Table 1.
Pre- and postoperative outcomes: data extraction from the included studies
| Study | Study design | Study population | Operation Type | Outcome Measures | Preoperative score | Postoperative score | Comparison | RTS + time to RTS | RTW + time to RTW | Confounding | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fuchs et al. [35] 2001; Germany [German] | Retrospective; follow-up: 8.5 m (range 6.5–61.4 m) |
14 pts who underwent revision TKA Age: 67.4y (range, 54–78 years) Sex: 3 (21%) male 11 (79%) female |
Revision TKA |
HSS KSFS Tegner Activity Score Patella Score VAS |
Unknown |
67.5 (± 12.3) (p = 0.0002) * 57.0 (± 16.9) (p = 0.0002) * 1.3 (± 0.8) (p < 0.0001) * 19.1 (± 7.9) (p < 0.0001) * 5.8 (± 7.9) (p < 0.0001) * |
Healthy volunteers 93.1 (± 10.3) 95.5 (± 15.1) 3.4 (± 0.8) 29.5 (± 1.5) 9.9 (± 0.3) |
Unknown | Unknown | Functional deficits may be caused by preoperative deficits and are not only due to the operation | |
| Barrack et al. [40] 2004; USA | Retrospective; follow up: 60 m (range, 24 – 84) |
143 pts who underwent revision TKA Age: 69.7y Sex: 46 (32%) men, 97 (68%) women |
Revision TKA with a revision of both the femoral and tibial components | UCLA | 5.3 |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
Stem design does appear to impact the incidence of end-of-stem pain in revision total knee arthroplasty | |||
| Dahm et al. [37] 2007; USA | Retrospective; follow-up: 5.6y (range, 3–9) |
206 pts who underwent revision TKA between 1995 and 2000 Age: 69y (range, 31–87 years) Sex: 107 (52%) male, 99 (48%) female |
Revision TKA |
UCLA KSFS Patient Satisfaction |
Unknown |
6.7 (range, 2–10) (NS) * 62 (range, 0–100) (p < 0.001) * 77% (p < 0.001) * |
Primary TKA 7.1 (range, 1–10) 71 (range, 0–100) 91% |
RTS: Individual activity mentioned. Time to RTS not reported |
RTW: 96% Time to RTW not reported |
Mentioned, not adjusted for: patient selection, time since revision Adjusted for in analysis: age, BMI, comorbidities, sex |
The average UCLA activity level rating was 6.7, which represents participation in active events such as swimming and bicycling |
| Mulhall et al. [38] 2007; USA | Prospective cohort study; follow-up: 6 m |
186 pts who underwent revision TKA Age: 68.0y (range, 24.5–89.0y) Sex: 93 (50%) male, 93 (50%) female |
Revision TKA |
SF-36, PCS WOMAC Function KSFS LEAS |
31.2 (± 7.3) 33.9 (± 14.2) 40.4 (± 21.4) 7.6 (± 2.5) |
37.2 (± 9.4) 21.9 (± 15.1) 62.7 (± 25.4) 8.5 (± 2.6) (p = 0.001) |
Unknown | Unknown | Improvement following rTKA is a multidimensional structure | ||
| Ghomrawi et al. [39] 2009; USA | Prospective cohort study; follow-up: 2y |
308 pts who underwent revision TKA, 221pts with 2y follow-up Age: 68.7y (range, 34–85) Sex: 139 (45%) male, 169 (55%) female |
Revision TKA |
SF-36 PCS WOMAC Function LEAS |
28.4 (± 7.5) 34.8 (± 13.8) 7.5 (± 2.6) |
34.8 (± 9.9) (p = 0.01) 23.8 (± 16.1) (p = 0.01) 8.7 (± 2.8) (p = 0.01) |
Unknown | Unknown |
Mentioned, not adjusted for: surgeon experience Adjusted for in analysis: age, BMI, comorbidities, reason for revision, sex |
The cohort of patients showed significant improvement in several functional outcomes in their first year following revision, however, the magnitude of the improvement was smaller than that after primary surgery | |
| Gooding et al. [45] 2011; Canada | Retrospective; follow-up: 9y (range, 5-12y) |
110 pts who underwent revision TKA, 48pts completed the outcome score questionnaires Age: 68y (range, 35-86y) Sex: 60 (55%) male, 50 (45%) female |
Revision TKA |
WOMAC Function OKS UCLA Patient Satisfaction |
42.6 32.1 |
63.2 (p = 0.001) 60.8 (p = 0.0003) 4.1 70.8 |
Unknown | Unknown | Mentioned not adjusted for: limited follow-up | Improvement was observed in the postoperative WOMAC function, pain, and global scores as well as the Oxford, SF-12 (mental) scores, and the satisfaction scores at last follow-up | |
| Richards et al. [46] 2011; Canada | Retrospective; follow-up: 2y (range, 24-98 m) |
24 pts who underwent revision TKA with FHSA Age: 72.8y Sex: 11 (46%) male, 13 (54%) female |
Revision TKA with FHSA |
WOMAC Function OKS SF-12 PCS Satisfaction function Satisfaction overall UCLA |
Unknown |
76 (p = 0.011) * 80 (p = 0.001) * 40 (p = 0.027) * 94 (p < 0.001) * 93 (p = 0.001) * UCLA: 4.9 (NS) * |
Revision TKA without FHSA 61 80 33 66 71 4.0 |
Unknown | Unknown | Mentioned, not adjusted for: lack of preoperative scores and difference in severity of preoperative bony defect | Patients with revision TKA with femoral head structural allograft had significant improved clinical outcomes compared to patients with revision TKA without femoral head structural allograft |
|
Efe et al [36] 2012; Germany |
Retrospective; follow up: 56 m ± 37 (range, 10 – 133) |
28 pts who underwent revision TKA Age: 72.5y Sex: 33 (37%) men, 56 (63%) women |
Revision TKA | UCLA | 4.1 ± 1 (range, 2 – 7) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
||||
| Baker et al. [47] 2013; Canada | Retrospective; follow-up: 58 m (range, 24-123 m) |
42 pts who underwent revision TKA with isolated polyethylene tibial insert exchange Age: 68y (range, 43-90y) Sex: 19 (45%) male, 23 (55%) female |
Revision TKA with isolated polyethylene tibial insert exchange |
OKS UCLA SF-12 PCS WOMAC Patient Satisfaction |
45 (range, 13–75) 4 (range, 2–5) 29 (range, 20–47) 50 (range, 9–84) |
75 (range, 6–100) (p < 0.001) 6 (range, 1–10) (NS) 39 (range, 18–58) (p = 0.007) 74 (range, 4–100) (p = 0.001) 86 |
Unknown | Unknown | When patients are selected appropriately, an isolated liner exchange can significantly improve the function of the knee | ||
|
Hitt et al [41] 2014; USA |
Prospective; follow up: 6 m |
95 pts who underwent revision TKA Age: 67.5y (range, 49 – 92y) Sex: 44 (46%) men, 51 (54%) women |
Revision TKA |
LEAS KOOS Sport |
7.7 ± 2.6 10.4 ± 18.4 |
8.8 ± 2.4 (p = 0.0027) 36.8 ± 28.8 (p < 0.0001) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
Patient expectations for improved outcomes are seen not only in primary replacement but also in revision cases | ||
| Stambough et al. [16] 2014; USA | Retrospective; follow-up: 4.6y (range, 2–13.4y) |
76 pts (81 knees) who underwent revision TKA Age: 48.5y (range, 25-55y) Sex: 28 (35%) male, 53 (65%) female |
Revision TKA |
KSFS UCLA |
46 (range, 5–100) (NS) 3.3 (range, 1–9) (NS) |
50.7 (range, 5–100) (p < 0.001) 4.1 (range, 1–10) (NS) |
Primary TKA pre-op: 45.6 (range, 20–80) post-op: 66.6 (range, 20–100) pre-op: 3.5 (range, 1–9) post-op: 4.7 (range, 2–10) |
Unknown | Unknown | Mentioned, not adjusted for: Different surgical techniques and designs of implant | Young patients undergoing revision TKR should be counselled that they can expect somewhat less improvement and a higher risk of complications than occur after primary TKR |
|
Grayson et al [42] 2016; USA |
Retrospective; follow up: 21 m (range, 9 – 54) |
92 pts who underwent revision TKA Age: 65.2y (range, 40 – 89y) Sex: 33 (37%) men, 56 (63%) women |
Revision TKA | UCLA | 2.7 | 4.7 |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
Adjusted for in analysis: reason for revision | Overall, our findings indicate that patients with flexion instability functionally improve after revision TKA but that they do not appear to improve as much relative to their higher baseline function as patients revised for infection or loosening/osteolysis | |
| Sandiford et al. [48] 2017; Canada | Retrospective; follow-up: 9y (range, 5-12y) |
30 pts who underwent revision TKA with FHSA Age: 66y (range, 30-85y) Sex: |
Revision TKA with FHSA |
OKS WOMAC UCLA Patient Satisfaction |
Unknown |
80 (range, 69–100) (NS) * 82.3 (range, 75–100) (NS) * 5.8 (range, 3–8) (NS) * 93 (range, 33–100) (NS) |
Revision TKA with trabecular metal cone 84 (range, 56–100) 84.6 (range, 58–100) 5.5 (range, 3–8) 95.2 (range, 66–100) |
Unknown | Unknown |
Mentioned, not adjusted for: patient selection, time since revision Adjusted for in analysis: reason for revision |
No difference was found in pain, function, or repeat revision when comparing femoral head allografts and trabecular metal cones for severe bone defects during revision TKA |
| Scott et al. [49] 2018; United Kingdom | Retrospective; follow-up: 3.8y (range, 1-9y) |
30 pts who underwent revision TKA Age: 58y (range, 46-64y) Sex: 16 (53%) male, 14 (47%) female |
Revision TKA |
OKS UCLA |
17.1 (range, 4–33) 4.3 (range, 1–10) |
OKS: 23.4 (range, 5–47) 5.1 (range, 1–10) |
Unknown |
RTW 2/28 (7.1%) after one year. RTW 5/28 (18%) after 3.8 year Time to RTW: 2 within 1 year, 3 after 1 year |
Mentioned, not adjusted for: preoperative intentions regarding returning to work Adjusted for in analysis: age, sex |
Very few patients RTW after revision TKA | |
| Turnbull et al. [50] 2019; United Kingdom | Prospective; follow-up: 3.9y (range, 1.2–11.8y) |
112 pts who underwent revision TKA Age: 71y (range, 47-94y) Sex: 67 (56%) male, 45 (44%) female |
Revision TKA |
OKS UCLA |
OKS: 15 (range, 0–46) UCLA: 4.4 (range, 2–6) |
OKS: 27 (range, 5–42) (p < 0.001) UCLA: 5.3 (range, 3–6) (p < 0.001) |
Unknown | Unknown | Adjusted for in analysis: age, BMI, sex, number of comorbidities, reason for revision, number of comorbidities, | Although 90% of the patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity levels | |
| Jacquet et al. [51] 2020; France | Retrospective; follow-up: 9.1y ± 2.1 |
99 pts who underwent revision TKA Age: 72y ± 2 Sex: Unknown |
Revision TKA | KOOS Sport | 13.9 ± 1.4 | 35.6 ± 2.6 |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
|||
| Piuzzi et al. [7] 2020; USA | Prospective; follow-up: 1y |
246 pts who underwent aseptic revision TKA Age: 64.9y (range, 55-74y) Sex: 105 (42.7%) male, 141 (57.3%) female |
Revision TKA |
KOOS Pain KOOS PS KOOS-QOL VR-12 PCS VR-12 MCS |
39.9 (± 19.9) 45.9 (± 17.8) 18.5 (± 18.8) 26.7 (± 8.28) 45.8 (± 13.2) |
70.2 (p < 0.001) 65.1 (p = 0.007) 48.2 (p = 0.024) 36.07 (p = 0.012) 50.2 (P = 0.033) |
Unknown | Unknown | Although overall QOL improved, other global-health PROMs remained unchanged | ||
| Erivan et al. [54] 2021; Russia | Retrospective; follow-up: ≥ 2y |
61 pts who underwent revision TKA Age: 60.4y (range, 34 – 80y) Sex: 30 (49%) men, 31 (51%) women |
Revision TKA with a revision of the tibial component |
Devane KOOS |
56.3 ± 10.8 (range, 36.9 – 66) |
2.6 71.8 ± 22.6 (range, 24.9 – 100) (p = 0.013) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
The present study of cones used for tibial revision supports shows excellent results; however, longer and larger follow-up is needed to better assess results in revision TKA | ||
| Houfani et al. [52] 2021; France | Retrospective; follow-up: 67.3 m ± 11.8 (range, 13–180) |
127 pts who underwent revision TKA Age: 69.5y (range, 42 – 89y) Sex: 48 (38%) men, 79 (62%) women |
Revision TKA | Devane | 2.7 ± 1 (range, 1 – 5) |
2.26 (p = 0.0003) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
|||
| Sonn et al. [43] 2021; USA | Retrospective; follow-up: 18.5 m (range, 11.0 – 78.7) |
107 pts who underwent revision TKA, with ≥ 50% pain relief with injections Age: 62.6y (range, 35 – 92y) Sex: 52 (36%) men, 92 (64%) women |
Revision TKA |
UCLA KOOS Jr |
3.5 (NS) 40.7 (NS) |
4.8 (NS) 60.9 (NS) |
37 pts who underwent revision TKA, with ≤ 50% pain relief with injections UCLA pre-op 4.0 (NS) UCLA post-op 4.3 (NS) KOOS Jr pre-op 44.4 (NS) KOOS Jr post-op 56.6 (NS) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
Adjusted for in analysis: reason for revision, prevalence of comorbidities | Study results showed that patients reporting > 50% pain relief after a diagnostic injection have significantly better improvement in UCLA Activity Level at minimum 1- year follow-up |
| Von Hitze et al. [53] 2021; Finland | Retrospective; follow-up: 7.3y (range, 4 – 12.7) |
119 pts who underwent revision TKA Age: 71.7y (range, 31 – 95y) Sex: 33 (28%) men, 86 (72%) women |
Revision TKA, using the single rotating hinged knee design | KOOS Sport | 33 (range, 0 – 100) |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
||||
| Auran et al. [44] 2022; USA | Prospective; follow-up: 2y |
181 pts who underwent revision TKA Age: 66y (range, 45 – 92y) Sex: 70 (39%) men, 111 (61%) women |
Revision TKA | LEAS | 7.8 | 9.5 |
RTS unknown Time to RTS unknown |
RTW unknown Time to RTW unknown |
Values in bold were included in the meta-analysis
BMI Body Mass Index, FHSA Femoral head structural allograft HSS Hospital for Special Surgery KA Knee arthroplasty KOOS Knee Injury and Osteoarthritis Outcome Score KOOS PS Koos Physical Function Shortform KSFS Knee Society Function Score LEAS Lower Extremity Activity Scale MCS Mental component score NS Not significant OKS Oxford Knee Score PCS Physical component score PKA Primary knee arthroplasty PROMs Patient reported outcome measures QOL Quality of life RTS Return to sports RTW Return to work SF-12 twelve item short form survey SF-36 thirty-six item short form survey TKA Total knee arthroplasty TKR Total knee replacement UCLA University of California at Los Angeles UKA Unicondylar knee arthroplasty VAS Visual Analogue Scale VR-12 MCS Veterans RAND-12 mental component score VR-12 PCS Veterans RAND-12 physical component score WOMAC Western Ontario and McMaster Universities Osteoarthritis Index rTKA Revision total knee arthroplasty
*p-value based on comparison of study population and ‘comparison’