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Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty

FRANCOIS HARDEMAN UGent, Jürgen Londers, Alexander Favril, Erik Witvrouw UGent, Johan Bellemans and Jan Victor UGent (2012) KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 20(6). p.1049-1056
abstract
The objective of this study was to investigate the outcome of revision total knee arthroplasty (TKA) in relation to the cause of index failure, the characteristics of the index procedure, and the elapsed time between index TKA and revision. A retrospective review based on a prospective database was performed on 146 consecutive revision TKA's. Variables tested were the cause of index failure; the elapsed time between the index and revision procedure; patient age at time of revision; partial or total revision of the implants; the performance of a tibial tubercle osteotomy; the presence of radiolucent lines; postoperative patellar tracking; and coronal plane alignment. Outcomes were measured with the Knee Society Knee Score (KS), Function Score (FS), and X-ray evaluation. Mean KS improved from 27.6 (SD 21.6) to 71.5 (SD 24.2) after revision ( < 0.0001), mean FS from 27.5 (SD 22.7) to 53.3 (SD27.7), < 0.0001. Overall survival rate was 90% at 5 years and 85% at 10 and 14 years. The cause of index failure had no significant influence on any of the outcome parameters. Significantly, better outcomes were noted for partial revisions and for revisions in older patients. Early revisions (< 2 years) were mostly performed for infection and instability, whereas late revisions (> 2 years) were mostly performed for polyethylene wear and loosening. The survival rate for late revisions was significantly better than for early revisions ( = 0.002). Revision TKA leads to a significant reduction in symptoms and improvement in function. The worst results can be expected for early revisions in young patients. Revision TKA is a demanding procedure with variable results and should therefore be performed by experienced surgeons.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PATIENT SATISFACTION, UNITED-STATES, TIBIAL TUBERCLE OSTEOTOMY, Survivorship analysis, Total knee arthroplasty, Revision total knee arthroplasty, Failure analysis, INFECTION, DIAGNOSIS, EXCHANGE, JOINT
journal title
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY
Knee Surg. Sports Traumatol. Arthrosc.
volume
20
issue
6
pages
1049 - 1056
Web of Science type
Article
Web of Science id
000304210900010
JCR category
SPORT SCIENCES
JCR impact factor
2.676 (2012)
JCR rank
11/84 (2012)
JCR quartile
1 (2012)
ISSN
0942-2056
DOI
10.1007/s00167-011-1624-8
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
3003352
handle
http://hdl.handle.net/1854/LU-3003352
date created
2012-10-01 14:24:53
date last changed
2014-02-14 15:20:22
@article{3003352,
  abstract     = {The objective of this study was to investigate the outcome of revision total knee arthroplasty (TKA) in relation to the cause of index failure, the characteristics of the index procedure, and the elapsed time between index TKA and revision. 
A retrospective review based on a prospective database was performed on 146 consecutive revision TKA's. Variables tested were the cause of index failure; the elapsed time between the index and revision procedure; patient age at time of revision; partial or total revision of the implants; the performance of a tibial tubercle osteotomy; the presence of radiolucent lines; postoperative patellar tracking; and coronal plane alignment. Outcomes were measured with the Knee Society Knee Score (KS), Function Score (FS), and X-ray evaluation. 
Mean KS improved from 27.6 (SD 21.6) to 71.5 (SD 24.2) after revision ( {\textlangle} 0.0001), mean FS from 27.5 (SD 22.7) to 53.3 (SD27.7), {\textlangle} 0.0001. Overall survival rate was 90\% at 5 years and 85\% at 10 and 14 years. The cause of index failure had no significant influence on any of the outcome parameters. Significantly, better outcomes were noted for partial revisions and for revisions in older patients. Early revisions ({\textlangle} 2 years) were mostly performed for infection and instability, whereas late revisions ({\textrangle} 2 years) were mostly performed for polyethylene wear and loosening. The survival rate for late revisions was significantly better than for early revisions ( = 0.002). 
Revision TKA leads to a significant reduction in symptoms and improvement in function. The worst results can be expected for early revisions in young patients. Revision TKA is a demanding procedure with variable results and should therefore be performed by experienced surgeons.},
  author       = {HARDEMAN, FRANCOIS and Londers, J{\"u}rgen and Favril, Alexander and Witvrouw, Erik and Bellemans, Johan and Victor, Jan},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keyword      = {PATIENT SATISFACTION,UNITED-STATES,TIBIAL TUBERCLE OSTEOTOMY,Survivorship analysis,Total knee arthroplasty,Revision total knee arthroplasty,Failure analysis,INFECTION,DIAGNOSIS,EXCHANGE,JOINT},
  language     = {eng},
  number       = {6},
  pages        = {1049--1056},
  title        = {Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty},
  url          = {http://dx.doi.org/10.1007/s00167-011-1624-8},
  volume       = {20},
  year         = {2012},
}

Chicago
HARDEMAN, FRANCOIS, Jürgen Londers, Alexander Favril, Erik Witvrouw, Johan Bellemans, and Jan Victor. 2012. “Predisposing Factors Which Are Relevant for the Clinical Outcome After Revision Total Knee Arthroplasty.” Knee Surgery Sports Traumatology Arthroscopy 20 (6): 1049–1056.
APA
HARDEMAN, F., Londers, J., Favril, A., Witvrouw, E., Bellemans, J., & Victor, J. (2012). Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 20(6), 1049–1056.
Vancouver
1.
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 SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2012;20(6):1049–56.
MLA
HARDEMAN, FRANCOIS, Jürgen Londers, Alexander Favril, et al. “Predisposing Factors Which Are Relevant for the Clinical Outcome After Revision Total Knee Arthroplasty.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 20.6 (2012): 1049–1056. Print.