Dataset Information

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review.

ABSTRACT:

Background

The aim of this systematic review was to summarise the evidence for the clinical effectiveness of revision knee arthroplasty (rKA) compared to non-operative treatment for the management of patients with elective, aseptic causes for a failed knee arthroplasty.

Methods

MEDLINE, Embase, AMED and PsychINFO were searched from inception to 1st December 2020 for studies on patients considering elective, aseptic rKA. Patient-relevant outcomes (PROs) were defined as implant survivorship, joint function, quality of life (QoL), complications and hospital admission impact.

Results

No studies compared elective, aseptic rKA to non-operative management. Forty uncontrolled studies reported on PROs following elective, aseptic rKA (434434 rKA). Pooled estimates for implant survivorship were: 95.5% (95% CI 93.2-97.7%) at 1 year [seven studies (5524 rKA)], 90.8% (95% CI 87.6-94.0%) at 5 years [13 studies (5754 rKA)], 87.4% (95% CI 81.7-93.1%) at 10 years [nine studies (2188 rKA)], and 83.2% (95% CI 76.7-89.7%) at 15 years [two studies (452 rKA)]. Twelve studies (2382 rKA) reported joint function and/or QoL: all found large improvements from baseline to follow-up. Mortality rates were low (0.16% to 2% within 1 year) [four studies (353064 rKA)]. Post-operative complications were common (9.1 to 37.2% at 90 days).

Conclusion

Higher-quality evidence is needed to support patients with decision-making in elective, aseptic rKA. This should include studies comparing operative and non-operative management. Implant survivorship following elective, aseptic rKA was ~ 96% at 1 year, ~ 91% at 5 years and ~ 87% at 10 years. Early complications were common after elective, aseptic rKA and the rates summarised here can be shared with patients during informed consent.

Systematic review registration

PROSPERO CRD42020196922.

SUBMITTER: Sabah SA

PROVIDER: S-EPMC10394899 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review.

Sabah Shiraz A SA Hedge Elizabeth A EA von Fritsch Lennart L Xu Joshua J Rajasekaran Raja Bhaskara RB Hamilton Thomas W TW Shearman Alexander D AD Alvand Abtin A Beard David J DJ Hopewell Sally S Price Andrew J AJ

Systematic reviews 20230801 1

<h4>Background</h4>The aim of this systematic review was to summarise the evidence for the clinical effectiveness of revision knee arthroplasty (rKA) compared to non-operative treatment for the management of patients with elective, aseptic causes for a failed knee arthroplasty.<h4>Methods</h4>MEDLINE, Embase, AMED and PsychINFO were searched from inception to 1st December 2020 for studies on patients considering elective, aseptic rKA. Patient-relevant outcomes (PROs) were defined as implant surv ...[more]

PMID: 37528486

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Project description:BackgroundTotal knee arthroplasty (TKA) is an effective treatment option for high body mass index (BMI) patients achieving similar outcomes to nonobese patients. However, increased rates of aseptic loosening in patients with a high BMI have been reported. Component fixation is a concern when performing TKA in the obese patient. To address this concern in cemented TKA, extended tibial stems have been used. Uncemented implants that take advantage of biologic osseointegration have also been advocated. This retrospective study examined the use of and revision rates of extended cemented tibial stems and uncemented implants compared with conventional cemented implants in our high BMI patient population.MethodsWe retrospectively reviewed a prospectively maintained database of 3239 primary Attune TKAs (Depuy, Warsaw, Indiana). All obese patients (BMI > 30 kg/m2) with > 30 months of follow-up were included in our analysis. Those who underwent cemented TKA using a tibial stem extension (Group 1) (n = 145) and those where cementless implants were used (Group 2) (n = 100) were compared to a control group (n = 1243) using a standard cemented implant. Primary outcome measures were all-cause revision, revision for aseptic loosening, and revision for tibial loosening. Kaplan-Meier survival analysis and Cox regression models were used to compare the primary outcomes between groups.ResultsIn total, there were 1512 knees that met the inclusion criteria. The mean follow-up was 6.8, 5.1, and 5.3 years for cemented, stemmed, and cementless groups, respectively. There were 37 all-cause revisions identified. Seven were for aseptic loosening (2 tibial, 1 femoral, and 4 involving both components); all of these were in the standard cemented implant group. There were no revisions in the stemmed or cementless implant groups. Survival analysis did not show any significant differences between groups for either all-cause revision or for aseptic loosening.ConclusionsThis retrospective analysis showed that there were no revisions required for aseptic loosening when a cemented, stemmed, or uncemented implant was used in obese patients. These findings show that cementless and extended stem implants are a reasonable option in obese patients.Level of evidenceLevel III.

Dataset Information

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review.

Background

Methods

Results

Conclusion

Systematic review registration

Publications

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review.

Similar Datasets

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