Abstract
Between 1983 and 2001, 25 revision of total knee arthroplasties were performed in our department. 16 tibiofemoral, 9 tibial revisions and 9 operations on the patella were performed.
The original implants of the 16 tibio femoral revisions were 8 total condylar, 2-IB1, 2-IB2,
1 AGC, 1 cruciate retaining AGC and 2 porous coated J& J.
The revision prostheses were: One IB1, 1 kinematic II, 7 CCK, 4 dual articular, 1 sigma and 2 Guepar.
The results were: very good 2, good 9, failure 2 (sepsis, removal of implants and knee fusion), 3 patients died during the study period of unrelated causes to surgery. One of them was followed for 13 years, having a very good result (Kin II) until his death.
Tibial component revisions were performed on 9 knees.
The original implants were: 5 total condylar, 1 IB-1 and 3 IB-2.
The revision implants were: 5 total condylar, tibiae, 1 IB-1, 1 IB-2 and 2 IB-2 with augments and intramedul-lary rods.
The results for the tibial revisions were: good – 4, fair 1, failures – 2 (sepsis and eventually arthrodesis. Two patients died within the study period of unrelated causes.
The patella posed a special problem, of 9 patients, 7 were operated for patellar component loosening, and the component was removed. In one patient a patellec-tomy was performed because patellar osteomyelitis was suspected. In another patient a tibial tuberosity transfer for patellar dislocation was performed.
The results of patellar surgery were: 4 – fair, 1 – unknown, and 4 patients died during the study period of causes unrelated to surgery.
Our series reflects the gathered experience in our department. During the early years tibial and patellar loosening were the main problems. Special revision prostheses were not available and were not needed in most cases. Later, with increasing number of arthroplasties performed, and with longer follow up periods, the need for special revision prostheses became overt. The most commonly used implant was the constrained con-dylar knee and was later replaced by the dual articular prostheses. The latter appealed to us because of its partially mobile tibial articular surface.
Our failures were due to Staphylococcus aureus sepsis, which we were unable to eradicate, in spite of performing staged procedures, repeated joint debride-ments and the use of gentamycin impregnated bone cement.
In all but one of these cases the implants had to be removed and the knee had to be fused. In one of our 4 failures even after solid fusion, the infection was not eradicated. We succeeded to revise only one infected knee with Staph. Aureus with a good functional result. In one case of candida infection, we succeeded to eradicate the infection and replaced the loose implants with a CK achieving a good result now for 4 years.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
