Isolated tibial insert exchange in revision total knee arthroplasty: reliable and durable for wear; less so for instability, insert fracture/dissociation, or stiffness. (1st June 2021)

• Record Type: Journal Article
• Authors: Tetreault, Matthew W.; Hines, Jeremy T.; Berry, Daniel J.; Pagnano, Mark W.; Trousdale, Robert T.; Abdel, Matthew P.
• Is Part Of: Bone & joint journal. Volume 103B:Number 6(2021)
• Page Start: 1103
• Page End: 1110
• Publication Date: 2021-06-01
• Subjects: Liner revision -- Polyethylene exchange -- Tibial insert exchange -- Revision total knee arthroplasty; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.103B6.BJJ-2020-1954.R2
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). Methods: From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. Results: Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. Conclusion: After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103–1110.