Revision Arthroplasty
Improved Range of Motion and Patient-Reported Outcome Scores With Fixed-Bearing Revision Total Knee Arthroplasty for Suboptimal Axial Implant Rotation

https://doi.org/10.1016/j.arth.2019.02.007Get rights and content

Abstract

Background

Suboptimal implant rotation has consequences with respect to knee kinematics and clinical outcomes. We evaluated the functional outcomes of revision total knee arthroplasty (TKA) for poor axial implant rotation.

Methods

We retrospectively reviewed 42 TKAs undergoing aseptic revision for poor axial implant rotation. We assessed improvements in Knee Society Score (KSS) and final range of motion (ROM). Subgroup analyses were performed for preoperative instability and stiffness, as well as the number of components revised and level of implant constraint used.

Results

Revision for poor axial rotation in isolation improved KSS from 52 ± 22 to 84 ± 25 (P < .001), and flexion increased from 105 ± 21° to 115 ± 13° (P = .001). Revision in the setting of instability significantly improved the KSS (P < .001) but did not affect ROM (P = .172). Revision in the setting of stiffness significantly improved both KSS (P < .001) and ROM (P = .002). There was no statistically significant difference between the postoperative KSS (P = .889) and final knee flexion (P = .629) with single- or both-component revision TKA for isolated poor axial rotation or between the postoperative KSS (P = .956) and final knee flexion (P = .541) with or without the use of higher constraint during revision TKA for isolated poor axial rotation.

Conclusion

Revision TKA for poor axial alignment improves clinical outcomes scores and functional ROM.

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.

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