Contemporary Revision Total Knee Arthroplasty in Patients Younger Than 50 Years

1 in 3 Risk of Re-Revision by 10 Years

Brian P. Chalmers, Graham D. Pallante, Rafael J. Sierra, David G. Lewallen, Mark Pagnano, Robert T. Trousdale

Research output: Contribution to journalArticle

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Abstract

Background: There is a paucity of literature on contemporary aseptic revision total knee arthroplasty in patients ≤50 years. We sought to determine risk factors for failure in this population, with specific emphasis on survivorship free of (1) all-cause re-revision and (2) re-revision for instability. Methods: We retrospectively reviewed 135 nononcologic revision total knee arthroplasties (TKAs) performed from 2000 to 2012 in patients ≤50 years. Mean age was 43 years, and mean body mass index was 31 kg/m2. Mean follow-up was 7 years. There were 99 (73%) first-time revisions, and 36 (27%) with prior revisions. Indications for revision included instability (47%), aseptic loosening (29%), and arthrofibrosis (9%). Multivariate Cox regression analysis was used to identify risk factors. Results: Survivorship free of all-cause re-revision was 66% at 10 years, with multiply revised TKAs (hazard ratio [HR] = 2.6, P = .008) having the poorest survivorship. Forty-three (32%) TKAs underwent re-revision including 10 (7%) for periprosthetic joint infection. Survivorship free of re-revision for instability was 88% at 10 years, with revision for instability (HR = 19, P = .03), male gender (HR = 3.0, P = .05), and multiply revised TKAs (HR = 3.5, P = .03) having poorer survival. Of the 64 TKAs revised for instability, 24 (38%) underwent re-revision, including 14 (22%) for recurrent instability. Conclusion: Patients ≤50 years undergoing contemporary aseptic revision TKA had a 1 in 3 risk of re-revision. Patients specifically revised for instability or had prior TKA revisions had the highest risk of re-revision at 10 years. Level of Evidence: IV.

Original languageEnglish (US)
Pages (from-to)S266-S270
JournalJournal of Arthroplasty
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2019

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Knee Replacement Arthroplasties
Survival Rate
Body Mass Index
Joints
Regression Analysis
Survival
Infection

Keywords

  • aseptic loosening
  • complications
  • instability
  • revision
  • total knee arthroplasty
  • young age

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Contemporary Revision Total Knee Arthroplasty in Patients Younger Than 50 Years : 1 in 3 Risk of Re-Revision by 10 Years. / Chalmers, Brian P.; Pallante, Graham D.; Sierra, Rafael J.; Lewallen, David G.; Pagnano, Mark; Trousdale, Robert T.

In: Journal of Arthroplasty, Vol. 34, No. 7, 01.07.2019, p. S266-S270.

Research output: Contribution to journalArticle

Chalmers, Brian P. ; Pallante, Graham D. ; Sierra, Rafael J. ; Lewallen, David G. ; Pagnano, Mark ; Trousdale, Robert T. / Contemporary Revision Total Knee Arthroplasty in Patients Younger Than 50 Years : 1 in 3 Risk of Re-Revision by 10 Years. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 7. pp. S266-S270.
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abstract = "Background: There is a paucity of literature on contemporary aseptic revision total knee arthroplasty in patients ≤50 years. We sought to determine risk factors for failure in this population, with specific emphasis on survivorship free of (1) all-cause re-revision and (2) re-revision for instability. Methods: We retrospectively reviewed 135 nononcologic revision total knee arthroplasties (TKAs) performed from 2000 to 2012 in patients ≤50 years. Mean age was 43 years, and mean body mass index was 31 kg/m2. Mean follow-up was 7 years. There were 99 (73{\%}) first-time revisions, and 36 (27{\%}) with prior revisions. Indications for revision included instability (47{\%}), aseptic loosening (29{\%}), and arthrofibrosis (9{\%}). Multivariate Cox regression analysis was used to identify risk factors. Results: Survivorship free of all-cause re-revision was 66{\%} at 10 years, with multiply revised TKAs (hazard ratio [HR] = 2.6, P = .008) having the poorest survivorship. Forty-three (32{\%}) TKAs underwent re-revision including 10 (7{\%}) for periprosthetic joint infection. Survivorship free of re-revision for instability was 88{\%} at 10 years, with revision for instability (HR = 19, P = .03), male gender (HR = 3.0, P = .05), and multiply revised TKAs (HR = 3.5, P = .03) having poorer survival. Of the 64 TKAs revised for instability, 24 (38{\%}) underwent re-revision, including 14 (22{\%}) for recurrent instability. Conclusion: Patients ≤50 years undergoing contemporary aseptic revision TKA had a 1 in 3 risk of re-revision. Patients specifically revised for instability or had prior TKA revisions had the highest risk of re-revision at 10 years. Level of Evidence: IV.",
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T1 - Contemporary Revision Total Knee Arthroplasty in Patients Younger Than 50 Years

T2 - 1 in 3 Risk of Re-Revision by 10 Years

AU - Chalmers, Brian P.

AU - Pallante, Graham D.

AU - Sierra, Rafael J.

AU - Lewallen, David G.

AU - Pagnano, Mark

AU - Trousdale, Robert T.

PY - 2019/7/1

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N2 - Background: There is a paucity of literature on contemporary aseptic revision total knee arthroplasty in patients ≤50 years. We sought to determine risk factors for failure in this population, with specific emphasis on survivorship free of (1) all-cause re-revision and (2) re-revision for instability. Methods: We retrospectively reviewed 135 nononcologic revision total knee arthroplasties (TKAs) performed from 2000 to 2012 in patients ≤50 years. Mean age was 43 years, and mean body mass index was 31 kg/m2. Mean follow-up was 7 years. There were 99 (73%) first-time revisions, and 36 (27%) with prior revisions. Indications for revision included instability (47%), aseptic loosening (29%), and arthrofibrosis (9%). Multivariate Cox regression analysis was used to identify risk factors. Results: Survivorship free of all-cause re-revision was 66% at 10 years, with multiply revised TKAs (hazard ratio [HR] = 2.6, P = .008) having the poorest survivorship. Forty-three (32%) TKAs underwent re-revision including 10 (7%) for periprosthetic joint infection. Survivorship free of re-revision for instability was 88% at 10 years, with revision for instability (HR = 19, P = .03), male gender (HR = 3.0, P = .05), and multiply revised TKAs (HR = 3.5, P = .03) having poorer survival. Of the 64 TKAs revised for instability, 24 (38%) underwent re-revision, including 14 (22%) for recurrent instability. Conclusion: Patients ≤50 years undergoing contemporary aseptic revision TKA had a 1 in 3 risk of re-revision. Patients specifically revised for instability or had prior TKA revisions had the highest risk of re-revision at 10 years. Level of Evidence: IV.

AB - Background: There is a paucity of literature on contemporary aseptic revision total knee arthroplasty in patients ≤50 years. We sought to determine risk factors for failure in this population, with specific emphasis on survivorship free of (1) all-cause re-revision and (2) re-revision for instability. Methods: We retrospectively reviewed 135 nononcologic revision total knee arthroplasties (TKAs) performed from 2000 to 2012 in patients ≤50 years. Mean age was 43 years, and mean body mass index was 31 kg/m2. Mean follow-up was 7 years. There were 99 (73%) first-time revisions, and 36 (27%) with prior revisions. Indications for revision included instability (47%), aseptic loosening (29%), and arthrofibrosis (9%). Multivariate Cox regression analysis was used to identify risk factors. Results: Survivorship free of all-cause re-revision was 66% at 10 years, with multiply revised TKAs (hazard ratio [HR] = 2.6, P = .008) having the poorest survivorship. Forty-three (32%) TKAs underwent re-revision including 10 (7%) for periprosthetic joint infection. Survivorship free of re-revision for instability was 88% at 10 years, with revision for instability (HR = 19, P = .03), male gender (HR = 3.0, P = .05), and multiply revised TKAs (HR = 3.5, P = .03) having poorer survival. Of the 64 TKAs revised for instability, 24 (38%) underwent re-revision, including 14 (22%) for recurrent instability. Conclusion: Patients ≤50 years undergoing contemporary aseptic revision TKA had a 1 in 3 risk of re-revision. Patients specifically revised for instability or had prior TKA revisions had the highest risk of re-revision at 10 years. Level of Evidence: IV.

KW - aseptic loosening

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KW - total knee arthroplasty

KW - young age

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