Re-revision Knee Arthroplasty in a Tertiary Center: Infection and Multiple Previous Surgeries Were Associated With Poor Early Clinical and Functional Outcomes

Lennart von Fritsch; Shiraz A Sabah; Joshua Xu; Andrew J Price; Christian Merle; Abtin Alvand

doi:10.1016/j.arth.2023.01.030

Re-revision Knee Arthroplasty in a Tertiary Center: Infection and Multiple Previous Surgeries Were Associated With Poor Early Clinical and Functional Outcomes

J Arthroplasty. 2023 Jul;38(7):1313-1319. doi: 10.1016/j.arth.2023.01.030. Epub 2023 Jan 27.

Authors

Lennart von Fritsch¹, Shiraz A Sabah², Joshua Xu², Andrew J Price³, Christian Merle⁴, Abtin Alvand³

Affiliations

¹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Clinic for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
³ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford, United Kingdom.
⁴ Clinic for Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany; Clinic for Orthopaedics Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany.

PMID: 36716900
DOI: 10.1016/j.arth.2023.01.030

Abstract

Background: The incidence of re-revision knee arthroplasty (re-revision KA) is increasing and associated with high complication and failure rates. The aim of this study was to investigate re-revision rates, complications, and patient-reported outcomes following re-revision KA and factors associated with poor outcome.

Methods: This was a retrospective cohort study of 206 patients (250 knees) undergoing re-revision KA at a major revision center from 2015 to 2018. The mean follow-up was 26 months (range, 0 to 61) and mean age at re-revision KA was 69 years (range, 31 to 91 years). The main indications for surgery were prosthetic joint infection (PJI) (n = 171/250, 68.4%) and aseptic loosening (n = 25/250, 10.0%). We compared re-revision rates, joint function, and complications for aseptic and infective indications. Logistic regressions were performed to identify risk factors for further reoperation.

Results: The estimated re-revision rates at 2 years were 28.7% (95% confidence interval [CI]: 22.7-35.9) and at 4 years were 42.0% (95% CI: 32.8-52.6). Mean Oxford Knee Score was 26 points (range, 1 to 48). Mean EuroQoL-5D-5L utility was 0.539 (range, -0.511 to 1.000). Multivariable analyses demonstrated that PJI (Odds Ratio [OR] 2.39, 95% CI 1.06-5.40, P = .036), greater number of previous surgeries (OR 1.18, 95% CI 1.04-1.33, P = .008), and higher Elixhauser score (OR 1.06, 95% CI 1.01-1.13, P = .045) were independently associated to further surgery.

Conclusion: Re-revision KA carried a high risk of early failure. Multiple revised joints and patients with more comorbidities had worse function. Patients undergoing re-revision KA for PJI should be counseled to expect higher failure rates and complications than patients who have aseptic indications.

Keywords: knee arthroplasty; patient reported outcome (PROM); prosthetic joint infection; revision; total knee replacement.

MeSH terms

Adult
Aged
Aged, 80 and over
Arthritis, Infectious* / etiology
Arthroplasty, Replacement, Knee* / adverse effects
Humans
Middle Aged
Prosthesis Failure
Prosthesis-Related Infections* / epidemiology
Prosthesis-Related Infections* / etiology
Prosthesis-Related Infections* / surgery
Reoperation / adverse effects
Retrospective Studies