifetime risk of revision surgery after primary knee arthroplasty (KA). The Scottish Arthroplasty Project dataset was utilised to identify all patients undergoing primary KA during the period 1998–2019. The cumulative incidence function for revision and death was calculated and adjusted analyses utilised cause-specific Cox regression modelling to determine the influence of patient-factors. The lifetime risk was calculated for patients aged between 45–99 years using multiple decrement lifetable methodology. The lifetime risk of revision ranged between 32.7% (95% Confidence Interval (CI) 22.62–47.31) for patients aged 45–49 years and 0.63% (95%CI 0.1–4.5) for patients aged over 90 years. Adjusted analyses demonstrated the converse effect of age on revision (Hazard Ratio (HR) 0.5, 95%CI 0.5–0.6) and death (HR 3.5, 95%CI 3.4–3.7). Male sex was associated with increased risks of revision (HR 1.1, 95%CI 1.1–1.2) and death (HR 1.4, 95%CI 1.3–1.4). Patients with inflammatory arthropathy had a higher risk of death (HR 1.7, 95%CI 1.7–1.8), but were less likely to be revised (HR 0.85, 95%CI 0.74–0.98) than those treated for osteoarthritis. Patients with greater number of comorbidities and greater levels of socio-economic deprivation were at increased risk of death, but neither increased the risk of revision. The lifetime risk of revision knee arthroplasty varies depending on patient sex, age at surgery and underlying diagnosis. Patients aged between 45 and 49 years have a one in three probability of revision surgery within their lifetime. Conversely, patients aged 90 years or over were very unlikely to experience revision

Aims

The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement.

Introduction. There has been renewed interest in the unicompartmental knee arthroplasty with reports of good long term outcomes. Advantages over a more extensive knee replacement include: preservation of bone stock, retention of both cruciate ligaments, preservation of other compartments and better knee kinematics. However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. Furthermore, a number of recent national register studies have shown inferior survivorship when compared to total knee arthroplasty. The purpose of this study was to review the cases of our patients who had a revision total knee arthroplasty for failed unicompartmental knee arthroplasty. To determine the reason for failure, describe the technical difficulties during revision surgery and record the clinical outcomes of the revision arthroplasties. Methods. Between 2003 and 2009 our institute performed thirty three revisions of a unicompartmental knee arthroplasty on thirty two patients. The time to revision surgery ranged from 2 months to 159 months with a median of 19 months. Details of the operations and complications were taken form case notes. Patient assessment included range of motion, need for walking aids and the functional status of the affected knee in the form of the Oxford knee score questionnaire. Results. The reasons for failure were aseptic loosening of tibial component, persistent pain, dislocated meniscus, mal-alignment and osteoarthritis in another compartment. Of the 33 revision knee arthroplasties 18 required additional intra-operative constructs. 11 knees required a long tibial stem while 1 required a long femoral stem. 10 knees required medial wedge augmentation and bone graft was used in 6. Mean 1 year Oxford knee scores for failed unicompartmental knee replacements was 29 compared to 39 for primary total knee replacements performed at the same institute. Of the revision knee replacements 2 required further revision due to infection and loosening. Conclusion. From the evidence of our group of failed unicompartmental knee replacements, revision surgery is technically difficult and often requires intra-operative constructs. Clinical outcome of revision total knee arthroplasty following failed unicompartmental knee arthroplasty is not comparable to primary total knee arthroplasty

Paget's disease of bone (PDB) is the second most common metabolic bone disease. Osteoarthritis (OA) affects one-third of patients with PDB. The incidence of THR (total hip replacement) and TKR (total knee replacement) is 3.1- and 1.7-fold higher in PDB patients compared to non-affected age-matched controls. No large studies or joint registry reports exist describing the outcomes following THR or TKR in patients with PDB. The objectives of this study were to investigate the outcomes following THR and TKR in patients with PDB using national joint registry data. 144 THR and 43 TKR were identified using the Scottish Arthroplasty Project from 1996–2013. For THR, the most common early post-operative surgical complications were haematoma formation (1.4%), and surgical site infection (1.4%). The absolute incidence during follow-up of dislocation was 2.8%, and revision hip arthroplasty was performed in 2.8% of cases. Implant survival of the primary prosthesis was 96.3% (CI: 92.8 – 99.8) at 10-years, and patient survival was 50.0% (39.6 – 60.4) at 10-years. For TKR, the most common early post-operative surgical complication was surgical site infection (2.3%). The absolute incidence during follow-up of revision knee arthroplasty was 4.7%. On survival analysis, implant survival of the primary prosthesis was 94.5% (CI: 87.1 – 100) at 10-years, and patient survival was 38.3% (16.7 – 59.9) at 10-years. This is the largest reported series of outcomes following primary THR and TKR in patients with PDB. PDB patients are not at increased risk of surgical complications following primary THR or TKR compared to non-PDB patients

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

Introduction. In contrast to knee arthroplasty, there is no national register on high tibial osteotomy (HTO) in Sweden. The knowledge of the outcome of HTO as a treatment alternative for knee osteoarthritis (OA) is insufficient. The rate of revision to knee arthroplasty after HTO at 10 years has been reported to vary between 8 and 49%. The aim of the study was to evaluate the outcome of HTO performed in Sweden 1998–2007, expressed by rate of revision to knee arthroplasty. Patienter och Material: 3 196 HTO (69% men) 30 years or older operated on for knee OA in Sweden 1998–2007 were identified through the in- and out-patient care registers from the Swedish National Board of Health and Welfare. Side, left/right, that was operated, diagnosis and indication for surgery were verified through surgical records. Conversions of HTO to knee arthroplasty before 2010 were identified through the Swedish Knee Arthroplasty Register (SKAR). In about 10% of the cases it was unknown what side the HTO had been performed on and thus if the arthroplasty had been on the same knee. In these cases we assumed a worst case scenario of all having been on the same side as the HTO. A 10-year survival analysis was performed using revision to an arthroplasty as the end point. Result. The mean age was 52 years (range 30- 80) with 97% of the patients younger than 65 years. The cumulative revision rate (CRR) at 10 year was 29.4% (95% CI 27.2–32.9) after adjusting for age and gender. The risk of revision increased by increasing age and the risk of revision after adjusting for age was significantly higher in women than men RR 1.30 (95% CI 1.11–4.54). Most of the HTO's were performed by open wedge osteotomy using external fixation. The risk of revision was higher for closed wedge osteotomies when comparing the closed and open wedge methods RR1.29 (95% CI 1.08–1.55). Conclusion. 70% of the high tibial osteotomies performed in Sweden 1998–2007 had not been converted to a knee replacement, using the 10 year cumulative revision rate. If it is considering beneficial to have no implant in the knee, high tibial osteotomy may be considered as an alternative to TKA in the younger and physically active patients

Introduction. Unicompartmental arthroplasty is still a controversial issue in knee replacement, mainly due to a marked variation in published survival rates of the implants. The aim of this study was to analyse possible risk factors for revision following Oxford unicompartmental knee arthroplasties (OUKA). Material and methods. Since 1997 data for all patients with primary and revision knee arthroplasties performed in our department have been stored in a database. Selected for the present study was all primary OUKA performed in the period 1997–2006 as well as any revision following these operations until the end of 2008. We got information from The National Health Register and the CPR register about any revision performed at other institutions and date in case of death. Primary OUKA were grouped in three categories according to the experience of the surgeon: 1 for operation done by a surgeon who had performed less than 20 OUKA, 2 for operation by a surgeon who had performed 20–40, and 3 for operation by a surgeon who had performed more than 40. Risk of revision was analysed by Cox regression. Revisions due to pain as the only reason were excluded from the analyses. Age and gender of the patients, previous surgical intervention, operation time, and the experience of the surgeon were included as possible risk factors in the analysis. Results. 445 primary Oxford knee arthroplasties were included. These were followed by 46 revisions. The indications for the revisions were: aseptic loosening 16 knees, progression of the osteoarthritis to the lateral compartment 7 knees, dislocation of the polyethylene meniscus 5 knees, varus-valgus instability 3 knees, fracture of the medial tibia condyle 3 knees, collision of the polyethylene meniscus and the femur condyle 1 knee, and pain as the only reason 11 knees. Age and gender of the patients as well as previous surgical intervention in the knee in question were not correlated to the risk of revision. Operation time was correlated to risk of revision with decreasing risk with increasing operation time (p=0,001). The experience of the surgeon was also correlated to risk of revision with decreasing risk with increasing experience (p=0,02). The 6 years survival rate for an experienced surgeon using an operation time at 90 min. or more was 97,5 % compared to a survival rate at 78,7 % for an inexperienced surgeon with an operation time less than 90 min. Conclusion. OUKA performed by an inexperienced surgeon and OUKA performed with short operation time had marked reduced survival rates. This seems to be an essential information to institutions performing OUKA