Evangelopoulos Dimitrios S, Ahmad Sufian S, Krismer Anna M, Albers Christoph E, Hoppe Sven, Kleer Barbara, Kohl Sandro, Ateschrang Atesch
Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
3rd Department of Orthopaedic Surgery, KAT Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Knee Surg. 2019 Oct;32(10):941-946. doi: 10.1055/s-0038-1672203. Epub 2018 Oct 18.
Revision total knee arthroplasty (RTKA) represents an effective treatment for failed TKA, but with less favorable outcomes. Considering the technical complexity and economic burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors for RTKA failure. The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange. Median follow-up was 6.3 ± 2.7 years (range: 2.2-10). Patient demographics, year of primary implantation, reasons for revision surgery, implant type, pain, knee mobility, systemic or local postoperative complications, and treatment of the complications were recorded and evaluated. Infection was a major cause of failure followed by aseptic loosening, instability, pain, malalignment, and inlay wear. Following RTKA, Knee Society Score (KSS) (knee score and functional score) demonstrated a significant improvement ( < 0.05). No significant difference in flexion, extension deficit, and KSS was detected between aseptic and septic primary TKAs preoperatively and following first RTKA. Reinfection rate of the septic primary TKAs was 5%. Infection was the major cause of a second revision, reaching as high as 50% in all cases. The results of this study support that septic failure of a primary TKA is likely to occur within the first 2 years following implantation. Septic failure of primary TKA does not influence survival of the revision prosthesis.
全膝关节置换翻修术（RTKA）是治疗失败的初次全膝关节置换术（TKA）的有效方法，但效果欠佳。鉴于RTKA手术的技术复杂性和经济负担，有必要研究当前RTKA失败的机制和预测因素。本研究的目的是评估RTKA的生存率并确定其失败的主要原因。从机构数据库中识别出2003年至2013年间接受RTKA的146例患者。翻修定义为需要更换整个假体（嵌体以及股骨和胫骨组件）的手术。中位随访时间为6.3±2.7年（范围：2.2 - 10年）。记录并评估患者的人口统计学数据、初次植入年份、翻修手术原因、植入物类型、疼痛、膝关节活动度、全身或局部术后并发症以及并发症的治疗情况。感染是失败的主要原因，其次是无菌性松动、不稳定、疼痛、对线不良和嵌体磨损。RTKA术后，膝关节协会评分（KSS）（膝关节评分和功能评分）有显著改善（<0.05）。术前和初次RTKA术后，无菌性和感染性初次TKA在屈曲、伸直受限和KSS方面均未检测到显著差异。感染性初次TKA的再感染率为5%。感染是二次翻修的主要原因，在所有病例中高达50%。本研究结果支持初次TKA的感染性失败可能发生在植入后的前2年内。初次TKA的感染性失败不影响翻修假体的生存率。
