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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
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Predictive factors for failure after total knee replacement revision.

Rafael Luque1, Belen Rizo, Antonio Urda

  • 1Department of Orthopaedics, Hospital Clinico San Carlos, Madrid, Spain, doctorluque@yahoo.es.

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This study found that younger age, rheumatic diseases, and kidney failure predict poor survival for constrained knee arthroplasty revisions. These factors can help predict outcomes for total knee replacement revision surgery.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Reconstructive Surgery

Background:

  • Total knee arthroplasty (TKA) is a common procedure for end-stage knee osteoarthritis.
  • Revision TKA is complex, with varying outcomes and survivorship.
  • Constrained knee implants are used in complex revision cases to improve stability.

Purpose of the Study:

  • To evaluate the survivorship, complications, clinical, radiological, and functional outcomes of the Optetrak Condylar Constrained (CCK) implant.
  • To identify pre-operative predictors of survival and clinical outcomes in patients undergoing CCK revision arthroplasty.

Main Methods:

  • Retrospective study of 125 CCK implants from 1999-2005 with a mean 9-year follow-up.
  • Assessment of pre-, operative, and post-operative conditions via medical files.
  • Clinical and functional evaluation using Hospital for Special Surgery (HSS) and Knee Society Scores (KSS); radiological analysis using Knee Society Roentgenographic evaluation; quality of life using Oxford Knee Score (OKS).

Main Results:

  • Mean KSS clinical score: 68.24; Mean KSS functional score: 63.85.
  • Overall survival rates at 24, 60, and 96 months were 92.7%, 87.8%, and 87.8%, respectively.
  • Factors associated with poor survival included younger age (<70), rheumatic diseases, kidney failure, tibial tuberosity osteotomy, prior PS primary arthroplasty, revision within 5 years, and septic loosening.

Conclusions:

  • Pre-operative factors significantly influence the survival of revision total knee replacement with constrained implants.
  • Identifying patients at higher risk for poor outcomes allows for more informed surgical planning and patient counseling.