Contemporary failure aetiologies of the primary, posterior-stabilised total knee arthroplasty

Matthew Abdel, C. K. Ledford, A. Kobic, M. J. Taunton, A. D. Hanssen

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Aims: The number of revision total knee arthroplasties (TKA) that are performed is expected to increase. However, previous reports of the causes of failure after TKA are limited in that they report the causes at specific institutions, which are often dependent on referral patterns. Our aim was to report the most common indications for re-operations and revisions in a large series of posterior-stabilised TKAs undertaken at a single institution, excluding referrals from elsewhere, which may bias the causes of failure. Patients and Methods: A total of 5098 TKAs which were undertaken between 2000 and 2012 were included in the study. Re-operations, revisions with modular component exchange, and revisions with non-modular component replacement or removal were identified from the medical records. The mean follow-up was five years (two to 12). Results: The Kaplan-Meier ten-year survival without a re-operation, modular component revision and non-modular component revision was 95.7%, 99.3% and 95.3%, respectively. The most common indications for a re-operation were: post-operative stiffness (58%), delayed wound healing (21%), and patellar clunk (11%). The indications for isolated modular component revision were acute periprosthetic joint infection (PJI) (64%) and instability (36%). The most common indications for non-modular component revision were chronic PJI (52%), aseptic loosening (17%), periprosthetic fracture (10%), and instability (10%). Conclusion: Post-operative stiffness remains the most common indication for re-operation after TKA. Infection is the most common indication for modular and non-modular component revision. Aseptic loosening was not an uncommon cause of failure, however, it was much less common than in national registry and non-registry data. Focusing on posterior-stabilised TKAs initially performed at our institution allowed for an accurate assessment of the causes of failure in a contemporary specialty practice.

Original languageEnglish (US)
Pages (from-to)647-652
Number of pages6
JournalBone and Joint Journal
Volume99B
Issue number5
DOIs
StatePublished - May 1 2017

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Knee Replacement Arthroplasties
Referral and Consultation
Joints
Infection
Periprosthetic Fractures
Wound Healing
Medical Records
Registries
Survival

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Contemporary failure aetiologies of the primary, posterior-stabilised total knee arthroplasty. / Abdel, Matthew; Ledford, C. K.; Kobic, A.; Taunton, M. J.; Hanssen, A. D.

In: Bone and Joint Journal, Vol. 99B, No. 5, 01.05.2017, p. 647-652.

Research output: Contribution to journalArticle

Abdel, Matthew ; Ledford, C. K. ; Kobic, A. ; Taunton, M. J. ; Hanssen, A. D. / Contemporary failure aetiologies of the primary, posterior-stabilised total knee arthroplasty. In: Bone and Joint Journal. 2017 ; Vol. 99B, No. 5. pp. 647-652.
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abstract = "Aims: The number of revision total knee arthroplasties (TKA) that are performed is expected to increase. However, previous reports of the causes of failure after TKA are limited in that they report the causes at specific institutions, which are often dependent on referral patterns. Our aim was to report the most common indications for re-operations and revisions in a large series of posterior-stabilised TKAs undertaken at a single institution, excluding referrals from elsewhere, which may bias the causes of failure. Patients and Methods: A total of 5098 TKAs which were undertaken between 2000 and 2012 were included in the study. Re-operations, revisions with modular component exchange, and revisions with non-modular component replacement or removal were identified from the medical records. The mean follow-up was five years (two to 12). Results: The Kaplan-Meier ten-year survival without a re-operation, modular component revision and non-modular component revision was 95.7{\%}, 99.3{\%} and 95.3{\%}, respectively. The most common indications for a re-operation were: post-operative stiffness (58{\%}), delayed wound healing (21{\%}), and patellar clunk (11{\%}). The indications for isolated modular component revision were acute periprosthetic joint infection (PJI) (64{\%}) and instability (36{\%}). The most common indications for non-modular component revision were chronic PJI (52{\%}), aseptic loosening (17{\%}), periprosthetic fracture (10{\%}), and instability (10{\%}). Conclusion: Post-operative stiffness remains the most common indication for re-operation after TKA. Infection is the most common indication for modular and non-modular component revision. Aseptic loosening was not an uncommon cause of failure, however, it was much less common than in national registry and non-registry data. Focusing on posterior-stabilised TKAs initially performed at our institution allowed for an accurate assessment of the causes of failure in a contemporary specialty practice.",
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