Experience Of Aseptic Revision Surgery After Primary Knee Joint Arthroplasty

Objective To investigate the causes,treatments and recovery of aseptic revision surgery after primary total knee joint arthroplasty(TKA).Methods A retrospective analysis was performed on the patients admitted to have revision surgery in the Peking Union Medical College Hospital from May 1991 to November 2016.27 patients(29 knees)were included after excluding the cases of septic revision,repeat admission,non-revision surgery and the cases with insufficient data.All the cases were divide into subgroups according to different causes.The surgery plans were summed up;the interval time between the revision and the primary total knee arthroplasty was calculated;the pre-and postoperative alignments were descriptively compared;the HSS scores and alignment were compared to the pre-operative ones by independent-sample t test.Results A total of 27 patients(29 knees)were admitted into this analysis.The main revision reasons and treatments were as follows:14 knees of aseptic loosening(48.3%),8 of them underwent total knee revision and the other 6 underwent partial component replacement;7 knees of joint stiffness(24.1%),5 of these knees underwent releasing surgery,and the other 2 underwent partial component replacement respectively;2 knees(6.9%)had the PE replaced because of dislocation;2 knees(6.9%)showed severe PE wear and underwent total knee revision.2 knee(6.9%)appeared pre-prosthesis fracture and underwent total knee revision.1 knee(3.5%)of foreign body in the articular cavity,the body was removed;1 knee(3.5%)of patella subluxation,the lateral side of the patella was released and the medial side was shrinked.After the revision surgeries,66.7%(8/12 knees)of the alignment restored well,mean improvement was 7.9 ± 1.7 degree(t=4.612,P<0.05).Mean HSS score was improved from(54.5± 17.1)to postoperative(81.1 ±7.4);the difference was significant(t=-4.520,P=0.001).Conclusions Reasons which result in failure after TKA could be complex.The major cause of aseptic revision after primary knee joint arthroplasty are aseptic loosening(46.7%),stiffness(23.3%).Modular augment and stem could be used to improve the stability of prosthesis when there is severe bone defect.Dealing with the complications after primary knee joint arthroplasty,such as aseptic loosening,stiffness and so on,total knee arthroplasty revision can sufficiently improve function and restore the alignment.