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Abstract
Background and purpose — From previous studies, we know that clinical outcomes of revision total knee arthroplasty (rTKA) differ among reasons for revision. Whether the prevalence of repeat rTKAs is different depending on the reason for index rTKA is unclear. Therefore, we (1) compared the repeat revision rates between the different reasons for index rTKA, and (2) evaluated whether the reason for repeat rTKA was the same as the reason for the index revision.
Patients and methods — Patients (n = 8,978) who underwent an index rTKA between 2010 and 2018 as registered in the Dutch Arthroplasty Register were included. Reasons for revision, as reported by the surgeon, were categorized as: infection, loosening, malposition, instability, stiffness, patellar problems, and other. Competing risk analyses were performed to determine the cumulative repeat revision rates after an index rTKA for each reason for revision.
Results — Overall, the cumulative repeat revision rate was 19% within 8 years after index rTKA. Patients revised for infection had the highest cumulative repeat revision rate (28%, 95% CI 25–32) within 8 years after index rTKA. The recurrence of the reason was more common than other reasons after index rTKA for infection (18%), instability (8%), stiffness (7%), and loosening (5%).
Interpretation — Poorest outcomes were found for rTKA for infection: over 1 out of 4 infection rTKAs required another surgical intervention, mostly due to infection. Recurrence of other reasons for revision (instability, stiffness, and loosening) was also considerable. Our findings also emphasize the importance of a clear diagnosis before doing rTKA to avert second revision surgeries.
Supplementary data
The cumulative repeat revision rates per reason for repeat rTKA and the sensitivity analysis are available as supplementary data in the online version of this article, http://dx.doi.org/10.1080/17453674.2021.1925036
MB, GH, JS, BS, KS: concept and design. MB, AS: collection and assembly of data. MB, GH: data analysis. MB, GH, JS, AS, BS, KS: interpretation of the data. MB: drafting of manuscript. MB, GH, JS, AS, BS, KS: critical revision and final approval of the version submitted.
Acta thanks Geir Hallan and Annette W-Dahl for help with peer review of this study.