Impact of time to revision total knee arthroplasty on outcomes following aseptic failure
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Prior studies have demonstrated an association between time to revision total knee arthroplasty (rTKA) and indication; however, the impact of early versus late revision on post-operative outcomes has not been reported. A retrospective, observational study examined patients who underwent unilateral, aseptic rTKA at an academic orthopedic hospital between 6/2011 and 4/2020 with > 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary TKA (pTKA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared. 470 rTKA were included (199 early, 271 late). Early rTKA patients were younger by 2.5 years ( p = 0.002). The predominant indications for early rTKA were instability (28.6%) and arthrofibrosis/stiffness (26.6%), and the predominant indications for late rTKA were aseptic loosening (45.8%) and instability (26.2%; p < 0.001). Late rTKA had longer operative times (119.20 ± 51.94 vs. 103.93 ± 44.66 min; p < 0.001). There were no differences in rTKA type, disposition, hospital length of stay, all-cause 90-day emergency department visits and readmissions, reoperations, and number of re-revisions. Aseptic rTKA performed before 2 years had different indications but demonstrated similar outcomes to those performed later. Early revisions had shorter surgical times, which could be attributed to differences in rTKA indication.III, retrospective observational analysis.
Abstract
Prior studies have demonstrated an association between time to revision total knee arthroplasty (rTKA) and indication; however, the impact of early versus late revision on post-operative outcomes has not been reported. A retrospective, observational study examined patients who underwent unilateral, aseptic rTKA at an academic orthopedic hospital between 6/2011 and 4/2020 with > 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary TKA (pTKA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared. 470 rTKA were included (199 early, 271 late). Early rTKA patients were younger by 2.5 years ( p = 0.002). The predominant indications for early rTKA were instability (28.6%) and arthrofibrosis/stiffness (26.6%), and the predominant indications for late rTKA were aseptic loosening (45.8%) and instability (26.2%; p < 0.001). Late rTKA had longer operative times (119.20 ± 51.94 vs. 103.93 ± 44.66 min; p < 0.001). There were no differences in rTKA type, disposition, hospital length of stay, all-cause 90-day emergency department visits and readmissions, reoperations, and number of re-revisions. Aseptic rTKA performed before 2 years had different indications but demonstrated similar outcomes to those performed later. Early revisions had shorter surgical times, which could be attributed to differences in rTKA indication.III, retrospective observational analysis.
참고문헌 (26)
- Sloan M, "Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030", J Bone Jt Surg, 100, pp.1455~1460 (2018)[DOI]
- Inacio MCS, "Projected increase in total knee arthroplasty in the United States—an alternative projection model", Osteoarthr Cartil, 25, pp.1797~1803 (2017)[DOI]
- Delanois RE, "Current epidemiology of revision total knee arthroplasty in the United States", J Arthroplasty, 32, pp.2663~2668 (2017)[DOI]
- Piedade SR, "Revision after early aseptic failures in primary total knee arthroplasty", Knee Surg Sport Traumatol Arthrosc, 17, pp.248~253 (2009)[DOI]
- Fehring TK, "Early failures in total knee arthroplasty", Clin Orthop Relat Res, 392, pp.315~318 (2001)[DOI]
- Furnes O, "Early failures among 7, 174 primary total knee replacements : a follow-up study from the Norwegian Arthroplasty Register 1994–2000", Acta Orthop Scand, 73, pp.117~129 (2002)[DOI]
- Bottle A, "Risk factors for early revision after total hip and knee arthroplasty : national observational study from a surgeon and population perspective", PLoS ONE, 14, pp.e0214855~ (2019)[DOI]
- Postler A, "Analysis of total knee arthroplasty revision causes", BMC Musculoskelet Disord, 19, pp.55~ (2018)[DOI]
- Dalury DF, "Why are total knee arthroplasties being revised?", J Arthroplasty, 28, pp.120~121 (2013)[DOI]
- Schroer WC, "Why are total knees failing today? Etiology of total knee revision in 2010 and 2011", J Arthroplasty, 28, pp.116~119 (2013)[DOI]
- Sharkey PF, "Why are total knee arthroplasties failing today?", Clin Orthop Relat Res, 404, pp.7~13 (2002)[DOI]
- Le DH, "Current modes of failure in TKA : infection, instability, and stiffness predominate", Clin Orthop Relat Res, 472, pp.2197~2200 (2014)[DOI]
- Sharkey PF, "Why are total knee arthroplasties failing today-has anything changed after 10 years?", J Arthroplasty, 29, pp.1774~1778 (2013)[DOI]
- Pietrzak J, "Have the frequency of and reasons for revision total knee arthroplasty changed since 200? Comparison of two cohorts from the same hospital : 255 cases(2013–2016)and 68 cases(1991–1998)", Orthop Traumatol Surg Res, 105, pp.639~645 (2019)[DOI]
- Walker-Santiago R, "Revision total knee arthroplasty in young patients : higher early reoperation and rerevision", J Arthroplasty, 36, pp.653~656 (2021)[DOI]
- Meehan JP, "Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty", JBJS, 96, pp.529~ (2014)
- Aggarwal VK, "Revision total knee arthroplasty in the young patient : is there trouble on the horizon?", JBJS, 96, pp.536~ (2014)
- Wilson CJ, "Knee instability as the primary cause of failure following Total Knee Arthroplasty(TKA) : a systematic review on the patient, surgical and implant characteristics of revised TKA patients", Knee, 24, pp.1271~1281 (2017)[DOI]
- Song SJ, "Causes of instability after total knee arthroplasty", J Arthroplasty, 29, pp.360~364 (2014)[DOI]
- Barnsley L, "Detection of aseptic loosening in total knee replacements : a systematic review and meta-analysis", Skelet Radiol, 48, pp.1565~1572 (2019)[DOI]
- Bordini B, "Factors affecting aseptic loosening of 4750 total hip arthroplasties : multivariate survival analysis", BMC Musculoskelet Disord, 8, pp.69~ (2007)[DOI]
- Garbarino LJ, "The effect of operative time on in-hospital length of stay in revision total knee arthroplasty", Ann Transl Med, 7, pp.66~66 (2019)[DOI]
- Naranje S, "Does operative time affect infection rate in primary total knee arthroplasty?", Clin Orthop Relat Res, 473, pp.64~69 (2015)[DOI]
- Chen AZ, "Increase in operative time is associated with postoperative complications in revision total knee arthroplasty", Orthopedics (2020)[DOI]
- Mari K, "Cost utility modeling of early vs late total knee replacement in osteoarthritis patients", Osteoarthr Cartil, 24, pp.2069~2076 (2016)[DOI]
- Okafor C, "Cost of septic and aseptic revision total knee arthroplasty : a systematic review", BMC Musculoskelet Disord, 22, pp.706~ (2021)[DOI]