Abstract
The purpose of this study is to evaluate the results of revision surgery in the treatment failed TKR with the TCP III like prosthesis.
Materials & Methods: Between 1985 till May 2001, 116 failed knees were managed. 91 underwent complete revision, 18 were arthrodesed, 6 underwent patella revision only and 1 arthrolysis. Among the complete revisions: 45 were due to mechanical failure (loosening, wear or instability) 29 for infection and 17 for painful or stiff knee.
In 81 of them the implanted prosthesis was TCP III or CCK and were evaluated in this study. 33 were males and 58 females. The average age at revision was 72 years. Most of the cases were performed by the senior author. All cases were osteoarthritic except one which was rheumatoid. The distribution of TCP III like prosthesis was as follows: 47 were TCP III, 33 were CCK and 2 dual. The infected cases were treated whether by one stage or two stage surgery. Patella was not resurfaced but reshaped if patella bone stock was not adequate.
Results: Nine patients died and 14 patients could not be traced in the last follow-up. The average follow up was around 6 years (range of 6 months to 16 years). As compared to preoperative situation almost all of the patients were on the overall subjectively satisfied. The preop HSS score was poor for all the patients. The average postop HSS score was 82 for mechanical failure, 76 for infection and 77 for painful knee. One infected knee got reinfected after 3 years. Three cases had to be revised for the second time to a rotating hinge prosthesis: 2 due to instability and one due to loosening.
Discussion: The TCP III like prosthesis proved in our hands to be a relatively successful implant in revision knee surgery. The new modular CCK design is quite an improvement over the TCP III design and is more versatile in allowing restoration of previous anatomy and joint line. The obvious advantage of this implant are its immediate inherent stability combined with a reproducible normal valgus alignment. The results were best in the treatment of failed knee due to mechanical failure.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
