Clinical Outcomes of Isolated Polyethylene Exchange Versus Full Component Revision for the Management of Instability Following Total Knee Arthroplasty

Ryan Cheng; Eytan M Debbi; Brian P Chalmers; Yu-Fen Chiu; Jose A Rodriguez; Gwo-Chin Lee

doi:10.1016/j.arth.2024.04.023

Clinical Outcomes of Isolated Polyethylene Exchange Versus Full Component Revision for the Management of Instability Following Total Knee Arthroplasty

J Arthroplasty. 2024 Apr 16:S0883-5403(24)00335-8. doi: 10.1016/j.arth.2024.04.023. Online ahead of print.

Authors

Ryan Cheng¹, Eytan M Debbi¹, Brian P Chalmers¹, Yu-Fen Chiu¹, Jose A Rodriguez¹, Gwo-Chin Lee¹

Affiliation

¹ Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.

PMID: 38631514
DOI: 10.1016/j.arth.2024.04.023

Abstract

Background: Instability following total knee arthroplasty (TKA) is a common cause for revision. Isolated polyethylene exchange (IPE) can be performed to increase knee joint stability, but results have been mixed. The purpose of this study was to compare the survivorship and patient-reported outcomes of patients undergoing revision TKA for instability with IPE versus full component revision.

Methods: We reviewed 280 primary TKAs undergoing revision TKA for instability. There were 181 knees that underwent revision with IPE, compared to 99 knees treated with full component revision. The mean follow-up was 32.8 months (range, 24.8 to 82.5). Patient demographics, radiographic parameters, prosthesis constraints, reoperations for instability, and patient-reported outcomes were compared.

Results: The survivorship for instability was significantly higher at 2 years (99 versus 92%, P = .024) and 5 years (94 versus 84%, P = .024) for patients undergoing full component revision. Although there was no difference in Knee Injury and Osteoarthritis Outcome Score for Joint Replacements and Veterans RAND 12 physical component scores between the 2 groups at 6 weeks, 1 year, and 2 years after surgery, full revision patients reported greater pain relief (P = .006) and greater improvements in Veterans RAND 12 physical component scores (P = .027) at 1 year and Knee Injury and Osteoarthritis Outcome Score for Joint Replacements scores at 2 years (P = .017) compared to IPE patients. Men were associated with an increased risk for recurrent instability following IPE (hazard ratio 3.3, 95% confidence interval: [1.0 to 10.6]).

Conclusions: Isolated polyethylene exchange was not as reliable or durable compared to full component revision for the management of postoperative instability. These procedures should only be reserved in cases with competent collaterals and when component position, offset, and rotation are optimized.

Keywords: complications; instability; outcomes; polyethylene exchange; revision total knee.