Consensus statement on problematic knee replacement and revision knee replacement: A collaboration between EKS and BASK.

BACKGROUND

Up to 20% of primary total knee arthroplasty (TKA) patients are not satisfied with their outcome. Both the analysis of these patients and revision surgery can be complex, expensive and outcomes can vary widely.

AIM

The aim of this study was to deliver consensus recommendations regarding outpatient analysis, surgical treatment and arrangement of clinical services concerning patients with a problematic TKA or revision knee replacement (RTKA).

METHODS

Members of BASK and EKS were invited to attend a joint meeting in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Eighty delegates attended the meeting and five consensus statements were considered, with a threshold level of 80% agreement required as the definition consensus. A further consensus meeting of EKS members in Kitzbuhl, Austria (January 2023) followed similar methodology and considered a further four statements on this topic.

RESULTS

From the first meeting, 5 consensus statements with accompanying supporting evidence and text were agreed. 1) In suspected infection, a recognised diagnostic pathway and definition should be used (e.g. MSIS, ICM, EBJIS) and documented; 2) Revision of an infected TKA should be treated in units with a multidisciplinary team; 3) Initial investigation of a problematic TKA should include a minimum of: clinical investigation, X-Rays and blood tests, with further discussion with the MDT if required; 4) Units providing RTKA should have surgeons with evidence of specific training or experience, and on-going minimum unit numbers; 5) National Orthopaedic/Knee Societies should develop a strategy on Revision TKA provision taking into account: workforce, revision burden, location, hospital infrastructure. From the second meeting a further 4 consensus statements were agreed. Two statements were agreed text content answering the questions: 1) What should be included in the basic diagnostic workup of a painful TKA? and 2) Which are the key factors for surgeons to consider before offering the patient revision surgery? The two other agreed statements are: 3) Pre-operative diagnosis is related to outcome in RTKA and 4) RTKA for pain, without a surgically treatable diagnosis, is unpredictable.

CONCLUSIONS

The agreed joint BASK-EKS consensus statements and the EKS consensus statements on the assessment of problematic RTKA are recommended as the contemporary basis of optimal care for these patients and should inform future training and service developments.