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. 2023 Aug 1;12(1):133.
doi: 10.1186/s13643-023-02290-6.

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review

Shiraz A Sabah  1   2 , Elizabeth A Hedge  3 , Lennart von Fritsch  3 , Joshua Xu  3 , Raja Bhaskara Rajasekaran  3   4 , Thomas W Hamilton  3   4 , Alexander D Shearman  4 , Abtin Alvand  3   4 , David J Beard  3 , Sally Hopewell  3   5 , Andrew J Price  3   4
Affiliations

Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review

Shiraz A Sabah et al. Syst Rev. .

Abstract

Background: The aim of this systematic review was to summarise the evidence for the clinical effectiveness of revision knee arthroplasty (rKA) compared to non-operative treatment for the management of patients with elective, aseptic causes for a failed knee arthroplasty.

Methods: MEDLINE, Embase, AMED and PsychINFO were searched from inception to 1st December 2020 for studies on patients considering elective, aseptic rKA. Patient-relevant outcomes (PROs) were defined as implant survivorship, joint function, quality of life (QoL), complications and hospital admission impact.

Results: No studies compared elective, aseptic rKA to non-operative management. Forty uncontrolled studies reported on PROs following elective, aseptic rKA (434434 rKA). Pooled estimates for implant survivorship were: 95.5% (95% CI 93.2-97.7%) at 1 year [seven studies (5524 rKA)], 90.8% (95% CI 87.6-94.0%) at 5 years [13 studies (5754 rKA)], 87.4% (95% CI 81.7-93.1%) at 10 years [nine studies (2188 rKA)], and 83.2% (95% CI 76.7-89.7%) at 15 years [two studies (452 rKA)]. Twelve studies (2382 rKA) reported joint function and/or QoL: all found large improvements from baseline to follow-up. Mortality rates were low (0.16% to 2% within 1 year) [four studies (353064 rKA)]. Post-operative complications were common (9.1 to 37.2% at 90 days).

Conclusion: Higher-quality evidence is needed to support patients with decision-making in elective, aseptic rKA. This should include studies comparing operative and non-operative management. Implant survivorship following elective, aseptic rKA was ~ 96% at 1 year, ~ 91% at 5 years and ~ 87% at 10 years. Early complications were common after elective, aseptic rKA and the rates summarised here can be shared with patients during informed consent.

Systematic review registration: PROSPERO CRD42020196922.

Keywords: Arthroplasty; Complications; Mortality; Patient reported outcome measures; Revision/reoperation; Total knee replacement.

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Conflict of interest statement

AA and AJP have received speaker bureau fees from Zimmer-Biomet, Medacta International and DePuy Synthes outside of the submitted work. The rest of the authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A diagram to illustrate the study population, interventions and comparisons, types of study and patient-relevant outcomes
Fig. 2
Fig. 2
PRISMA flow diagram
Fig. 3
Fig. 3
Forest plot of estimates for reported implant survivorship following elective, aseptic rKA
See this image and copyright information in PMC

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