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Revision total knee arthroplasty for aseptic failure
M A Jacobs1, D S Hungerford, K A Krackow
1Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Baltimore, MD 21239.
Clinical Orthopaedics and Related Research
|January 1, 1988
Summary
Revision total knee arthroplasty using porous-coated anatomic (PCA) components shows good outcomes for mechanical failures. However, revisions for pain or unclear issues yielded limited improvement, with complications like sepsis causing poor results.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Total knee arthroplasty (TKA) is a common procedure for end-stage knee arthritis.
- Component failure and loosening are significant challenges in TKA, necessitating revision surgery.
- Porous-coated anatomic (PCA) components are utilized in primary and revision TKA to promote bone ingrowth and component stability.
Purpose of the Study:
- To evaluate the clinical outcomes of revision total knee arthroplasty (TKA) using porous-coated anatomic (PCA) components.
- To identify factors influencing the success of revision TKA, specifically relating to the mode of failure.
- To assess the impact of preoperative diagnosis on revision TKA outcomes.
Main Methods:
- A retrospective study of 24 patients who underwent 28 revision TKAs with PCA components.
- Follow-up period ranged from two to four years.
- Outcomes were assessed based on functional results, pain levels, and complication rates, categorized by the mode of failure.
Main Results:
- Overall, 68% of revision TKAs with PCA components achieved good or excellent results.
- Revision TKA for a definable mechanical failure demonstrated an 83% success rate (good or excellent results).
- Patients revised for incapacitating pain or with no clearly defined preoperative issue showed no significant improvement. Deep sepsis, wound necrosis, and extensor mechanism abnormalities were associated with poor outcomes.
Conclusions:
- Revision TKA with PCA components is effective for addressing mechanical failures.
- The etiology of failure significantly impacts revision TKA outcomes, with mechanical issues faring better than pain or undefined problems.
- Careful patient selection and diagnosis are crucial for successful revision TKA, as complications like infection can lead to poor results.