Risk factors for aseptic loosening in complex revision total knee arthroplasty using rotating hinge implants
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ORIGINAL PAPER
Risk factors for aseptic loosening in complex revision total knee arthroplasty using rotating hinge implants Ali Levent 1 & Eduardo M. Suero 2 & Thorsten Gehrke 1 & Iman Godarzi Bakhtiari 1 & Mustafa Citak 1 Received: 13 August 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
Abstract Purpose This study aimed to determine the risk factors of aseptic loosening (AL) in complex revision total knee arthroplasty (TKA) cases using rotating hinge knee prosthesis. Methods Patients who had undergone re-revision rotating hinge prosthesis surgery between January 2012 and December 2017 were included. Parameters related to AL were retrospectively reviewed. For this purpose, 31 aseptic loosening patients and 30 control patients were included in the study. Various risk factors were evaluated. Risk factors for AL after re-revision were determined using univariate and multiple logistic regression analyses. Results Thirty-one AL patients and 30 control patients were included. In the AL group, tibial tantalum cone and impaction grafting were performed significantly less frequently than the control group (p = 0.002 and p < 0.001). Logistic regression analysis revealed that smoking, right-sided TKA, and large femoral canal anteroposterior diameter were factors that increased the risk of AL after re-revision, while tibial tantalum cone decreased the risk of loosening. Smokers had an 11.847-fold higher risk for AL; right-sided TKA led to a 4.594-fold higher risk for AL. However, the presence of a tibial tantalum cone was associated with an 8.403-fold lower risk for AL. Conclusions We conclude that smoking, right-sided prosthesis, and large femoral canal diameter increased the risk of AL, while tantalum cone and impaction grafting reduced this risk in patients who underwent re-revision surgery with rotating hinge prosthesis after TKA. Keywords Total knee arthroplasty . Rotating hinge prosthesis . Re-revision surgery . Aseptic loosening
Introduction Total knee arthroplasty (TKA) is a cost-effective surgery aimed at reducing pain and dysfunction due to advanced arthritis in the knee [1–3]. Although it is mostly associated with favourable outcomes, unfavorable results may ensue from infection, instability, aseptic loosening (AL), and other reasons. Revision and re-revision surgeries may also be needed in these cases. Loosening, which causes instability, can be defined as the loss of attachment of the prosthesis to the bone.
* Mustafa Citak [email protected] 1
Department of Ortopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany
2
Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
Revision TKA can be required due to multiple factors, including the implant design, surgical technique used, and time after the TKA procedure [1, 4]. In TKA revision surgery, bone losses caused by loosening or osteolysis are challenging for the surgeon to manage [5]. The severity of the bone defect can be determined before revision surgery, and its reconstruction wit
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