Revision ArthroplastyImproved Range of Motion and Patient-Reported Outcome Scores With Fixed-Bearing Revision Total Knee Arthroplasty for Suboptimal Axial Implant Rotation
Section snippets
Methods
Using the total joint registry of our institution, we retrospectively reviewed all revision TKAs between January 2002 and December 2015 performed by 3 surgeons (JIH, SBG, and WJM) using Zimmer NexGen, LCCK, or RHK (Warsaw, IN); Smith & Nephew JOURNEY or LEGION (London, UK); DePuy SIGMA (Rayham, MA), and Stryker Scorpio (Kalamazoo, MI) components. Patients with evidence of loosening or infection were excluded. Patients with poor preoperative coronal anatomic alignment on 3-foot standing long-leg
Results
Symptoms reported preoperatively in this revision population included pain (42/42, 100%), instability (20/42, 48%), stiffness (14/42, 33%), and/or issues with patellofemoral tracking (18/42, 43%). No difference was found between mean tibiofemoral alignment preoperatively (4° ± 5° valgus) and postoperatively (5° ± 4° valgus, P = .123).
The most common technical issues identified at the time of revision TKA were femoral component internal rotation (25/42, 60%) and tibial component internal
Discussion
The primary outcome of this study showed that correcting suboptimal axial orientation with a fixed-bearing design resulted in improved ROM as well as clinical outcome scores. While the optimal axial orientation is determined by multiple factors, using the intraoperative landmarks described led to improved patient outcomes. Similar improvements are supported in smaller retrospective studies. Pietsch and Hofmann [31] reviewed 14 isolated femoral revisions and found improved KSS from 52 ± 13 to 85
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Investigation was performed at the Stanford University Medical Center, Redwood City, CA.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.02.007.