The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty
Aims: Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requirin...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The British Editorial Society of Bone & Joint Surgery
2021-08-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0086.R1 |
| _version_ | 1819130448101507072 |
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| author | Amy J. Garner Thomas C. Edwards Alexander D. Liddle Gareth G. Jones Justin P. Cobb |
| author_facet | Amy J. Garner Thomas C. Edwards Alexander D. Liddle Gareth G. Jones Justin P. Cobb |
| author_sort | Amy J. Garner |
| collection | DOAJ |
| description | Aims: Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics. Methods: Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system. Results: Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall’s W 0.97; p < 0.005), rising to 93% in round two (Kendall’s W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall’s W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall’s W 0.92; p < 0.001). Conclusion: The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It has been shown to be reliable, repeatable and pragmatic. The implications for patient care and health economics are discussed. Cite this article: Bone Jt Open 2021;2(8):638–645. |
| first_indexed | 2024-12-22T08:59:46Z |
| format | Article |
| id | doaj.art-b75eb96280044655a8c4cbabcbc95a5e |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-22T08:59:46Z |
| publishDate | 2021-08-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-b75eb96280044655a8c4cbabcbc95a5e2022-12-21T18:31:45ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-08-012863864510.1302/2633-1462.28.BJO-2021-0086.R1The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplastyAmy J. Garner0Thomas C. Edwards1Alexander D. Liddle2Gareth G. Jones3Justin P. Cobb4MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UKMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UKMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UKMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UKMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UKAims: Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics. Methods: Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system. Results: Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall’s W 0.97; p < 0.005), rising to 93% in round two (Kendall’s W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall’s W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall’s W 0.92; p < 0.001). Conclusion: The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It has been shown to be reliable, repeatable and pragmatic. The implications for patient care and health economics are discussed. Cite this article: Bone Jt Open 2021;2(8):638–645.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0086.R1revisionkneearthroplastypartialclassificationpatient safetycompartmentalcomplexitypartial knee arthroplastykneestotal knee arthroplasty (tka)arthroplastyrevision surgerybone-implantcorrelation coefficienttotal knee prosthesisanterior cruciate ligamenttibial components |
| spellingShingle | Amy J. Garner Thomas C. Edwards Alexander D. Liddle Gareth G. Jones Justin P. Cobb The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty Bone & Joint Open revision knee arthroplasty partial classification patient safety compartmental complexity partial knee arthroplasty knees total knee arthroplasty (tka) arthroplasty revision surgery bone-implant correlation coefficient total knee prosthesis anterior cruciate ligament tibial components |
| title | The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| title_full | The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| title_fullStr | The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| title_full_unstemmed | The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| title_short | The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| title_sort | revision partial knee classification system understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty |
| topic | revision knee arthroplasty partial classification patient safety compartmental complexity partial knee arthroplasty knees total knee arthroplasty (tka) arthroplasty revision surgery bone-implant correlation coefficient total knee prosthesis anterior cruciate ligament tibial components |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.28.BJO-2021-0086.R1 |
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