Elsevier

The Journal of Arthroplasty

Volume 28, Issue 8, September 2013, Pages 1329-1332
The Journal of Arthroplasty

Revision Surgery After Total Joint Arthroplasty: A Complication-Based Analysis Using Worldwide Arthroplasty Registers

https://doi.org/10.1016/j.arth.2013.01.012Get rights and content

Abstract

The authors performed a complication-based analysis of total knee (TKA), total hip (THA), and total ankle arthroplasty (TAA) using worldwide arthroplasty registers. We extracted data with respect to reason for revision surgery and pooled causes. The most common causes for revisions in THA were aseptic loosening (55.2%), dislocation (11.8 %), septic loosening (7.5%), periprosthetic fractures (6%), and others. The most common causes in TKA were aseptic loosening (29.8%), septic loosening (14.8%), pain (9.5%), wear (8.2%), and others. The most common causes in TAA were aseptic loosening (38%), technical errors (15%), pain (12%), septic loosening (9.8%), and others. Revisions in TKA and THA differ with respect to type of complication. However, in case of TAA, higher rates of technically related complications are reported.

Section snippets

Material and Methods

The authors performed a systematic review of published national arthroplasty registers as well as clinically relevant literature. Therefore, national arthroplasty registers were identified using the EFORT-portal and its link-solving mechanism [10]. In addition, publications in journal articles were searched according to the registries reference lists [9].

Inclusion criteria compromised data sets of national joint arthroplasty registers with at least 90% of attrition with respect to the whole

Results

We were able to identify reasons for revision surgery in case of total knee and total hip arthroplasty using the register data from Sweden, Norway, Finland, Denmark, Australia, and New Zealand including 391,913 primary and 36,307 (9%) cases of revised TKAs and 485,790 primary and 77,036 (15%) cases of revised THAs. Revision surgeries were reported from prosthesis, which had been implanted from 1979 to 2009 in THAs and TKAs. In case of total ankle arthroplasty we were able to include data from

Discussion

The aim of this study was therefore to perform a complication-based analysis in case of revision surgery of total knee (TKA), total hip (THA), and total ankle arthroplasty (TAA) using worldwide Arthroplasty Registers by summarizing relative likelihood of different causes for revision surgery, and to describe differences between the arthroplasties and registers, if applicable.

The study hypothesis was that revision rates and causes for revision surgery after total ankle arthroplasty (TAA) differ

Conclusion

Causes for revision surgery in total knee and total hip arthroplasty differ with respect to type of complication and likelihood. Sixty-six percent of all revisions after total hip arthroplasty are due to aseptic loosening and dislocation whereas septic complications, wear, pain without other reasons for revision, and implant fracture are more common after total knee arthroplasty. In case of total ankle arthroplasty (TAA), higher rates of technically related complications are reported. This

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    The study was performed in cooperation with the EUPHORIC project (funded by EU Commission DG SANCO, Grant agreement 2003134). Further information concerning the project is available at www.euphoric-project.eu.

    Level of Evidence: Level III study — Retrospective analysis of prospectively collected registry data.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.01.012.

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