Monday, April 7, 2014

Revision arthroplasties have a higher risk of failure.

Revision Total Knee Arthroplasty in the Young Patient: Is There Trouble on the Horizon?

These authors reviewed perioperative data for all total knee arthroplasty revisions performed from August 1999 to December 2009. They found a cohort of eighty-four patients who were fifty years of age or younger and a matched them to a cohort of eighty-four patients who were sixty to seventy years of age with similar dates of surgery, sex, and body mass indices (BMI).

The most common reason for the initial revision was aseptic loosening (27%; 95% confidence interval [CI] = 19% to 38%) in the younger cohort and infection (30%; 95% CI = 21% to 40%) in the older cohort. 

Of the twenty-five second revisions in younger patients, 32% (95% CI = 17% to 52%) were for infection, whereas 50% (95% CI = 32% to 68%) of the twenty-six second revisions in the older cohort were for infection

Infection and a BMI of >40 kg/m2 posed the greatest risk of failure of revision procedures, with risk ratios of 2.731 (p = 0.006) and 2.934 (p = 0.009), respectively.

This study showed a relatively poor six-year cumulative survivorship of revision total knee arthroplasties in the younger (71%) and older (66%) groups.

Comment: This series again emphasizes that arthritis in young individuals is a different matter than arthritis. It also emphasizes that revision arthroplasties have a greater risk of infection than primary arthroplasties and that revision of a previously infected arthroplasty has a higher risk of failure.


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