Gottfriedsen, J Bone Joint Surg Am 2016 - Knee Arthrodesis after Failure of Knee Arthroplasty

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Knee Arthrodesis after Failure of Knee Arthroplasty

Gottfriedsen, Odgaard, et al.·J Bone Joint Surg Am·2016·60 citations·Retrospective cohort

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Background

Arthrodesis is considered a salvage procedure for failed knee arthroplasty. Data on the use of this procedure is limited. The purpose of the present study was to identify the incidence, causes, surgical techniques and outcomes of arthrodesis after failed knee arthroplasty in a nationwide population.

Methods

Data were extracted from the Danish Civil Registration System, the Danish National Patient Register and the Danish Knee Arthroplasty Register.
Using individual data linkage, a total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified.
Of these, 165 were followed by arthrodesis.
Hospital records of all identified cases were reviewed.
A competing risk model was used to estimate the cumulative incidence of arthrodesis in the study period.
Differences in cumulative incidences were compared with Gray's test.

Results

A total of 164 arthrodeses were performed for causes related to failed knee arthroplasty.
The 15-year cumulative incidence of arthrodesis was 0.26% (95% CI, 0.21-0.31%).
A significant decrease in the 5-year cumulative incidence from 0.32% for procedures performed from 1997 to 2002 to 0.09% for procedures performed from 2008 to 2013 was observed (p<0.0001).
The most common causes of arthrodesis were periprosthetic infection in 152 patients (93%), extensor mechanism disruption in 46 patients (28%), soft tissue deficiency in 25 patients (15%) and severe bone loss in 11 patients (7%).
In 79 patients (48%), there were two or more indications for arthrodesis.
Solid fusion was achieved in 65% of the patients.
Fusion was significantly improved with intramedullary nail fixation compared to external fixation (p=0.01).
A total of 34 patients (21%) were treated with repeat arthrodesis, and 23 patients (14%) eventually required above-knee amputation.

Conclusions

The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. The results showed a significant decrease in the 5-year cumulative incidence during the study period, suggesting an overall improvement in prevention of this adverse outcome of knee arthroplasty.

Level of evidence: Prognostic Level III, retrospective cohort study. Copyright remains with the authors and publisher.

Knee Arthrodesis after Failure of Knee Arthroplasty

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Knee Arthrodesis after Failure of Knee Arthroplasty

Gottfriedsen, Odgaard, et al.·J Bone Joint Surg Am·2016·60 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Arthrodesis is considered a salvage procedure for failed knee arthroplasty. Data on the use of this procedure is limited. The purpose of the present study was to identify the incidence, causes, surgical techniques and outcomes of arthrodesis after failed knee arthroplasty in a nationwide population.

Methods

Data were extracted from the Danish Civil Registration System, the Danish National Patient Register and the Danish Knee Arthroplasty Register.
Using individual data linkage, a total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified.
Of these, 165 were followed by arthrodesis.
Hospital records of all identified cases were reviewed.
A competing risk model was used to estimate the cumulative incidence of arthrodesis in the study period.
Differences in cumulative incidences were compared with Gray's test.

Results

A total of 164 arthrodeses were performed for causes related to failed knee arthroplasty.
The 15-year cumulative incidence of arthrodesis was 0.26% (95% CI, 0.21-0.31%).
A significant decrease in the 5-year cumulative incidence from 0.32% for procedures performed from 1997 to 2002 to 0.09% for procedures performed from 2008 to 2013 was observed (p<0.0001).
The most common causes of arthrodesis were periprosthetic infection in 152 patients (93%), extensor mechanism disruption in 46 patients (28%), soft tissue deficiency in 25 patients (15%) and severe bone loss in 11 patients (7%).
In 79 patients (48%), there were two or more indications for arthrodesis.
Solid fusion was achieved in 65% of the patients.
Fusion was significantly improved with intramedullary nail fixation compared to external fixation (p=0.01).
A total of 34 patients (21%) were treated with repeat arthrodesis, and 23 patients (14%) eventually required above-knee amputation.

Conclusions

The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. The results showed a significant decrease in the 5-year cumulative incidence during the study period, suggesting an overall improvement in prevention of this adverse outcome of knee arthroplasty.

Level of evidence: Prognostic Level III, retrospective cohort study. Copyright remains with the authors and publisher.

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