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Revision for coronal malalignment will improve functional outcome up to 5 years postoperatively

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Revision of a total knee arthroplasty (TKA) for the diagnosis of malalignment is widely performed. However, very little is known about the functional outcome in revision TKA surgery for malalignment. The aim of this study was to assess the functional outcome and to identify factors influencing the functional outcome of patients who have had a revision of a TKA for the diagnosis of malalignment at 5 years follow-up.

Methods

All patients with a revision of a TKA for malalignment as the primary reason were selected from a prospective database. The diagnosis of symptomatic malalignment was made by the surgeon and quantified by radiologic examination. Functional outcome was scored by the functional score of the Knee Society Clinical Rating System (fKSS) at 0, 12, 24 and 60 months. Multiple imputation for missing data and multivariable analysis were performed to identify factors influencing functional outcome.

Results

After selection, 105 patients (age: 65.1 ± 9.1 years, gender M:F 30:75) were eligible for outcome analysis. Functional outcome significantly improved from the preoperative (fKSS: 44.1 ± 22.0) to 5 years postoperative (64.7 ± 24.0, p < 0.001) time frames. Higher degree of coronal deviation, younger age and lower preoperative KSS were found to be strongest positive influencing factors for the change in fKSS.

Conclusion

Revision of TKA for malalignment appears to be an effective treatment to improve functional outcome up to 5 years postoperatively. Higher degree of coronal deviation, younger age and lower preoperative KSS are the strongest contributing factors for functional improvement.

Level of evidence

Level III; Therapeutic prospective cohort study.

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Data availability

The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author (SNvL) on reasonable request.

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Acknowledgements

None.

Funding

The institute (with authors SNvL, PJCH and ABW) received funding from Smith & Nephew to start the prospective database. Smith & Nephew had no involvement in the present study design, data collection, analysis and interpretation, writing of the paper.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands

    S. N. van Laarhoven  & A. B. Wymenga

  2. Sint Maartenskliniek Research, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands

    P. J. C. Heesterbeek

  3. Section Biostatistics, Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    S. Teerenstra

Authors
  1. S. N. van Laarhoven
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  2. P. J. C. Heesterbeek
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  3. S. Teerenstra
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  4. A. B. Wymenga
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Contributions

Authors (SNvL, PJCH, ABW) designed the study, interpreted data and wrote the manuscript. ST made the statistical analyses, interpreted data and wrote the statistical analysis. All authors critically revised multiple versions of the manuscript, and all authors read the final version of the manuscript.

Corresponding author

Correspondence to S. N. van Laarhoven .

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Conflict of interest

Author ABW received funding for consultancy from Smith and Nephew, Zimmer and Bodycad. Author ABW receives royalties from Smith and Nephew.

Ethical approval

The study protocol was assessed by the regional Medical Ethical Committee [CMO Arnhem-Nijmegen (no. 2003/173)]. Ethical approval was waived by the Medical Ethical Committee on basis of the Dutch Medical Research Involving Human Subjects Act (WMO).

Informed consent

Informed consent was obtained from all study participants.

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van Laarhoven , S.N., Heesterbeek, P.J.C., Teerenstra, S. et al. Revision for coronal malalignment will improve functional outcome up to 5 years postoperatively. Knee Surg Sports Traumatol Arthrosc 30, 2731–2737 (2022). https://doi.org/10.1007/s00167-021-06616-6

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  • DOI: https://doi.org/10.1007/s00167-021-06616-6

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