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Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties

A study of survival and clinical outcome from the Norwegian Arthroplasty Register (1994–2011)

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Abstract

Purpose

In Norway, 19 % of revisions of non-resurfaced total knee arthroplasties done for knee pain between 1994 and 2011 were Secondary Patella Resurfacing (SPR). It is, however, unclear whether SPR actually resolves the pain. The aim was to investigate prostheses survival and clinical outcomes following SPR.

Method

A total of 308 knees (301 patients) with SPR were used to assess implant survival, and a sub-cohort (n = 114 out of 301 patients) with Patient Reported Outcome Measures (PROMs) data were used to assess the clinical outcomes. The EuroQol (EQ-5D), the Knee Injury and Osteoarthritis Outcome Score, and Visual Analogue Scales on satisfaction and pain were used to collect PROM data. Outcomes were analysed by Kaplan-Meier, Cox regression, and multiple linear regression.

Results

The five- and ten-year Kaplan-Meier survival percentages were 91 % and 87 %, respectively. Overall, 35 knees were re-revised at a median follow-up of eight years and pain alone (10 knees) was the main cause of re-revision. Younger patients (<60 years) had nearly nine times higher risk of re-revision compared to older patients (>70 years) (RR = 8.6; p < 0.001). Mean EQ-5D index score had improved from 0.41 (SD 0.21) preoperative to 0.56 (SD 0.25) postoperative following SPR. A total of 63 % of patients with PROM data were satisfied with the outcomes of SPR.

Conclusion

The long-term prostheses survival following SPR was satisfactory, although not as good as for primary knee replacement. Patients’ health related quality of life improved significantly following SPR. Still, more than a third of patients with PROMs data were dissatisfied with the outcomes of the SPR procedure.

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Acknowledgments

We would like to thank the NAR for allowing us to access the register dataset and all Norwegian orthopaedic surgeons for reporting their surgical cases to the NAR. Many thanks also go to all patients who gave their consent to be entered into the NAR database as well as for their willingness to participate and respond to the survey on which this study was also based.

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Authors and Affiliations

  1. The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway

    Tesfaye H. Leta, Arne Skredderstuen, Geir Hallan, Jan-Erik Gjertsen & Ove Furnes

  2. Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

    Tesfaye H. Leta, Jan-Erik Gjertsen & Ove Furnes

  3. Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway

    Stein Håkon L. Lygre

  4. Department of Research and Development, Haukeland University Hospital, Bergen, Norway

    Berit Rokne

  5. Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

    Berit Rokne

Authors
  1. Tesfaye H. Leta
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  2. Stein Håkon L. Lygre
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  3. Arne Skredderstuen
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  4. Geir Hallan
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  5. Jan-Erik Gjertsen
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  6. Berit Rokne
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  7. Ove Furnes
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Corresponding author

Correspondence to Tesfaye H. Leta.

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Funding

The NAR is financed by the Western Norway Regional Health Authority (Helse-Vest) and Helse Bergen. During this study, THL received a study grant from the Department of Orthopaedic Surgery and from the Health Research Program at Haukeland University Hospital.

Conflict of interest

No competing interests declared.

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Leta, T.H., Lygre, S.H.L., Skredderstuen, A. et al. Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties. International Orthopaedics (SICOT) 40, 715–722 (2016). https://doi.org/10.1007/s00264-015-3017-y

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