Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis). Based on pre-, intra-, and postoperative assessments, the novel grading system allocates a quantitative score (0, 0.5, or 1 point) for the quality of fixation achieved in each anatomical zone. The criteria used by the algorithm to assign the score include the bone quality, the size of the bone defect, and the type of fixation used. A consecutive cohort of 245 patients undergoing rTKA from 2012 to 2018 were evaluated using the current novel scoring system and followed prospectively. In addition, 100 first-time revision cases were assessed radiologically from the original cohort and graded by three observers to evaluate the intra- and inter-rater reliability of the novel radiological grading system.Aims
Methods
Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to “start again”. This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options. Patients undergoing revision TKA for isolated aseptic tibial loosening between 2012 and 2017 were identified. Those with revision implants or revised for infection, instability, osteolysis, or femoral component loosening were excluded. A total of 164 patients were included; 88 had an isolated tibial revision and 76 had revision of both components despite only having a loose tibial component. The demographics and clinical and radiological outcomes were recorded.Aims
Methods
The aim of this study was to assess the effects of transferring patients to a specialized arthroplasty centre between the first and second stages (interstage) of prosthetic joint infection (PJI) of the knee. A search of our institutional database was performed to identify patients having undergone two-stage revision total knee arthroplasty (TKA) for PJI. Two cohorts were created: continuous care (CC) and transferred care (TC). Baseline characteristics and outcomes were collected and compared between cohorts.Aims
Patients and Methods
Revision total knee arthroplasty (rTKA) accounts for approximately 5% to 10% of all TKAs. Although the complexity of these procedures is well recognized, few investigators have evaluated the cost and value-added with the implementation of a dedicated revision arthroplasty service. The aim of the present study is to compare and contrast surgeon productivity in several differing models of activity. All patients that underwent primary or revision TKA from January 2016 to June 2018 were included as the primary source of data. All rTKA patients were categorized by the number of components revised (e.g. liner exchange, two or more components). Three models were used to assess the potential surgical productivity of a dedicated rTKA service : 1) work relative value unit (RVU) Aims
Materials and Methods
Bone loss in the proximal tibia and distal femur
is frequently encountered in revision knee replacement surgery.
The various options for dealing with this depend on the extent of
any bone loss. We present our results with the use of cementless
metaphyseal metal sleeves in 103 patients (104 knees) with a mean
follow-up of 43 months (30 to 65). At final follow-up, sleeves in
102 knees had good osseointegration. Two tibial sleeves were revised
for loosening, possibly due to infection. The average pre-operative Oxford Knee Score was 23 (11 to 36)
and this improved to 32 (15 to 46) post-operatively. These early
results encourage us to continue with the technique and monitor
the outcomes in the long term. Cite this article:
We report the results of revision total knee
replacement (TKR) in 26 patients with major metaphyseal osteolytic defects
using 29 trabecular metal cones in conjunction with a rotating hinged
total knee prosthesis. The osteolytic defects were types II and
III (A or B) according to the Anderson Orthopaedic Research Institute
(AORI) classification. The mean age of the patients was 72 years
(62 to 84) and there were 15 men and 11 women. In this series patients had
undergone a mean of 2.34 previous total knee arthroplasties. The
main objective was to restore anatomy along with stability and function
of the knee joint to allow immediate full weight-bearing and active
knee movement. Outcomes were measured using Knee Society scores,
Oxford knee scores, range of movement of the knee and serial radiographs.
Patients were followed for a mean of 36 months (24 to 49). The mean
Oxford knee clinical scores improved from 12.83 (10 to 15) to 35.20
(32 to 38) (p <
0.001) and mean American Knee Society scores
improved from 33.24 (13 to 36) to 81.12 (78 to 86) (p <
0.001).
No radiolucent lines suggestive of loosening were seen around the trabecular
metal cones, and by one year all the radiographs showed good osteo-integration.
There was no evidence of any collapse or implant migration. Our
early results confirm the findings of others that trabecular metal
cones offer a useful way of managing severe bone loss in revision
TKR. Cite this article:
We identified 148 patients who had undergone a revision total knee replacement using a single implant system between 1990 and 2000. Of these 18 patients had died, six had developed a peri-prosthetic fracture and ten had incomplete records or radiographs. This left 114 with prospectively-collected radiographs and Bristol knee scores available for study. The height of the joint line before and after revision total knee replacement was measured and classified as either restored to within 5 mm of the pre-operative height or elevated if it was positioned more than 5 mm above the pre-operative height. The joint line was elevated in 41 knees (36%) and restored in 73 (64%). Revision surgery significantly improved the mean Bristol knee score from 41.1 ( Our findings show that restoration of the joint line at revision total knee replacement gives a significantly better result than leaving it unrestored by more than 5 mm. We recommend the greater use of distal femoral augments to help to achieve this goal.
We investigated the changes in surface roughness of retrieved femoral components in 18 men and four women at revision knee surgery. The mean age at revision was 68.4 years and the mean period of implantation was for 55.6 months. Eighteen implants were retrieved for aseptic loosening and four for infection. The surface changes in the articulating areas were inspected visually and the roughness (Ra) analysed with a profilometer. Parallel scratching and burnishing were the two main forms of damage. The mean Ra measurements in the articulating areas showed no statistically significant difference when compared with those in a control area on either side of the patellar groove at the apex of the femoral flange. This suggests that it is not essential to revise a well-fixed and correctly aligned femoral component where the polished surface has become burnished or bears fine parallel scratches, if the revision is conducted solely for failure of the tibial component.
