The Journal of arthroplasty · 2026
The AAHKS Surgical Techniques and Technologies Award: What Is the Ideal Technique and Implant in Aseptic Revision Total Knee Arthroplasty? An Analysis of Second Revision and Component Loosening Rates From the Australian Orthopaedic Association National Joint Replacement Registry.
СтатьяНазвание и аннотация: Перевод в очереди
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Hoskins Wayne, Gusho Charles, McAuliffe Michael, Wall Christopher, Xu Qunyan, Vince Kelly G
Аннотация
BACKGROUND: Failed total knee arthroplasties (TKAs) can be revised via a range of techniques and fixation strategies. This study assessed the cumulative percent second revision (CP2R) rates based on what components were revised and the stem extensions and porous metal augments (cones/sleeves) used.
METHODS: Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing revision TKA (RTKA) for aseptic failures, following an initial diagnosis of osteoarthritis, from September 1999 to December 2024. The components revised (femur, tibia, and/or liner) and use of stems and cones or sleeves and their location were recorded. Complete revision where femoral and tibial stems and either cones or sleeves were used became the referent that all other revision constructs were compared to. The two primary outcomes were (1) CP2R for all-cause revision and (2) CP2R for aseptic loosening. Age, sex, body mass index, American Society of Anesthesiologists score, bearing surface, bearing type, and surgeon volume were included as covariates in Cox proportional hazard models. A total of 22,238 aseptic RTKAs met inclusion criteria, with 14 different revision construct permutations and 2,565 as the referent (mean age 70 years [median 71]; 59.1% women, mean follow-up from RTKA 4.5 years (range 0 to 22.3). The referent was compared with the other constructs, which were associated with similar patient characteristics and surgeon volumes.
RESULTS: When compared with all other constructs, the referent had the lowest raw CP2R rates for all-cause revision and component loosening. When adjusting for covariates, there was statistical evidence that the referent had a lower risk of all-cause revisions and revision for loosening than complete revisions, partial revisions, and isolated liner exchange.
CONCLUSIONS: Complete component revision using both stems and cones or sleeves has the lowest CP2R rates for all-causes and specifically for component loosening. Enhanced fixation with stems and cones or sleeves should be considered strongly for RTKA.
LEVEL OF EVIDENCE: III.
METHODS: Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing revision TKA (RTKA) for aseptic failures, following an initial diagnosis of osteoarthritis, from September 1999 to December 2024. The components revised (femur, tibia, and/or liner) and use of stems and cones or sleeves and their location were recorded. Complete revision where femoral and tibial stems and either cones or sleeves were used became the referent that all other revision constructs were compared to. The two primary outcomes were (1) CP2R for all-cause revision and (2) CP2R for aseptic loosening. Age, sex, body mass index, American Society of Anesthesiologists score, bearing surface, bearing type, and surgeon volume were included as covariates in Cox proportional hazard models. A total of 22,238 aseptic RTKAs met inclusion criteria, with 14 different revision construct permutations and 2,565 as the referent (mean age 70 years [median 71]; 59.1% women, mean follow-up from RTKA 4.5 years (range 0 to 22.3). The referent was compared with the other constructs, which were associated with similar patient characteristics and surgeon volumes.
RESULTS: When compared with all other constructs, the referent had the lowest raw CP2R rates for all-cause revision and component loosening. When adjusting for covariates, there was statistical evidence that the referent had a lower risk of all-cause revisions and revision for loosening than complete revisions, partial revisions, and isolated liner exchange.
CONCLUSIONS: Complete component revision using both stems and cones or sleeves has the lowest CP2R rates for all-causes and specifically for component loosening. Enhanced fixation with stems and cones or sleeves should be considered strongly for RTKA.
LEVEL OF EVIDENCE: III.