Revision TKA Patients Are Getting Younger, But They’re More Likely to Need Re-Revision Surgery

More and more younger patients are undergoing total knee arthroplasty (TKA) and, as a result, revision TKA (rTKA). However, these younger patients may be more likely to require re-rTKA down the line compared to their traditional TKA-aged counterparts.

“Advances in the field of joint replacement along with newer implant designs have encouraged surgeons to expand TKA to a younger age group,” explained senior study author James Keeney, MD, associate professor of orthopaedic surgery, in a press release. “Most of our younger patients who have had knee replacement surgery are doing very well, but this patient group has a higher likelihood of needing an additional surgery during their lifetime. A small percentage of these patients may undergo a revision surgery during the first five years after their knee replacement. We wanted to know more about the potential causes of poor outcomes.”

Dr. Keeney and colleagues reviewed medical records of rTKA patients and collected data on patient demographics, medical comorbidities, surgical rTKA indications, timing from index TKA to rTKA, subsequent reoperation rates, component re-revision rates, and salvage procedures. Two patient cohorts were identified: patients aged ≤55 years (young patients; n=147 [158 knees]) and patients aged between 60 and 70 years (traditional patients; n=276 [300 knees]). They compared the aforementioned variables between the groups and estimated five-year implant survival determined by reoperation or component revision and salvage procedures.

The younger cohort, compared to the traditional group, had a higher rate of initial aseptic rTKA within two years of the primary TKA (52.5% vs. 29.0%; P<0.001). Younger patients were more likely, after rTKA, to require early reoperation (17.7% vs. 9.7%; P=0.02) or component re-revision (11.4% vs. 6.0%; P<0.05); they also had higher rates of infection and extensor mechanism complications. Five-year survival estimates were poorer for younger patients in terms of reoperation (59.4% vs. 65.7%; P=0.02) and component re-revision or salvage (65.8% vs. 80.1%; P=0.02).

The reasons behind the disparity are likely multi-faceted, but Dr. Keeney suggested that increase tobacco use among younger patients may play a role.

“Smokers have been noted in previous studies to experience increased joint infection risk after primary hip and knee replacement surgery and higher rates of wound complications,” he said.

The study was published in The Journal of Arthroplasty.