Clinical Orthopaedics and Related Research®

, Volume 470, Issue 8, pp 2244–2252 | Cite as

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

  • Paul Baker
  • Paul Cowling
  • Steven Kurtz
  • Simon Jameson
  • Paul Gregg
  • David Deehan
Clinical Research

Abstract

Background

Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear.

Questions/purposes

We determined differences in patient-reported outcomes and rates of satisfaction between primary and revision TKAs, and determine whether the reason for revision influences patient-reported outcomes after revision TKA.

Methods

We retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) for 24,190 patients (23,393 TKAs; 797 aseptic revision TKAs). We compared patient-reported outcomes using the Oxford Knee Score (OKS), EuroQol (EQ-5D), and patient satisfaction between primary TKA and revision TKA, and for subsets of the revision TKA cohort. The followup data were collected between 6 and 12 months (7 months average) postoperatively.

Results

Improvements in the OKS (10) and EQ-5D (0.231) were smaller after revision when compared with primary TKA (OKS, 15; EQ-5D, 0.303). Patients who had revision TKA were less satisfied (66% versus 83%). Revisions for aseptic loosening or lysis were associated with the best patient outcomes (OKS improvement = 11; EQ-5D improvement = 0.232; satisfaction = 72%). Revisions for stiffness had the worst results (OKS improvement = 6; EQ-5D improvement = 0.176; satisfaction = 47%).

Conclusions

The early improvements in knee function and general health after revision TKA are only 69% to 76% of those observed for primary TKA. Levels of patient-reported knee function, general health, and satisfaction after revision are varied and related to the reason for revision. Even the best revision group does not approach the levels of function and satisfaction observed after primary TKA at a mean of 7 months postoperatively. Longer-term followup would be required to determine whether conclusions from these early data will need to be modified.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Australian Orthopaedic Association. The Australian Orthopaedic Association National Joint Replacement Registry Annual report 2009: Hip and knee Arthroplasty September 1998 to December 2008. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2009.pdf. Accessed December 15, 2011.
  2. 2.
    Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br. 2007;89:893–900.PubMedCrossRefGoogle Scholar
  3. 3.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  4. 4.
    Bertin KC, Freeman MAR, Samuelson KM, Ratcliffe SS, Todd RC. Stemmed revision arthroplasty for aseptic loosening of total knee replacement. J Bone Joint Surg Br. 1985;67:242–248.PubMedGoogle Scholar
  5. 5.
    Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–272.PubMedCrossRefGoogle Scholar
  7. 7.
    Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Deehan D, Murray JD, Birdsall PD, Pinder IM. Quality of life after knee revision arthroplasty. Acta Orthop. 2006;77:761–766.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunbar MJ, Robertsson O, Ryd L, Lidgren L. Appropriate questionnaires for knee arthroplasty: results of a survey of 3600 patients from the Swedish knee Arthroplasty Registry. J Bone Joint Surg Br. 2001;83:339–344.PubMedCrossRefGoogle Scholar
  10. 10.
    EuroQol Group. EQ-5D: a standardised instrument for use as a measure of health outcome. Available at: http://www.euroqol.org/home.html. Accessed June 8, 2011.
  11. 11.
    Fieller EC. Some problems in interval estimation. J R Stat Soc Ser C Appl Stat. 1954:16:2:175–185.Google Scholar
  12. 12.
    Ghomrawi HM, Kane RL, Eberly LE, Bershadsky B. Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am. 2009;91:2838–2845.PubMedCrossRefGoogle Scholar
  13. 13.
    Gooding CR, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:985–993.PubMedCrossRefGoogle Scholar
  14. 14.
    Greidanus NV, Peterson RC, Masri BA, Garbuz DS. Quality of life outcomes in revision versus primary total knee arthroplasty. J Arthroplasty. 2011;26;615–620.PubMedCrossRefGoogle Scholar
  15. 15.
    Hanssen AD, Rand JA. A comparison of primary and revision total knee arthroplasty using the kinematic stabilizer prosthesis. J Bone Joint Surg Am. 1988;70:491–499.PubMedGoogle Scholar
  16. 16.
    Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW. Early patient outcomes after primary and revision total knee arthroplasty. J Bone Joint Surg Br. 2002;84: 994–999.PubMedCrossRefGoogle Scholar
  17. 17.
    Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health related quality of life after knee replacement. J Bone Joint Surg Am. 1998;80:163–173.PubMedGoogle Scholar
  18. 18.
    Hossein F, Patel S, Haddad FS. Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res. 2010;468:1221–1228.CrossRefGoogle Scholar
  19. 19.
    Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMedGoogle Scholar
  20. 20.
    KAT Trial Group, Johnston L, MacLennan G, McCormack K, Ramsay C, Walker A. The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement J Bone Joint Surg Am. 2009;91:134–141.PubMedCrossRefGoogle Scholar
  21. 21.
    Katz JN, Mahomed NN, Baron JA, Barrett JJ, Fossel AH, Creel AH, Wright J, Wright EA, Losing E. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum. 2007;56:568–574.PubMedCrossRefGoogle Scholar
  22. 22.
    Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. J Bone Joint Surg Am. 2004;86:1479–1484.PubMedCrossRefGoogle Scholar
  23. 23.
    Malviya A, Bettinson K, Kurtz SM, Deehan DJ. When do patient-reported assessments peak after revision knee arthroplasty? Clin Orthop Relat Res. 2011 Nov 5. [Epub ahead of print].Google Scholar
  24. 24.
    March LM, Barcenilla AL, Cross MJ, Lapsley HM, Parker D, Brooks PM. Costs and outcomes of total hip and total knee joint replacement for rheumatoid arthritis. Clin Rheumatol. 2008;27:1235–1242.PubMedCrossRefGoogle Scholar
  25. 25.
    National Joint Registry. National Joint Registry 7th Annual Report 2010.Available at: http://www.njrcentre.org.uk/njrcentre/AbouttheNJR/Publicationsandreports/Annualreports/Archivedannualreports/tabid/87/Default.aspx. Accessed December 15, 2011.
  26. 26.
    Nilsdotter AK, Toksvig-Larsen S, Roos EM. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis Cartilage. 2009;17:601–606.PubMedCrossRefGoogle Scholar
  27. 27.
    Pearse AJ, Hooper GJ, Rothwell A, Frampton C. Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br. 2010;92:508–512.PubMedGoogle Scholar
  28. 28.
    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patients satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRefGoogle Scholar
  29. 29.
    Saleh KJ, Dykes DC, Tweedie RL, Mohamed K, Ravichandran A, Saleh RM, Gioe TJ, Heck DA. Functional outcome after total knee arthroplasty revision: a meta- analysis. J Arthroplasty. 2002;17:967–977.PubMedCrossRefGoogle Scholar
  30. 30.
    Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to Their Development and Use. Oxford, UK: Oxford University Press; 2008.Google Scholar
  31. 31.
    Ware J Jr, Kosinski M, Keller SD. A 12-item Short Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.PubMedCrossRefGoogle Scholar
  32. 32.
    Woolhead GM, Donovan JL, Dieppe PA. Outcomes of total knee replacement: a qualitative study. Rheumatology. 2005;44:1032–1037.PubMedCrossRefGoogle Scholar
  33. 33.
    Wright J, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA. Patient-reported outcome and survivorship after kinemax total knee arthroplasty. J Bone Joint Surg Am. 2004;86;2464–2470.PubMedGoogle Scholar
  34. 34.
    Wylde V, Learmonth I, Potter A, Bettinson K, Lingard E. Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement. J Bone Joint Surg Br. 2008;90:1172–1179.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Paul Baker
    • 1
  • Paul Cowling
    • 2
  • Steven Kurtz
    • 3
  • Simon Jameson
    • 2
  • Paul Gregg
    • 2
  • David Deehan
    • 4
  1. 1.Institute of Cellular MedicineUniversity of NewcastleNewcastle upon TyneEngland
  2. 2.James Cook University HospitalMiddlesboroughEngland
  3. 3.School of Biomedical Engineering & Science and Health SystemsDrexel UniversityPhiladelphiaUSA
  4. 4.Royal Victoria InfirmaryNewcastle upon TyneEngland

Personalised recommendations