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Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months



The aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients.


This retrospective, case–control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years.


The final study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1 months (range 36.1–69). Postoperatively, there was no significant difference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical difference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no difference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no significant difference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36 months.


Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term.

Level of evidence

IV, retrospective case–control study.

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  1. Aguirre-Pastor A, Ortolá DJ, Lizaur-Utrilla A, Rosa MA, Lopez-Prats FA (2020) Is pseudo-patella Baja really a serious complication of total knee arthroplasty? J Arthroplasty 35:557–562

    Article  Google Scholar 

  2. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee and Shoulder Arthroplasty Annual Report 2020, Revision Joint Replacement, AOA, Adelaide; 2020: 1–92. Accessed 22 Jul 2021

  3. Baker P, Cowling P, Kurtz S, Jameson S, Gregg P, Deehan D (2012) Reason for revision influences early patient outcomes after aseptic knee revision. Clin Orthop Relat Res 470:2244–2252

    Article  Google Scholar 

  4. Barlow BT, Oi KK, Lee Y-Y, Joseph AD, Alexiades MM (2017) Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3611–3619

    Article  Google Scholar 

  5. Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey M (2000) Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty. J Arthroplasty 15:990–993

    CAS  Article  Google Scholar 

  6. Berend ME, Davis PJ, Ritter MA, Keating EM, Faris PM, Meding JB, Malinzak RA (2010) “Thicker” polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty. J Arthroplasty 25:17–20

    Article  Google Scholar 

  7. Bugelli G, Ascione F, Cazzella N, Franceschetti E, Franceschi F, Dell’Osso G, Svantesson E, Samuelsson K, Giannotti S (2018) Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1831–1837

    Article  Google Scholar 

  8. Chalmers BP, Elmasry SS, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Imhauser CW, Sculco PK, Cross MB (2021) Additional distal femoral resection increases mid-flexion coronal laxity in posterior-stabilized total knee arthroplasty with flexion contracture: a computational study. Bone Joint J 103B:87–93

    Article  Google Scholar 

  9. Engh G (1997) A classification of bone defects. In: Engh G, Rorabeck C (eds) Revision knee arthroplasty. Williams & Wilkins, Baltimore, pp 63–120

    Google Scholar 

  10. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Article  Google Scholar 

  11. Fournier G, Yener C, Gaillard R, Kenney R, Lustig S, Servien E (2020) Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 28:3919–3925

    Article  Google Scholar 

  12. Garceau SP, Harris NH, Felberbaum DL, Teo GM, Weinblatt AI, Long WJ (2020) Reduced aseptic loosening with fully cemented short-stemmed tibial components in primary cemented total knee arthroplasty. J Arthroplasty 35:1591-1594.e3

    Article  Google Scholar 

  13. Gomes LS, Bechtold JE, Gustilo RB (1988) Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res 236:72–81

    Google Scholar 

  14. Hamilton DF, Simpson PM, Patton JT, Howie CR, Burnett R (2017) Aseptic revision knee arthroplasty with total stabilizer prostheses achieves similar functional outcomes to primary total knee arthroplasty at 2 years: a longitudinal cohort study. J Arthroplasty 32:1234-1240.e1

    Article  Google Scholar 

  15. Hardeman F, Londers J, Favril A, Witvrouw E, Bellemans J, Victor J (2012) Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1049–1056

    Article  Google Scholar 

  16. Hwang S-C, Kong J-Y, Nam D-C, Kim D-H, Park H-B, Jeong S-T, Cho S-H (2010) Revision total knee arthroplasty with a cemented posterior stabilized, condylar constrained or fully constrained prosthesis: a minimum 2-year follow-up analysis. Clin Orthop Surg 2:112–120

    Article  Google Scholar 

  17. Indelli PF, Giori N, Maloney W (2015) Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med 8:390–397

    Article  Google Scholar 

  18. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Article  Google Scholar 

  19. Klasan A, Magill P, Frampton C, Zhu M, Young SW (2021) Factors predicting repeat revision and outcome after aseptic revision total knee arthroplasty: results from the New Zealand Joint Registry. Knee Surg Sports Traumatol Arthrosc 29:579–585

    Article  Google Scholar 

  20. Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weißenberger M, Kutzner KP (2020) The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 15:1–12

    Google Scholar 

  21. Kunze KN, Akram F, Fuller BC, Choi J, Sporer SM, Levine BR (2019) Superior survivorship for posterior stabilized versus constrained condylar articulations after revision total knee arthroplasty: a retrospective, comparative analysis at short-term follow-up. J Arthroplasty 34:3012-3017.e1

    Article  Google Scholar 

  22. Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Jt Surg Am 83A:1856–1864

    Article  Google Scholar 

  23. Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J (2018) Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 476:601–611

    Article  Google Scholar 

  24. Mabry TM, Hanssen AD (2007) The role of stems and augments for bone loss in revision knee arthroplasty. J Arthroplasty 22:56–60

    Article  Google Scholar 

  25. Morgan H, Battista V, Leopold SS (2005) Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg 13:515–524

    Article  Google Scholar 

  26. Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:945–948

    Article  Google Scholar 

  27. Peters CL, Hennessey R, Barden RM, Galante JO, Rosenberg AG (1997) Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study. J Arthroplasty 12:896–903

    CAS  Article  Google Scholar 

  28. van Rensch PJH, Hannink G, Heesterbeek PJC, Wymenga AB, van Hellemondt GG (2020) Long-term outcome following revision total knee arthroplasty is associated with indication for revision. J Arthroplasty 35:1671–1677

    Article  Google Scholar 

  29. Schmidt A, Batailler C, Lording T, Badet R, Servien E, Committee W, Lustig S (2020) Why reintervention after total knee arthroplasty fails? A consecutive cohort of 1170 surgeries. J Arthroplasty 35:2550–2560

    Article  Google Scholar 

  30. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J (2014) Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty 29:1774–1778

    Article  Google Scholar 

  31. Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the U.S., 2014–2030. J Bone Jt Surg Am 100:1455–1460

    Article  Google Scholar 

  32. Stirling P, Middleton SD, Brenkel IJ, Walmsley PJ (2020) Revision total knee arthroplasty versus primary total knee arthroplasty: a matched cohort study. Bone Jt Open 1:29–34

    Article  Google Scholar 

  33. Verbeek JFM, Hannink G, Defoort KC, Wymenga AB, Heesterbeek PJC (2019) Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model. Knee Surg Sports Traumatol Arthrosc 27:2289–2296

    Article  Google Scholar 

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Correspondence to S. Lustig.

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ESM, SF, HK, JS, CB: No conflict of interest; ES: institutional research support from Corin and Amplitude; SL: Royalties from Stryker and Smith Nephew, institutional research support from Corin and Amplitude.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sappey-Marinier, E., Fratini, S., Kremer, H. et al. Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months. Knee Surg Sports Traumatol Arthrosc 30, 2854–2861 (2022).

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  • Revision
  • Primary
  • Knee replacement
  • Posterior-stabilised
  • Outcomes
  • Survival