Complications of revision knee arthroplasty

Authors

DOI:

https://doi.org/10.14739/2310-1210.2024.4.298245

Keywords:

knee joint, knee joint instability, revision arthroplasty

Abstract

Due to the growing scale of arthroplasty and the widening of indications for knee joint replacement, the durability of joint functioning has become a critical issue. Untimely diagnosis and inadequate treatment of patients with endoprosthesis component loosening leads to major bone defects.

This problem arises from repeated joint interventions, large bone defects and duration of revision surgeries, that is fraught with catastrophic consequences for patients – revision prosthesis removal or even limb amputation. The project aims to improve the treatment for patients with instability of components after knee joint arthroplasty.

The aim of the study is to analyze the results of revision knee arthroplasty and identify the causes of mistakes and complications of revision arthroplasty with the intention of prevention.

Materials and methods. A retrospective analysis of 50 revision knee arthroplasties performed at the Centre for Arthroplasty of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” was conducted. Clinical and radiological findings were evaluated for all patients. All revision prostheses used in this study were of the semi-constrained type. Cementation technique was used for all implants. In the revision of the septic complication group, a full cementation technique with antibiotics according to a sensitivity profile were used, while in the aseptic complication group, a surface cementation technique with antibiotics according to sensitivities were used.

Results. The authors of the project have analyzed the results of treatment of 50 revision arthroplasty procedures performed between 2013 and 2022 for instability of the endoprosthesis components. The structure of complications has been examined and the causes of failure in revision knee arthroplasty have been identified. This study has shown promise in preventing complications and developing personalized approaches to revision arthroplasty.

Conclusions. The analysis of revision knee arthroplasty failure has shown the prevalence of septic complications (56.0 %). In the case of septic complications after revision arthroplasty, Staphylococcus aureus prevailed (57.1 %), gram (-) microorganisms were causative agents in other cases. Factors resulting in aseptic complications included those associated with the surgical intervention (81.8 %), the patient (45.4 %) and the combination thereof (72.7 %). Significant causes of the femoral revision component loosening were residual valgus deformity, medial instability in the frontal plane; significant causes of the tibial component loosening were residual varus deformity and lateral instability in the frontal plane.

Author Biographies

H. V. Haiko, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, DSc, Professor, Head of the Department of Traumatology and Orthopedics of Adults, Academician of the National Academy of Medical Sciences of Ukraine

V. M. Pidhaietskyi, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, Senior Researcher of the Department of Traumatology and Orthopedics of Adults

O. M. Sulyma, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, Senior Researcher of the Department of Traumatology and Orthopedics of Adults

V. M. Chornyi, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Professor of the Department of Traumatology and Orthopedics

References

Wyles CC, Tibbo ME, Yuan BJ, Trousdale RT, Berry DJ, Abdel MP. Long-Term Results of Total Knee Arthroplasty with Contemporary Distal Femoral Replacement. J Bone Joint Surg Am. 2020;102(1):45-51. doi: https://doi.org/10.2106/JBJS.19.00489

Wang KY, LaVelle MJ, Gazgalis A, Bender JM, Geller JA, Neuwirth AL, et al. Bilateral Total Knee Arthroplasty: Current Concepts Review. JBJS Rev. 2023;11(1). doi: https://doi.org/10.2106/JBJS.RVW.22.00194

Zeng W, Yu Z, Wang S, Chen A, Zeng Y, Yang Q, et al. Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial. Chin Med J (Engl). 2023;136(1):73-81. doi: https://doi.org/10.1097/CM9.0000000000002205

González-Sáenz-de-Tejada M, Quintana JM, Arenaza JC, Azcarate-Garitano JR, Esnaola-Guisasola PM, García-Sánchez I, et al. Long-term health related quality of life in total knee arthroplasty. BMC Musculoskelet Disord. 2023;24(1):327. doi: https://doi.org/10.1186/s12891-023-06399-6

Carter J, Springer B, Curtin BM. Early complications of revision total knee arthroplasty in morbidly obese patients. Eur J Orthop Surg Traumatol. 2019;29(5):1101-4. doi: https://doi.org/10.1007/s00590-019-02403-9

Mak RW, Chau WW, Chung KY, Chiu KH, Ho KK. The long-term results of total knee arthroplasty in octogenarian. J Orthop Surg (Hong Kong). 2021;29(3):23094990211055226. doi: https://doi.org/10.1177/23094990211055226

Nelson SB, Pinkney JA, Chen AF, Tande AJ. Periprosthetic Joint Infection: Current Clinical Challenges. Clin Infect Dis. 2023;77(7):e34-e45. doi: https://doi.org/10.1093/cid/ciad360

Wignadasan W, Chang JS, Kayani B, Kontoghiorghe C, Haddad FS. Long-term results of revision total knee arthroplasty using a rotating hinge implant. Knee. 2021;28:72-80. doi: https://doi.org/10.1016/j.knee.2020.11.009

Rashed S, Lakhani S, Mann A, Best LM, Shehzad S, Saeed MZ. The impact of the largest national joint registry on current knee replacement longevity estimates: An analysis and review of knee prosthesis brand and fixation technique. J Arthroplasty. 2021;36(9):3168-73.e1. doi: https://doi.org/10.1016/j.arth.2021.05.001

Lachiewicz PF, Wellman SS, Peterson JR. Antibiotic Cement Spacers for Infected Total Knee Arthroplasties. J Am Acad Orthop Surg. 2020;28(5):180-8. doi: https://doi.org/10.5435/JAAOS-D-19-00332

Baek JH, Lee SC, Jin H, Kim JW, Ahn HS, Nam CH. Long-term outcomes of total knee arthroplasty in patients with windswept deformity. J Orthop Sci. 2023;28(5):1068-73. doi: https://doi.org/10.1016/j.jos.2022.08.002

Pitsaer E, Chergui S, Lavoie F. Long-term results of a rotationally unconstrained fixed-bearing total knee prosthesis. Int Orthop. 2024;48(4):965-70. doi: https://doi.org/10.1007/s00264-024-06097-5

Hakim J, Volpin G, Amashah M, Alkeesh F, Khamaisy S, Cohen M, et al. Long-term outcome of total knee arthroplasty in patients with morbid obesity. Int Orthop. 2020;44(1):95-104. doi: https://doi.org/10.1007/s00264-019-04378-y

Ahmed SS, Begum F, Kayani B, Haddad FS. Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty. Expert Rev Med Devices. 2019;16(12):1063-70. doi: https://doi.org/10.1080/17434440.2019.1696673

Li K, Cuadra M, Scarola G, Odum S, Otero J, Griffin W, et al. Complications in the treatment of periprosthetic joint infection of the hip: when do they occur? J Bone Jt Infect. 2021;6(7):295-303. doi: https://doi.org/10.5194/jbji-6-295-2021

Baek JH, Lee SC, Choi K, Ahn HS, Nam CH. Long-term survivorship of total knee arthroplasty with a single-radius, high-flexion posterior stabilized prosthesis. Knee. 2021;30:275-82. doi: https://doi.org/10.1016/j.knee.2021.04.017

Chun KC, Baik JS, Kim KR, Chun CH. Long-term Results of Partial Release Versus Nonrelease of the Posterior Cruciate Ligament at Cruciate-Retaining Total Knee Arthroplasty: Minimum 15-Year Follow-up. Orthopedics. 2022;45(4):233-8. doi: https://doi.org/10.3928/01477447-20220225-01

Tao J, Yan Z, Pu B, Chen M, Hu X, Dong H. Comparison of dynamic and static spacers for the treatment of infections following total knee replacement: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):348. doi: https://doi.org/10.1186/s13018-022-03238-7

Bourdon CE, Broberg JS, McCalden RW, Naudie DD, MacDonald SJ, Lanting BA, et al. Comparison of long-term kinematics and wear of total knee arthroplasty implant designs. J Mech Behav Biomed Mater. 2021;124:104845. doi: https://doi.org/10.1016/j.jmbbm.2021.104845

Bakircioglu S, Caglar O, Tokgozoglu AM, Atilla B. The influence of alignment in long-term functional outcome of total knee arthroplasty. Int Orthop. 2022;46(9):1985-90. doi: https://doi.org/10.1007/s00264-022-05420-2

Monotti IC, Preston CA, Kidd SW. Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement. Vet Comp Orthop Traumatol. 2020;33(5):370-376. doi: https://doi.org/10.1055/s-0040-1709486

Downloads

Published

2024-07-17

How to Cite

1.
Haiko HV, Pidhaietskyi VM, Sulyma OM, Chornyi VM. Complications of revision knee arthroplasty. Zaporozhye Medical Journal [Internet]. 2024Jul.17 [cited 2024Jul.18];26(4):288-95. Available from: http://zmj.zsmu.edu.ua/article/view/298245

Issue

Vol. 26 No. 4 (2024): Zaporozhye medical journal

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)