Document Detail


Incidence and reasons for nonrevision reoperation after total knee arthroplasty.
MedLine Citation:
PMID:  20848243     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A dramatic increase in the demand for TKA is expected. The current burden of revision TKA is well known but the incidence and etiology of nonrevision reoperations after primary TKA is not.
QUESTIONS/PURPOSES: We determined the rate, reason, timing, and predictors of nonrevision reoperation after TKA.
METHODS: Using our institutional joint arthroplasty database, we identified 10,188 TKA performed on 7,613 patients between April 2000 and March 2008. A nonrevision reoperation was defined as any procedure requiring anesthetic in which components with bony interfaces were not removed or exchanged. Procedures after revision TKA were excluded. Potential risk factors investigated included age, gender, laterality, and simultaneous bilateral versus staged bilateral versus unilateral TKA. The minimum followup was 1 year (median, 4.1 years; range, 1.1 to 9.1 years).
RESULTS: Three hundred fifty-three patients of 7,613 (4.6%) underwent 434 nonrevision reoperations on 384 of 10,188 (3.8%) knees. The most common indication for nonrevision reoperation was stiffness (58%; 252 of 434), followed by patellar clunk (12%; 53), infection (12%; 52), wound revision (6%; 26), hematoma (4.4%; 19), among others. The median time to reoperation was 74.5 days (range, 1-3058 days) but varied widely. Younger patients and those with unilateral TKA were more likely to have a nonrevision reoperation.
CONCLUSIONS: The majority of nonrevision reoperations are performed for stiffness. Patellar clunk and infection also result in a large number of nonrevision reoperations. In weighing the future economic and workforce burden of TKA, nonrevision reoperations need to be acknowledged, and preventive measures need to be implemented.
LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Authors:
Benjamin Zmistowski; Camilo Restrepo; Lauren K Kahl; Javad Parvizi; Peter F Sharkey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-25     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  138-45     Citation Subset:  AIM; IM    
Affiliation:
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arthroplasty, Replacement, Knee* / adverse effects,  instrumentation
Chi-Square Distribution
Female
Hematoma / etiology,  surgery
Humans
Knee Prosthesis
Male
Philadelphia
Postoperative Complications / etiology,  surgery*
Prosthesis-Related Infections / etiology,  surgery
Registries
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
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