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Antibiotic cement was associated with half the risk of re-revision in 1,154 aseptic revision total knee arthroplasties.

Bini SA, Chan PH, Inacio MC, Paxton EW, Khatod M - Acta Orthop (2015)

Bottom Line: We determined the incidence of re-revision TKA, the reasons for re-revision, and risk factors associated with these procedures.In adjusted models, use of antibiotic-loaded cement was associated with a 50% lower risk of all-cause re-revision surgery (hazard ratio (HR) = 0.5, 95% CI: 0.3-0.9), age with a 20% lower risk for every 10-year increase (HR = 0.8, CI: 0.7-1.0), body mass index (BMI) with a 20% lower risk for every 5-unit increase (HR = 0.8, CI: 0.7-1.0), and a surgeon's greater cumulative experience (≥ 20 cases vs. < 20 cases) with a 3 times higher risk of re-revision (HR = 2.8, CI: 1.5-5).Revised TKAs were at high risk of subsequent failure.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedic Surgery , The Permanente Medical Group , Oakland , CA.

ABSTRACT

Background and purpose: Aseptic revisions comprise 80% of revision total knee arthroplasties (TKAs). We determined the incidence of re-revision TKA, the reasons for re-revision, and risk factors associated with these procedures.

Patients and methods: We conducted a retrospective cohort study of 1,154 patients who underwent aseptic revision TKA between 2002 and 2013 and were followed prospectively by a total joint replacement registry in the USA. Revision was defined as any operation in which an implanted component was replaced. Patient-, surgeon-, and procedure-related risk factors were evaluated. Survival analyses were conducted.

Results: There were 114 re-revisions (10%) with a median time to reoperation of 3.6 years (interquartile range (IQR): 2.6-5.2). The infection rate was 2.9% (34/1,154) and accounted for 30% of re-revisions (34 of 114). In adjusted models, use of antibiotic-loaded cement was associated with a 50% lower risk of all-cause re-revision surgery (hazard ratio (HR) = 0.5, 95% CI: 0.3-0.9), age with a 20% lower risk for every 10-year increase (HR = 0.8, CI: 0.7-1.0), body mass index (BMI) with a 20% lower risk for every 5-unit increase (HR = 0.8, CI: 0.7-1.0), and a surgeon's greater cumulative experience (≥ 20 cases vs. < 20 cases) with a 3 times higher risk of re-revision (HR = 2.8, CI: 1.5-5).

Interpretation: Revised TKAs were at high risk of subsequent failure. The use of antibiotic-loaded cement, higher age, and higher BMI were associated with lower risk of further revision whereas a higher degree of surgeon experience was associated with higher risk.

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Cumulative probability of re-revision (with 95% CI) after index revision total knee arthroplasty.
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Figure 0001: Cumulative probability of re-revision (with 95% CI) after index revision total knee arthroplasty.

Mentions: The crude incidence of re-revision surgeries was 9.9% and the median time to revision was 3.6 years (IQR: 2.6–5.2). At 2 years, the cumulative probability of re-revision was 2.9% (CI: 1.9–4.3) and at 5 years it was 20% (CI: 16–24) (Figure 1). The most common reasons for re-revision surgery were infection, instability, pain, and aseptic loosening (Table 2).


Antibiotic cement was associated with half the risk of re-revision in 1,154 aseptic revision total knee arthroplasties.

Bini SA, Chan PH, Inacio MC, Paxton EW, Khatod M - Acta Orthop (2015)

Cumulative probability of re-revision (with 95% CI) after index revision total knee arthroplasty.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940593&req=5

Figure 0001: Cumulative probability of re-revision (with 95% CI) after index revision total knee arthroplasty.
Mentions: The crude incidence of re-revision surgeries was 9.9% and the median time to revision was 3.6 years (IQR: 2.6–5.2). At 2 years, the cumulative probability of re-revision was 2.9% (CI: 1.9–4.3) and at 5 years it was 20% (CI: 16–24) (Figure 1). The most common reasons for re-revision surgery were infection, instability, pain, and aseptic loosening (Table 2).

Bottom Line: We determined the incidence of re-revision TKA, the reasons for re-revision, and risk factors associated with these procedures.In adjusted models, use of antibiotic-loaded cement was associated with a 50% lower risk of all-cause re-revision surgery (hazard ratio (HR) = 0.5, 95% CI: 0.3-0.9), age with a 20% lower risk for every 10-year increase (HR = 0.8, CI: 0.7-1.0), body mass index (BMI) with a 20% lower risk for every 5-unit increase (HR = 0.8, CI: 0.7-1.0), and a surgeon's greater cumulative experience (≥ 20 cases vs. < 20 cases) with a 3 times higher risk of re-revision (HR = 2.8, CI: 1.5-5).Revised TKAs were at high risk of subsequent failure.

View Article: PubMed Central - PubMed

Affiliation: a Department of Orthopaedic Surgery , The Permanente Medical Group , Oakland , CA.

ABSTRACT

Background and purpose: Aseptic revisions comprise 80% of revision total knee arthroplasties (TKAs). We determined the incidence of re-revision TKA, the reasons for re-revision, and risk factors associated with these procedures.

Patients and methods: We conducted a retrospective cohort study of 1,154 patients who underwent aseptic revision TKA between 2002 and 2013 and were followed prospectively by a total joint replacement registry in the USA. Revision was defined as any operation in which an implanted component was replaced. Patient-, surgeon-, and procedure-related risk factors were evaluated. Survival analyses were conducted.

Results: There were 114 re-revisions (10%) with a median time to reoperation of 3.6 years (interquartile range (IQR): 2.6-5.2). The infection rate was 2.9% (34/1,154) and accounted for 30% of re-revisions (34 of 114). In adjusted models, use of antibiotic-loaded cement was associated with a 50% lower risk of all-cause re-revision surgery (hazard ratio (HR) = 0.5, 95% CI: 0.3-0.9), age with a 20% lower risk for every 10-year increase (HR = 0.8, CI: 0.7-1.0), body mass index (BMI) with a 20% lower risk for every 5-unit increase (HR = 0.8, CI: 0.7-1.0), and a surgeon's greater cumulative experience (≥ 20 cases vs. < 20 cases) with a 3 times higher risk of re-revision (HR = 2.8, CI: 1.5-5).

Interpretation: Revised TKAs were at high risk of subsequent failure. The use of antibiotic-loaded cement, higher age, and higher BMI were associated with lower risk of further revision whereas a higher degree of surgeon experience was associated with higher risk.

Show MeSH
Related in: MedlinePlus