Background: The aim of this study was to categorize reasons for failure and to analyze the survivorship of multiple total knee arthroplasty (TKA) revisions.
Methods: The study retrospectively evaluated all multiple TKA revisions performed between 2005 and 2015 at the authors' institutions. Sixty-three patients (35 female, 28 male, age 64 ± 10 years, follow-up 55 ± 36 months) underwent a total of 157 re-revision TKA surgeries (range 2-5). The revision indications were divided up into main diagnoses. Survivorship was evaluated by mixed model analysis.
Results: The main overall reason for re-revision was periprosthetic joint infection (PJI) (48%), followed by instability (12%), polyethylene wear (11%), malpositioning (8%), and aseptic loosening (8%). Survivorship shortened with an increasing number of revision surgeries ( = 0.003). While PJI was in 38% of all cases, the reason for the first revision, incidence increased constantly with the number of revisions (48% at second revision, 55% at third revision, 86% at fourth revision, and 100% at fifth revision, = 0.022). If periprosthetic infection caused the first revision, patients showed an average of two more septic revisions at follow-up than patients with an aseptic first revision indication ( < 0.001). In 36% of cases, the reason for follow-up surgery in case of periprosthetic infection was again PJI.
Conclusion: The probability of survival of the implanted knee arthroplasty is significantly reduced with each subsequent revision. Periprosthetic infection is the main cause of multiple revisions.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779106 | PMC |
| http://dx.doi.org/10.3390/jcm11020376 | DOI Listing |
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