The reason a total knee replacement has to be revised has an impact on patient reported outcomes, according to researchers in the United Kingdom.
Patients who undergo revision for pain and stiffness were found to have the poorest overall outcomes, while patients revised for aseptic loosening were found to have the best outcomes, the researchers reported. Paul Baker, MB, ChB, presented his team’s findings at the American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco.
“When assessing outcomes of knee revision, it is difficult because they are a very heterogeneous group of operations done for a number of reasons, and often we get this situation where we have multiple re-revisions clouding the picture,” Baker said.
According to the study abstract, Baker and his team collected patient-reported outcomes data on 1,066 patients who underwent revision knee surgery since Jan. 4, 2008. Of these cases, 496 patients underwent revision for a single mode of failure. His team excluded any revisions for infection, as well as revisions driven by multiple reasons for failure.
The 496 revisions were stratified into groups: aseptic loosening (194), pain (78), instability (56), stiffness (17) and other reasons (151). Oxford Knee Scores (OKS), Euroqol-5D (EQ5D) questionnaires and patient satisfaction reports were all collected preoperatively, as well as at the 6.9-month postoperative mark.
“When we dive into the reason for revision, we see the reason for revision did influence the improvement in scores,” Baker said. “In the EQ5D, the better scores were seen in those patients revised for malalignment, loosening and component wear … the highest levels of satisfaction were seen in the loosening and component wear groups. Similarly, for the [OKS], stiffness and unexplained were associated with the poorest results, with only the smallest improvements in their EQ5D scores.”
- Baker P, Cowling P, Jameson S, et al. Does the reason for knee revision surgery influence the patient reported outcomes? Paper #127. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.