ABSTRACT
We have studied a consecutive series of 72 salvage knee procedures using a Kinematic rotating hinge prosthesis performed in a single arthroplasty unit between 1983 and 1997. Clinical and radiographic assessment of the survivorship of the Kinematic rotating hinge total knee arthroplasty (Howmedica, Rutherford, NJ) were analyzed. Survival analysis revealed a best-case 10-year implant survival of 90%. Concurrently, this group of patients exhibited a significant and sustained improvement in Knee Society Score and pain relief after implantation of a rotating hinge component. There were 10 deaths due to unrelated causes during the study period. This constrained hinged prosthesis remains a viable option in the face of gross deformity, bone loss, and failed multiple previous surgical procedures.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Knee Joint/surgery , Range of Motion, Articular , Salvage Therapy/instrumentation , Salvage Therapy/methods , Aged , Arthroplasty, Replacement, Knee/instrumentation , Biomechanical Phenomena , Female , Humans , Internal Fixators , Knee Joint/diagnostic imaging , Knee Joint/physiology , Knee Prosthesis , Male , Middle Aged , Prospective Studies , Prosthesis Design , Quality of Life , Radiography , Range of Motion, Articular/physiology , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND AND PURPOSE: Radiographic and clinical survival analyses of revision total knee replacement (TKR) are considered acceptable outcome measures. However, the full influence of revision knee replacement on the overall health status of patients remains poorly defined. METHODS: We prospectively studied the health-related quality of life outcome in 94 patients who underwent revision knee replacement surgery over a 5-year period. Comparisons were drawn between the Nottingham health profile (NHP) scores and the Knee Society score pre-revision, and those obtained at 3 months, 1 year and 5 years after revision knee arthroplasty. RESULTS: We found a significant improvement in Knee Society score and NHP pain scores 3 and 12 months after revision TKR (p < 0.05). No other modalities of the NHP showed a significant change. 5 years after surgery, pain was less than before revision (p = 0.2), but energy level was considered worse (p = 0.07). Knee Society scores were found to be higher pre- and postoperatively for patients undergoing revision for reasons other than sepsis than for patients with sepsis. Patients requiring implantation of a hinged prosthesis also had lower Knee Society scores than those patients receiving a non-hinged implant. Repeated revision was associated with a downward trend in Knee Society score with each surgical intervention.
Subject(s)
Arthroplasty, Replacement, Knee/psychology , Quality of Life , Adult , Arthroplasty, Replacement, Knee/adverse effects , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Prosthesis Failure , ReoperationABSTRACT
Deprivation correlates with poor health and psychosocial variables can affect the symptoms of knee arthritis. Our aim was to determine the effect of deprivation on the level of knee function and health-related quality of life at the time of arthroplasty and 12 months after total knee replacement. From our database of over 2500 knee replacements, we analysed both clinical and quality of life outcome measures. We analysed the relationship between deprivation (by Townsend score), knee function (Knee Society Score) and health-related quality of life (Nottingham Health Profile) before total knee replacement (TKR) and at 12 months post-operation. There was no significant correlation between Townsend score, Knee Society Score and Nottingham Health Profile preoperatively or at 12 months after knee replacement, thus showing that there was no association between deprivation and the severity of knee arthritis at the time of joint replacement nor was there a relationship between deprivation and the short-term outcome from total knee replacement.
