Revision after early aseptic failures in primary total knee arthroplasty

The purpose of this study was to evaluate cases of early aseptic failures presented during the first 5-year follow-up in a group of 981 primary total knee arthroplasty (primary TKA). Predisposing factors as well causes of failures and postoperative complications in different groups of aseptic failures were re-assessed and compared to a control group. A retrospective and cohort study compared one group of 944 primary TKA without surgical revision (890 patients) (Group A) with 22 primary TKA (22 patients) (Group B) that had revision TKA secondary to aseptic failure during the first five years follow-up. The cases of isolated patellar button replacement (n = 8) and infection (n = 7) were not considered in this study. All patients underwent a systematic assessment that included clinical and radiographic examinations, and IKS scores. Aseptic failure was more prevalent at the first 2-year follow-up (63%). TKA loosening (n = 11) and undiagnosed pain (n = 7) were considered the most frequent modes of failures, and laxity (n = 1) was a very rare early cause of failure. The aseptic failure group was characterized as average 5 years younger with a greater number of previous knee surgeries, lower IKS scores improvement, and more postoperative pain compared to control group, despite the fact that the aseptic failure group showed a prevalence of cases during the first 2-year follow-up. Inside this group, the undiagnosed pain group had lower improvement of IKS scores, a remarkable prevalence in prior surgical procedure (71%) and a minor mean interval between primary and revision TKA (11.6 months)

Poorer survival after a primary implant during revision total knee arthroplasty

<p>Revision total knee arthroplasty (rTKA) is a complex procedure. Depending on the degree of ligament and bone damage, either primary or revision implants are used. The purpose of this study was to compare survival rates of primary implants with revision implants when used during rTKA.</p><p>A retrospective comparative study was conducted between 1998 and 2009 during which 69 rTKAs were performed on 65 patients. Most common indications for revision were infection (30 %), aseptic loosening (25 %) and wear/osteolysis (25 %). During rTKA, a primary implant was used in nine knees and a revision implant in 60.</p><p>Survival of primary implants was 100 % at one year, 73 % [95 % confidence interval (CI) 41-100] at two years and 44 % (95 % CI 7-81) at five years. Survival of revision implants was 95 % (95 % CI 89-100) at one year, 92 % (95 % CI 84-99) at two years and 92 % (95 % CI 84-99) at five years. Primary implants had a significantly worse survival rate than revision implants when implanted during rTKA [P = 0.039 (hazard ratio = 4.56, 95 % CI 1.08-19.27)].</p><p>Based on these results, it has to be considered whether primary implants are even an option during rTKA.</p>