Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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Goodlooks,
Of course, as you know, TKA revision depends greatly on what needs to be revised. The spacer may just need replacement, in which case it is nowhere near the amount of healing time, as the bony surfaces dont have to adjust to the cutting, reaming, pounding, etc. Outcomes can be fantastic. Of course they can be not so great too. If your mom had a good outcome the first time, she should certainly shoot for this the second time as well. If the first outcome wasnt great, the challenge is to avoid the problems with the previous rehab program, perhaps by reminding her that often one gets out what one puts in, in terms of effort and compliance = results. The rehab is quite similiar, if not exactly the same as the first TKA, but again, weight bearing may not be affected due to no bony changes, and your mom may be WBAT ASAP. ONe of the most interesting things that I see in post-op rehab of TKA and/or TKR, is that those who struggle with ROM, whether it be extension or flexion, cant do a good quad set. Im sure there is more to it than this, but it is a constant and consistent finding in patients who do poorly. HHmmmmmm.
Some abstracts
The Knee
Volume 11, Issue 1 , February 2004, Pages 45-49
Ching-Jen Wang, , a, Ming-Chun Hsieha, Ting-Wen Huanga, Jun-Wen Wanga, Han-Shiang Chenb and Chen-Yeo Liuc
a Department of Orthopedic Surgery, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, Taiwan
b Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
c National Taiwan University, Taipei, Taiwan
Received 5 April 2002; revised 27 July 2002; accepted 15 August 2002. ; Available online 23 October 2002.
Abstract
This study compares clinical outcome and patient satisfaction in 33 aseptic and 15 septic revision total knee arthroplasties across a 30–130-month follow-up. Aseptic revisions included only knees in which the femoral, tibial and patellar components had been exchanged, and excluded knees in which only isolated patellar components had been revised or only the tibial insert exchanged. Septic revisions included only knees in which there had been successful revision for chronic infection without recurrence of infection for at least 2 years from the index revision. The evaluation included pain scores, knee scores, functional scores, SF-12 functional surveys and radiographs of the knee. The results for the aseptic group were excellent in 26 (78.8%), good in 3 (9.0%), fair in 2 (6.1%) and poor in 2 (6.1%); those for the septic group were excellent in 5 (33.3%), good in 7 (46.7%), fair in 2 (13.3%) and poor in 1 (6.7%). The overall results of septic revision were less satisfactory than for aseptic revision. Aseptic revisions achieved significantly better knee scores and ranges of motion than septic revisions, but their pain and functional scores were similar. Despite the difference in knee scores, 85% of the patients from both groups were equally satisfied with the results of treatment. There was no discernible radiographic difference between the two groups, including radiolucency.
Author Keywords: Revision; Total knee arthroplasties; Aseptic; Septic; Outcome
Clin Orthop. 2003 Nov;(416):84-92
Patellar options in revision total knee arthroplasty.
Rorabeck CH, Mehin R, Barrack RL.
Division of Orthopaedic Surgery, London Health Sciences Center, University of Western Ontario London, Ontario, Canada. Cecil.Rorabeck@lhsc.on.ca
There are numerous options that need to be considered by the surgeon at the time of revision total knee arthroplasty (TKA). One needs to consider the reason for the revision, the type of patella in place, and the length of time the patella has been in place. The surgeon also needs to consider the status of the patellar bone stock, the stability of the patellar component (well-fixed or loose), and the component type (cemented or metal-backed). Assuming that the existing prosthesis is not metal-backed and has minimal PE wear, then it is preferable to retain a well-fixed all-PE cemented patellar button. However, if the button is metal-backed, then it probably is best to remove the button and replace it with an all-PE domed patellar component. Assuming more than 8 mm of patellar bone stock is remaining, it usually is best to cement an all-PE dome-shaped patella. However, if less than 8 mm is remaining, then that patient can be left with a patelloplasty, recognizing that this individual is going to continue with a high likelihood of anterior knee pain, subluxation, and poor functional results. In that situation, it may be preferable to consider a bone stock augmentation.
Int Orthop. 2003 Nov 20 [Epub ahead of print]
Patient outcome following revision total knee arthroplasty: a meta-analysis.
Sheng P, Lehto M, Kataja M, Halonen P, Moilanen T, Pajamaki J.
Coxa, Hospital for Joint Replacement, PO Box 652, 33101, Tampere, Finland.
The purpose of this study was to summarize the literature describing patient outcome following revision total knee arthroplasty. Original studies were included if they were published between 1990 and 2002, enrolled ten or more patients, and measured patient outcome using a global knee rating scale. We found 33 studies with a total number of 1,356 patients. There were 429 men and 611 women with a mean age of 67 (45-90) years. The weighted mean follow-up time was 57 (6-108) months. The main indication of revision was loosening. The weighted mean preoperative and postoperative knee scores were 49 (15-82) and 84 (58-109) respectively. There were significant differences between preoperative and postoperative knee and function scores and motion (knee: t=12.507 p<0.001, function: t=4.704 p<0.001, motion: t=5.346 p<0.001). Loosening was also the main complication after revision surgery. In this analysis, revision total knee arthroplasty was a safe and effective procedure.
J Arthroplasty. 2003 Oct;18(7 Suppl 1):27-32. Related Articles, Links
Revision total knee arthroplasty with cemented components and uncemented intramedullary stems.
Shannon BD, Klassen JF, Rand JA, Berry DJ, Trousdale RT.
Mayo Clinic Foundation, Rochester, Minnesota, USA.
Sixty-three failed total knee arthroplasties in 60 patients (27 females, 33 males; average age, 66 years) were treated consecutively with revision using cemented component fixation and an uncemented stem. Patients were followed for a mean of 5.75 years (range, 2-10 years); none were lost to follow-up. There were 12 (19%) re-revisions: 6 (10%) were revised for aseptic loosening, 4 (6%) for recurrent infection, and 2 (3%) for instability. Knee Society Pain Scores improved from 56 to 81, and function scores improved from 49 to 62 points. Latest radiographs in retained knees showed none with definite femoral loosening but 4 with tibial component loosening. Combining those revised for aseptic loosening and radiographic aseptic loosening, mechanical failure occurred in 10 patients (16%).
PMID: 14560407 [PubMed - indexed for MEDLINE]
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