The Methods and Results of Revision Total Knee Arthroplasty

Woo-Shin Cho; Yoon-Seok Youm; Ji-Hyo Hwang; Sung-Chan Ahn; Ji-Hoon Suh; Soo-Heon Hong

doi:10.4055/jkoa.2007.42.5.578

Journal List > J Korean Orthop Assoc > v.42(5) > 1012699

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Youm, Hwang, Ahn, Suh, and Hong: The Methods and Results of Revision Total Knee Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(5): 578-585.

Published online: 31 October 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.5.578

The Methods and Results of Revision Total Knee Arthroplasty

Woo-Shin Cho, M.D., Yoon-Seok Youm, M.D.^*, Ji-Hyo Hwang, M.D.^†, Sung-Chan Ahn, M.D., Ji-Hoon Suh, M.D., Soo-Heon Hong, M.D.

Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea.

^*Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea.

^†Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.

Address reprint requests to Woo-Shin Cho, M.D. Department of Orthopaedic Surgery, Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82.2-3010-3530, Fax: +82.2-488-7877, wscho@amc.seoul.kr

Abstract

Purpose

To suggest operative methods for revision total knee arthroplasty (TKA) according to the causes of revision surgery.

Materials and Methods

The operative methods of 70 revision total knee arthroplasties in 64 patients between December 1996 and December 2004 were analyzed according to the causes. The mean follow-up period was 65 months (25-120 months). The range of motion and Hospital for Special Surgery (HSS) score were used for the clinical evaluation and the scoring system of American Knee Society was used for the radiographic evaluation.

Results

The mean periods of revision surgery from the initial operation was 59 months (1 month-20 years). Posterior cruciate retaining prosthesis was used in 8 cases, posterior cruciate substituting prosthesis in 14 cases, and constrained type prosthesis in 48 cases. The extension stem was required in 51 cases, metal augmentation in 34 cases, and structural allograft in 15 cases for bone defect treatment and firm fixation. The average range of motion improved from 88.8° preoperatively to 105.8° at the final follow-up. HSS score also improved from 60.5 to 87.6 points. The complications after revision TKA were 3 infections (4.3%), 1 patellar dislocation (1.4%), and 1 polyethylene dislocation (1.4%).

Conclusion

Constrained type prostheses were needed in many cases of revision TKA. Satisfactory results were obtained using an additional structural allograft, metal augmentation, and extension stem for bone defect treatment and firm fixation.

Keywords: Knee, Revision arthroplasty, Methods

Figures and Tables

Fig. 1

(A) Radiograph of the right knee of a 69-year-old woman shows severe polyethylene wear and varus deformity. (B) Radiograph taken 2 years after revision surgery shows good alignment of the component with extension stems.

Fig. 2

(A) Radiograph of the left knee of a 72-year-old woman shows patellar dislocation. (B) Radiograph taken 6 months after revision surgery shows persistent patellar dislocation.

Table 1

The Causes of Revision Total Knee Arthroplasty

Table 2

Exchange of the Components in Revision Total Knee Arthroplasty

Table 3

Operative Procedures

Table 4

Clinical and Radiological Results

References

1. Ahlberg A, Lunden A. Secondary operations after knee joint replacement. Clin Orthop Relat Res. 1981. 156:170–174.

2. Bert JM. Dislocation/subluxation of meniscal bearing elements after New Jersey low-contact stress total knee arthroplasty. Clin Orthop Relat Res. 1990. 254:211–215.

3. Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res. 1988. 231:163–178.

4. Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings. Clin Orthop Relat Res. 1990. 260:162–169.

5. Cameron HU, Hunter GA, Welsh RP, Bailey WH. Revision of total knee replacement. Can J Surg. 1981. 24:418–420.

6. Chin KR, Bae DS, Lonner JH, Scott RD. Revision surgery for patellar dislocation after primary total knee arthroplasty. J Arthroplasty. 2004. 19:956–961.

7. Elia EA, Lotke PA. Results of revision total knee arthroplasty associated with significant bone loss. Clin Orthop Relat Res. 1991. 271:114–121.

8. Friedman RJ, Poss R. Revision total knee arthroplasty in patients with osteoarthritis. Rheum Dis Clin North Am. 1988. 14:537–544.

9. Goldberg VM, Figgie MP, Figgie HE 3rd, Sobel M. The results of revision total knee arthroplasty. Clin Orthop Relat Res. 1988. 226:86–92.

10. Goldman RT, Scuderi GR, Insall JN. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res. 1996. 331:118–124.

11. Gustke KA. Preoperative planning for revision total knee arthroplasty: avoiding chaos. J Arthroplasty. 2005. 20:Suppl 2. 37–40.

12. Haas SB, Insall JN, Montgomery W 3rd, Windsor RE. Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am. 1995. 77:1700–1707.

13. Hanssen AD, Rand JA, Osmon DR. Treatment of the infected total knee arthoplasty with insertion of another prosthesis: the effect of antibiotic-impregnated bone cement. Clin Orthop Relat Res. 1994. 309:44–55.

14. Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res. 1995. 321:45–54.

15. Insall JN. Revision of total knee replacement. Instr Course Lect. 1986. 35:290–296.

16. Rand JA, Bryan RS. Revision after total knee arthroplasty. Orthop Clin North Am. 1982. 13:201–212.

17. Ritter MA, Eizember LE, Fechtman RW, Keating EM, Faris PM. Revision total knee arthroplasty. A survival analysis. J Arthroplasty. 1991. 6:351–356.

18. Vince KG, Long W. Revision knee arthroplasty. The limits of press fit medullary fixation. Clin Orthop Relat Res. 1995. 317:172–177.

19. Vince KG. Revision knee arthroplasty technique. Instr Course Lect. 1993. 42:325–339.

20. Windsor RE, Insall JN, Urs WK, Miller DV, Brause BD. Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection: further follow-up and refinement of indications. J Bone Joint Surg Am. 1990. 72:272–278.

TOOLS

Similar articles