Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2007 Oct;42(5):578-585. Korean.
    Published online Oct 31, 2007.
    https://doi.org/10.4055/jkoa.2007.42.5.578
    Copyright © 2007 The Korean Orthopaedic Association
    Original Article

    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. and 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, Email: 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

    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.

    Tables

    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.
      1. 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.
      1. Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop Relat Res 1988;231:163–178.
      1. 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.
      1. Cameron HU, Hunter GA, Welsh RP, Bailey WH. Revision of total knee replacement. Can J Surg 1981;24:418–420.
      1. Chin KR, Bae DS, Lonner JH, Scott RD. Revision surgery for patellar dislocation after primary total knee arthroplasty. J Arthroplasty 2004;19:956–961.
      1. Elia EA, Lotke PA. Results of revision total knee arthroplasty associated with significant bone loss. Clin Orthop Relat Res 1991;271:114–121.
      1. Friedman RJ, Poss R. Revision total knee arthroplasty in patients with osteoarthritis. Rheum Dis Clin North Am 1988;14:537–544.
      1. Goldberg VM, Figgie MP, Figgie HE 3rd, Sobel M. The results of revision total knee arthroplasty. Clin Orthop Relat Res 1988;226:86–92.
      1. Goldman RT, Scuderi GR, Insall JN. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res 1996;331:118–124.
      1. Gustke KA. Preoperative planning for revision total knee arthroplasty: avoiding chaos. J Arthroplasty 2005;20 Suppl 2:37–40.
      1. 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.
      1. 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.
      1. 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.
      1. Insall JN. Revision of total knee replacement. Instr Course Lect 1986;35:290–296.
      1. Rand JA, Bryan RS. Revision after total knee arthroplasty. Orthop Clin North Am 1982;13:201–212.
      1. Ritter MA, Eizember LE, Fechtman RW, Keating EM, Faris PM. Revision total knee arthroplasty. A survival analysis. J Arthroplasty 1991;6:351–356.
      1. Vince KG, Long W. Revision knee arthroplasty. The limits of press fit medullary fixation. Clin Orthop Relat Res 1995;317:172–177.
      1. Vince KG. Revision knee arthroplasty technique. Instr Course Lect 1993;42:325–339.
      1. 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.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Allografts
    Arthroplasty*
    Dislocations
    Follow-Up Studies
    Humans
    Knee*
    Methods
    Patellar Dislocation
    Polyethylene
    Prostheses and Implants
    Range of Motion, Articular
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide
    slide

    1 / 4

    PERMALINK