CORRInsights®: Have the Causes of Revision for Total and Unicompartmental Knee Arthroplasties Changed During the Past Two Decades?

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Knee arthroplasty remains one of the most successful treatments for patients with knee osteoarthritis who originally pursued nonsurgical care [5, 9, 13]. Advances in prosthesis design and surgical safety have increased the number of arthroplasty procedures, with more than 700,000 of these surgeries performed annually in the United States alone [5]—a number expected to rise when considering the aging American demographic [2, 5, 9]. Concomitant with the rise in primary knee joint replacement procedures are burgeoning rates of revision arthroplasty [2, 3, 7, 9]. While approximately 30,000 revision knee arthroplasties are performed per year, this number is expected to increase by a factor of six during the next 10 to 15 years [3, 7, 13].
Revision knee arthroplasty procedures are more expensive, disproportionately consume more resources, carry higher risks of perioperative morbidity, and generally lead to inferior results compared to primary surgery [2-4, 7, 10, 12]. Orthopaedic surgeons need a better understanding of the factors that can lead to primary knee arthroplasty revision and minimize the likelihood of such events.
In this context, Dyrhovden and colleagues examined 20 years of data from the Norwegian Arthroplasty Registry and reported encouraging news: 10-year survival rates for primary total knee replacement increased from 91% to 94% between the years 1994-2004 and 2005-2015. At the same time, 10-year survival of unicompartmental knee arthroplasty remained static, holding steady at around 80%. One of the most-impressive findings in this paper, however, is the change in the diagnoses associated with the revision procedures that are performed. In the most recent period (2005-2015), revisions precipitated by wear-related changes and aseptic loosening diminished, while infection became a more-prominent indication for repeat surgery.
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