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Isolated Femoral or Tibial Component Revision in Total Knee Arthroplasty: A Systematic Review
Marco Maestri1, Francesco Castagnini2, Federico Giardina2
1Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, marcomaestri93@hotmail.it.
Objective:
The purpose of this systematic review was to assess clinical and radiographic outcomes, complication rates, rates and reasons of re-revision of isolated femoral or tibial component revisions, comparing them with total knee revisions.
Methods:
A review of the published literature was performed using MEDLINE, Embase, and Cochrane libraries. The terms "isolate" and "revision" and "knee arthroplasty" or "knee replacement" were together used as MeSH terms. Partial knee replacement, non-English literature, case reports, and papers published before 2000 were excluded.
Results:
Out of 911 papers, six papers met the inclusion criteria. Mean MINORS scores achieved quite low values (13.33 and 13.67). No study encompassed revisions for septic loosening or infection. Total revisions performed for instability and wear achieved better clinical outcomes: in the other cases, partial and total revisions showed no differences in clinical outcomes. Both the cohorts showed similar radiographic features. Lesser bleeding and shorter operative times were observed in partial revisions compared to total revisions. The re-revision rates were similar in most of comparative studies: only one study noticed a significant difference in the failure rate between partial (25% at 3 years) and full (7% at 3.5 years) revisions.
Conclusions:
The poor quality of the studies precluded sound conclusions. Isolated tibial or femoral component revision is an option when the other component is well fixed and positioned and in absence of chronic periprosthetic infection; nevertheless, it should be carefully evaluated when the reasons for revision are wear or instability.
