Which Total Knee Arthroplasty Revisions Do Not Improve Patient-Reported Outcomes?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Patient-Reported Outcomes

Background:

• Limited literature exists comparing patient-reported outcomes for primary versus revision total knee arthroplasty (TKA) in the same patient.
• Existing comparisons between revision and primary TKA are sparse.
• This study addresses this gap by comparing outcomes for primary and revision TKA within individual patients.

Purpose of the Study:

• To compare patient-reported outcomes, specifically the Oxford Knee Score (OKS) and satisfaction, between primary and revision total knee arthroplasty (TKA) in the same patient.
• To assess these outcomes based on the specific reasons for revision surgery.
• To identify factors influencing patient satisfaction following revision TKA.

Main Methods:

• A retrospective cohort study of 11,584 patients undergoing TKA, with 382 requiring revision.
• Collection of Oxford Knee Score (OKS) and satisfaction data preoperatively and postoperatively at 1, 5, and 10 years for both primary and revision TKA.
• Descriptive analyses and logistic regression to evaluate associations between patient characteristics and outcomes.

Main Results:

• Infection was the most frequent reason for first revision (N=127), followed by instability, loosening, and stiffness.
• Patients revised for aseptic loosening/osteolysis reported the highest satisfaction rates.
• Revision for stiffness resulted in the lowest OKS scores both preoperatively and postoperatively.
• A significant proportion of patients dissatisfied after primary TKA remained dissatisfied after revision, though 50% of those revised for stiffness were satisfied post-revision.
• Late revisions (after 10 years) were associated with higher patient satisfaction compared to early revisions (within 2 years).

Conclusions:

• Patients with good primary TKA results who underwent late revision for mechanical issues like aseptic loosening generally experienced favorable outcomes.
• Earlier revisions, particularly for stiff knees or in patients with low primary satisfaction, were less likely to demonstrate significant benefits.
• Patient-reported outcomes after revision TKA are influenced by the reason for revision and the timing of the procedure.