Multiply revised TKAs have worse outcomes compared to index revision TKAs
Aims: Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure follo...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-05-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.45.BJO-2023-0025.R1 |
| _version_ | 1827939429405163520 |
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| author | Mackenzie A. Roof Katherine Lygrisse Ittai Shichman Scott E. Marwin Morteza Meftah Ran Schwarzkopf |
| author_facet | Mackenzie A. Roof Katherine Lygrisse Ittai Shichman Scott E. Marwin Morteza Meftah Ran Schwarzkopf |
| author_sort | Mackenzie A. Roof |
| collection | DOAJ |
| description | Aims: Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised. Methods: This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups. Results: A total of 663 cases were identified (486 index rTKAs and 177 multiply revised TKAs). There were no differences in demographics, rTKA type, or indication for revision. Multiply revised patients had significantly longer rTKA operative times (p < 0.001), and were more likely to be discharged to an acute rehabilitation centre (6.2% vs 4.5%) or skilled nursing facility (29.9% vs 17.5%; p = 0.003). Patients who had been multiply revised were also significantly more likely to have subsequent reoperation (18.1% vs 9.5%; p = 0.004) and re-revision (27.1% vs 18.1%; p = 0.013). The number of previous revisions did not correlate with the number of subsequent reoperations (r = 0.038; p = 0.670) or re-revisions (r = −0.102; p = 0.251). Conclusion: Multiply revised TKA had worse outcomes, with higher rates of facility discharge, longer operative times, and greater reoperation and re-revision rates compared to index rTKA. Cite this article: Bone Jt Open 2023;4(5):393–398. |
| first_indexed | 2024-03-13T08:53:23Z |
| format | Article |
| id | doaj.art-87655cfb815046a8a45b8b3d08e7f346 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-13T08:53:23Z |
| publishDate | 2023-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-87655cfb815046a8a45b8b3d08e7f3462023-05-29T05:54:47ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622023-05-014539339810.1302/2633-1462.45.BJO-2023-0025.R1Multiply revised TKAs have worse outcomes compared to index revision TKAsMackenzie A. Roof0Katherine Lygrisse1Ittai Shichman2Scott E. Marwin3Morteza Meftah4Ran Schwarzkopf5Department of Orthopedic Surgery, NYU Langone Health, New York, USADepartment of Orthopedic Surgery, Huntington Hospital at Northwell Health, Plainview, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, USAAims: Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised. Methods: This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups. Results: A total of 663 cases were identified (486 index rTKAs and 177 multiply revised TKAs). There were no differences in demographics, rTKA type, or indication for revision. Multiply revised patients had significantly longer rTKA operative times (p < 0.001), and were more likely to be discharged to an acute rehabilitation centre (6.2% vs 4.5%) or skilled nursing facility (29.9% vs 17.5%; p = 0.003). Patients who had been multiply revised were also significantly more likely to have subsequent reoperation (18.1% vs 9.5%; p = 0.004) and re-revision (27.1% vs 18.1%; p = 0.013). The number of previous revisions did not correlate with the number of subsequent reoperations (r = 0.038; p = 0.670) or re-revisions (r = −0.102; p = 0.251). Conclusion: Multiply revised TKA had worse outcomes, with higher rates of facility discharge, longer operative times, and greater reoperation and re-revision rates compared to index rTKA. Cite this article: Bone Jt Open 2023;4(5):393–398.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.45.BJO-2023-0025.R1total knee arthroplastyrevision knee arthroplastyrisk factorsoutcomesre-revisionrevision total knee arthroplasty (rtka)total knee arthroplasty (tka)revision surgeriesprimary tkaacute rehabilitationt-testfemoral componentchi-squared testkneesfisher’s exact test |
| spellingShingle | Mackenzie A. Roof Katherine Lygrisse Ittai Shichman Scott E. Marwin Morteza Meftah Ran Schwarzkopf Multiply revised TKAs have worse outcomes compared to index revision TKAs Bone & Joint Open total knee arthroplasty revision knee arthroplasty risk factors outcomes re-revision revision total knee arthroplasty (rtka) total knee arthroplasty (tka) revision surgeries primary tka acute rehabilitation t-test femoral component chi-squared test knees fisher’s exact test |
| title | Multiply revised TKAs have worse outcomes compared to index revision TKAs |
| title_full | Multiply revised TKAs have worse outcomes compared to index revision TKAs |
| title_fullStr | Multiply revised TKAs have worse outcomes compared to index revision TKAs |
| title_full_unstemmed | Multiply revised TKAs have worse outcomes compared to index revision TKAs |
| title_short | Multiply revised TKAs have worse outcomes compared to index revision TKAs |
| title_sort | multiply revised tkas have worse outcomes compared to index revision tkas |
| topic | total knee arthroplasty revision knee arthroplasty risk factors outcomes re-revision revision total knee arthroplasty (rtka) total knee arthroplasty (tka) revision surgeries primary tka acute rehabilitation t-test femoral component chi-squared test knees fisher’s exact test |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.45.BJO-2023-0025.R1 |
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