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Comparative Study
. 2024 Oct 12;25(1):806.
doi: 10.1186/s12891-024-07925-w.

Isolated aseptic loosening in total knee arthroplasty: a comprehensive 10-year review of partial vs. total component revisions

Yu-Chih Lin  1   2   3 , Sheng-Hsun Lee  1   2   3 , Chih-Hsiang Chang  1   2   3 , Yu-Kai Lin  1   2   3 , Chih-Chien Hu  4   5   6 , Sheng-Hsuan Lin  7
Affiliations
Comparative Study

Isolated aseptic loosening in total knee arthroplasty: a comprehensive 10-year review of partial vs. total component revisions

Yu-Chih Lin et al. BMC Musculoskelet Disord. .

Abstract

Background: In total knee arthroplasty (TKA), isolated aseptic loosening (IAL) requires the replacement of prosthetic components, with ongoing debate regarding the effectiveness of partial component revision (PCR) compared to total component revision (TCR). This study aims to compare implant survival and surgical outcomes between PCR and TCR in the context of IAL.

Methods: This retrospective study analyzed data from 285 patients who underwent revision TKA for IAL between January 2000 and December 2013. After applying exclusion criteria, 112 patients were included in the analysis-60 undergoing TCR and 52 undergoing PCR.

Results: PCR was associated with shorter operative times and hospital stays compared to TCR, alongside significant differences in the choice of revision prostheses. Although the prosthesis failure rates were comparable between the groups (13.6% for TCR and 18.33% for PCR), significant risk factors for failure were identified, including a canal filling ratio (CFR) below 0.8 and a discrepancy over 0.2 between CFR views. However, no significant differences in overall survivorship were observed between the groups.

Conclusions: Both PCR and TCR provide similar survival rates and clinical outcomes for managing IAL in TKA. PCR provides advantages in terms of surgical efficiency and patient recovery, while reducing the need for more constrained prosthetic solutions. The study identifies CFR as a critical predictor of prosthesis failure, highlighting the importance of detailed preoperative planning and implant selection. These findings contribute valuable insights for improving revision strategies in IAL, enhancing surgical outcomes in TKA.

Level of evidence: III.

Keywords: Isolated aseptic loosening; Partial component revision; Total component revision.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient recruitment from the retrospective database
Fig. 2
Fig. 2
This figure illustrates a stable femoral component of RTKA in both the AP and lateral views of the knee X-ray. On the left (AP view), the stem diameter is 16.3 mm, while the narrowest part of the medullary canal occupied by the stem measures 19.0 mm. The calculated CFRmax is 16.3/18.3 = 0.89, which is considered positive as CFRmax > 0.8. On the right (lateral view), the calculated CFRmax is 16.3/23.8 = 0.68. Since CFRmax < 0.8, with a discrepancy of more than 0.2 between the AP and lateral views, this patient experienced aseptic loosening 3 years later
Fig. 3
Fig. 3
Survival curve of partial component revision (PCR) and total component revision (TCR) free from re-revision. *p < 0.05
See this image and copyright information in PMC

References

    1. Röhner E, Heinecke M, Matziolis G. Bone defect management in revision knee arthroplasty. Orthopade. 2021;50(12):1004–10. - PubMed
    1. Münger P, Röder C, Ackermann-Liebrich U, Busato A. Patient-related risk factors leading to aseptic stem loosening in total hip arthroplasty: a case-control study of 5,035 patients. Acta Orthop. 2009;77(4):567–74. - PubMed
    1. Kutzner I, Hallan G, Høl PJ, et al. Early aseptic loosening of a mobile-bearing total knee replacement. Acta Orthop. 2018;89(1):77–83. - PMC - PubMed
    1. Jie JJ, Hevesi M, O’Byrne MM, et al. Long-term mortality trends after revision total knee arthroplasty. J Arthroplasty. 2019;34(3):542–8. - PubMed
    1. Shichman I, Oakley CT, Thomas J, et al. Comparison of aseptic partial- and full-component revision total knee arthroplasty. J Arthroplasty. 2023;38(7 Suppl):S360–8. - PubMed

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