Total Knee Replacement Of The Initial Postoperative Revision Surgery Cause Analysis And Efficacy Of Follow-up

Objective:To discuss why primary total knee arthroplasties (PTKA) are revised in order that the rate of revision total knee arthroplasties (RTKA) could be lowered and the survivorship of knee protheses could be improved,and to determine the effects of revision total knee arthroplasties through the follow-up.Methods:Retrospectively analysed the data about 32 RTKA which were done in the second Xiangya hospital of central south university or done by doctors of the second Xiangya hospital in other hospitals between January 2000 and December 2010 in order to present the reasons that why PTKA were revised and follow up the patients who were revised during the time. We used the Hospital for Special Surgery score(HSS) to evaluate and made Re-revision, arthrodesis, amputation and death as the endpoint.In the light of the time interval between PTKA and RTKA, the patients were divided into early revision group and late revision group. Meanwhile, in light of the failed reasons for PTKA, the patients were also divided into several groups. Statistical software SPSS 13.0 was utilized so as to analyse the data about the etiology of RTKA between early revision group and late revision group by chi-square analysis, to analyse the data about HSS between the time before RTKA and the time when the follow-up was made by Paired-samples t test, and to analyse the data about HSS between early revision group and late revision group, between infection patients in early revision group and infection ones in late revision group,as well as between the infection group and the aseptic loosening of prostheses group by independent-samples t test.Results:40.6%(13/32) of the patients had two or more than two reasons for RTKA. Early revison group:the mean time interval between PTKA and RTKA was 16.73 (7-24) months, main reasons for RTKA were infection (73.3%), malalignment and instability (20.0%), Patellofemoral joint problems (13.3%) and so on. Late revision group:the mean time interval between PTKA and RTKA was 67.53 (25-168) months, main reasons for RTKA were aspetic loosening of prostheses (52.9%), sepsis (29.4%), wear (23.5%) and so on. Statistical significance existed in"infection"(P=0.032) and "aseptic loosening"(P=0.007) between the two groups, and Statistical significance also existed between mean HSS score before RTKA 43(14～61) and mean HSS score when follow-up was made 87(80～93), P<0.01.There were not statistical significance in other comparisons.Conclusion:1.Infection is the primary cause in early revison group and the primary one among all etiologies of RTKA. So we should have a priority to reduce the rate of infection.2.Aseptic loosening is the primary cause in late revison group, therefore, prevention and treatment of aseptic loosening of prostheses is also worthy of attention and consideration.3. RTKA remains a safe and effective way as a salvage operation for the failure of PTKA.