Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision
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.
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.
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.
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%).
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.
KeywordsAseptic Loosening Knee Function Oxford Knee Score Unexplained Pain National Joint Registry
We thank the patients and staff of all the hospitals in England and Wales who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR steering committee, and the staff at the NJR for facilitating this work. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Register Steering committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented. We also thank Mike Reed MD, FRCS (Trauma & Orthop), for his assistance and support during the preparation of this manuscript.
- 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.
- 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
- 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.Fieller EC. Some problems in interval estimation. J R Stat Soc Ser C Appl Stat. 1954:16:2:175–185.Google Scholar
- 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.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
- 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
- 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.
- 30.Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to Their Development and Use. Oxford, UK: Oxford University Press; 2008.Google Scholar