Table 4.
Overview of the literature: outcomes of stemmed revision implants after RTKA/ReRTKA
| Research group | Year | All cases (PJI cases) | Metaphyseal fixation | Stem fixation | Implant type | Stem design | FU (years) | Survival | Aseptic loosening (AL) | PJI | Others |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Murray et al. | 1994 | 40 (0) | Cemented | Kinematic stabilizer (Howmedica) | Co | 4.9 | N/A | 2.5% (RLL 32%) | N/A | N/A | |
| Whaley et al. | 2003 | 38 (1) | Cemented | Kinematic stabilizer (Howmedica) | Co | 10.1 | 10y-, 11y-survival 96.7%, 95.7% (for AL) | 5.3% | 2.6% | 10.5% failure | |
| Pradhan et al. | 2004 | 51 (23) | Cemented | ENDO Model (LINK) | Co | 4 | N/A | N/A | 4.3% | N/A | |
| Joshi et al. | 2008 | 78 (0) | Cemented | ENDO Model (LINK) | Co | 7.8 | N/A | 5.1% | 2.6% | N/A | |
| Schmitz et al. | 2013 | 38 (0) | Cones | Cemented |
ENDO Model (LINK) 41% rotational knee, 59% hinge knee |
Co | 3.1 | N/A | 5.3% | 0% | 5.3% ReRTKA |
| Abdelaziz et al. | 2019 | 25 (0) | Cones | Cemented |
ENDO Model (LINK) 12 hinged, 13 rotating hinged |
Co | 10.5 | 10y- survival 75% | 20% (4/5 pure hinged) | 12% | 52% ReRTKA. 80% of asept failure in pure hinged and no-cones RTKA |
| Brown et al. | 2019 | 100 (19) | Cemented | ENDO Model RH (LINK) | Co | 8.2 |
1y-, 5y-survival 99%, 95% 5y-aseptic survival 97% |
1% | 5% |
8% ReRTKA 29% Compli (17 infections) |
|
| Ohlmeier et al. | 2021 | 52 (17) | Cones | Cemented | ENDO Model RH (LINK) | Co | 1.8 | N/A | 1.9% (RLL 10.7%) | 3.8% | 7.7% ReOP |
| Bertin et al. | 1985 | 53 (0) | Cementless |
49% stemmed ICKH prosthesis 51% Freeman–Samuelson prosthesis |
Co | 1.5 | N/A | 0% (RLL 23% f, 26% t) | 3.8% | 35.8% Compli | |
| Gofton et al. | 2002 | 89 (0) | 16% cemented | Coordinate (DePuy) | Cy (Co) | 5.9 | 9y-survival 93% | N/A | N/A | 5.6% failure | |
| De Martino et al. | 2015 | 18 (13) | Cones | 17% cemented |
33.3% LCCK, 66.7% RHK (NexGen, Zimmer) |
Cy | 6 | N/A | 0% | 11% | 11.1% ReRTKA |
| Bae et al. | 2013 | 224 (22) | 29% cemented | PFC (DePuy), 89.7% stem extension | Cy (Co)* | 8.1 |
5y-, 8y-, 10y-survival 97.2%, 91.6%, 86.1% |
2.7% | 3% | 8.9% ReRTKA | |
| Villanueva-Martinez et al. | 2013 | 21 (5) | Cones | 43% cemented | 47.6% RHK, 52.4% LCCK (Zimmer) | Cy | 3 | N/A | 0% | 9.5% | 4.8% ReRTKA, 52.4% Compli |
| Gómez-Vallejo et al. | 2018 | 67 (0) | Sleeves | 43% cemented |
Cemented: NK II, (Zimmer) Cementless: Sigma TC3 (DePuy) |
Cy (Co)* Cy |
7 |
5y-, 10y-survival 93%, 84% (cemented) 94%, 94% (cementless) |
Cemented: 0% 6 possible AL (2 f, 4 t) Cementless: 0% 5 possible AL (4 f, 1 t) |
4.5% | 9% failures |
| Chalmers et al. | 2017 | 227 (84) | Sleeves | 48% cemented | 22% Sigma PS, 73% TC3, 4% LPS (DePuy) | Cy (Co)* | 3.2 | 5y-survival 96% | 1.3% | 5.3% | 6.6% ReRTKA 11.8% Compli, 12.7%ReOP |
| Fehring et al. | 2003 |
113 (33) 202 metaph. stems |
53% cemented |
49% Insall–Burstein II MR (Zimmer) 44% PFC Modular Revision (DePuy) |
Cy Cy (Co)* |
> 2 | N/A |
0% cemented stems 10% cementless stems (8 f, 2 t) |
N/A | N/A | |
| Lachiewicz et al. | 2012 | 27 (13) | Cones | 57% cemented |
81.5% LCCK (18.5% PS), 11.1% RHK, 7.4% NKII (Zimmer) |
Cy Cy (Co)* |
3.3 | N/A | 3.7% | 3.7% | 7.4% ReRTKA |
| Mabry et al. | 2007 | 70 (0) | 70% cemented | PFC 41% PS, 59% SC (DePuy) | Cy (Co)* | 10.2 | 5y-, 10y-survival 98%, 92% | 7.1% (RLL 9 f, 13 t) | 2.9% | 10% failure, 9% Compli | |
| Wilke et al. | 2014 | 234 (0) | Sleeves | 98% cemented | TC3 (DePuy) | Cy (Co)* | 9 | 5y-, 10y-survival 91%, 81% | 9.4% (AL, osteolysis or pain) | 7.7% | 17.1% ReRTKA |
| Haas et al. | 1995 | 65 (0) | Cementless | Insall-Burstein (Zimmer) | Cy | 3.5 | 8y-survival 83% | 3% (RLL 1% f, 7% t) | N/A | N/A | |
| Barrack et al. | 2000 | 14 (0) | Sleeves | Cementless | S-ROM Noiles (DePuy) | Cy | 4.2 | N/A | 0% | 0% | 7% ReOP |
| Shannon et al. | 2003 | 63 (21) | Cementless |
46% PFC (DePuy) 54% Genesis I (Smith&Nephew) |
Cy | 5.8 | N/A |
16% (10% revised, 6.3% radiographic) |
6% | 19% failure | |
| Peters et al. | 2009 | 184 (53) | Cementless | Vanguard, 45% PS (Zimmer Biomed) | Cy | 4.1 | N/A | 1.1% (only f) | 7.1% | 8.2% failure | |
| Wood et al. | 2009 | 135 (34) | Cementless | Genesis II Revision, 49% PS (Smith&Nephew) | Cy | 5 | Aseptic 12y-survival 98% | 2% only t (RLL 19%) | 2% | 6% failure | |
| Rao et al. | 2013 | 26 (9) | Cones | Cementless | RHK (Zimmer) | Cy | 3 | N/A | 0% | 7.7% | 3.8% ReRTKA |
| Derome et al. | 2014 | 29 (7) | Cones | Cementless | 62% LCCK, 37.8% LCCK PS (Zimmer) | Cy | 2.8 | N/A | 3.5% | 6.9% | 6.9% ReRTKA, 17.2% ReOP |
| Huang et al. | 2014 | 83 (20) | Sleeves | Cementless |
88% Sigma PS 12% S-ROM Noiles (DePuy) |
Cy | 2.4 | Survival 92.8% | 3.6% (progressive RLL in 12 stems) | 7.2% | 16.9% ReOP |
| Jensen et al. | 2014 | 36 (15) | Cones | Cementless | 16.7% PS, 38.9% LCCK, 44.4% RHK (Zimmer) | Cy | 3.9 | N/A | 5.6% (RLL 10%) | 5.6% | 11.1% ReRTKA |
| Lique et al. | 2014 | 77 | Cementless | Optetrak CCK (Exactech) | Cy | 9 |
2y-, 5y-, 8y-survival 92.7%, 87.8%, 87.8% |
6.6% (aseptic failure) | 7.4% | 29% major Compli | |
| Bugler et al. | 2015 | 35 (0) | Sleeves | Cementless | PFC Sigma (DePuy) | Cy | 3.3 | N/A | 0% | 0% | 0% ReRTKA, 25.7% Compli |
| Graichen et al. | 2015 | 121 (0) | Sleeves | Cementless | 63.6% Sigma PS, 22.3% TC3, 14% S-ROM® Noiles (DePuy) | Cy | 3.6 | Aseptic sleeve-survival 98.3% | 4.1% (RLL 5.8%) | 3.3% | 11.4% ReRTKA |
| Dalury et al. | 2016 | 40 (6) | Sleeves | Cementless | 15% S-ROM Noiles, 85% Sigma RKS (DePuy) | Cy | 4.8 | N/A | 2.5% | 0% | 2.5% ReRTKA |
| Girerd et al. | 2016 | 52 (19) | Cones | Cementless | 73% RHK, 27% LCCK (Zimmer) | Cy | 2.8 | N/A | 0% | 7.7% | 7.7% ReRTKA, 9.6% Compli |
| Martin-Hernandez et al. | 2016 | 134 | Sleeves | Cementless | Sigma TC3 (DePuy) | Cy | 6 | Aseptic survival 100% | 0% | 1.3% | 12% Compli, 2.3% ReOP |
| Watters et al. | 2017 | 116 | Sleeves | Cementless | 2.6% Hinge, 28.4% LCS VVC, 56% Sigma TC3, 13% Sigma PS (DePuy) | Cy | 5.3 | Sleeve survival 98.5% | 0.9% | 5.2% | 16.4% ReOP |
| Agarwal et al. | 2018 | 104 | Sleeves | Cementless | Sigma TC3 (DePuy) | Cy | 8 | N/A | 6.7% | 4.8% | 22.1% ReRTKA |
| Burastero et al. | 2018 | 60 (60) | Cones | Cementless | 30% RHK, 70% LCCK (Zimmer) | Cy | 3.6 | Survival 90% | 5% (RLL 13.3%) | 3.3% | 10% ReOP |
| Fedorka et al. | 2018 | 50 (25) | Sleeves | Cementless | Sigma TC3, LCS Complete RKS (DePuy) | Cy | 4.9 | N/A | 4% | 2.7% | 6.8% ReRTKA, 18.9% ReOP |
| Klim et al. | 2018 | 56 (56) | Sleeves | Cementless | 80.4% LCS Complete RKS, 35.7% S-ROM Noiles (DePuy) | Cy | 5.3 | N/A | 0% | 16% | 16% ReRTKA |
| Wirries et al. | 2019 | 62 (17) | Sleeves | Cementless | 51.1% TC3, 48.9% S-ROM Noiles (DePuy) | Cy | 5 |
Survival 87.2% Aseptic survival 93.6% |
6.4% (RLL 29.4%) | 6.4% | 12.8% failure |
| Algarni et al. | 2020 | 27 (3) | Sleeves | Cementless | 88.9% TC3, 3.7% S-ROM Noiles, 7.4% LPS (DePuy) | Cy | 4.1 |
Survival 96.3% Aseptic survival 100% |
0% | N/A | 3.7% ReRTKA |
| Berti et al. | 2020 | 56 (0) | Cementless | AMP Revision (MicroPort) | Cy | 8.8 | 15y-survival 94.1% | 1.7% (RLL 15.8%) | 3.4% | ||
| Bloch et al. | 2020 | 319 (70) | Sleeves | Cementless | PFC Sigma PS, TC3, S-ROM Noiles, LPS (DePuy) | Cy | 7.6 |
3y-, 5y-, 10y-survival 99.1%, 98.7%, 97.8% |
0% (RLL 2.8% sleeves) | 1.3% | 1.6% ReRTKA |
| Erivan et al. | 2020 | 53 (2) | Cones | Cementless | 70.5% PS, 19.7% CCK, 9.8% Hinged (Zimmer) | Cy | 2 | 5y-survival 93.4% | 3.5% | 7% | 8.8% ReRTKA |
| Klim et al. | 2020 | 93 (52) | Sleeves | Cementless | Complete RKS CCK (DePuy) | Cy | 6.3 | N/A | 0% | 15 | 18.2% ReRTKA |
| Lai et al. | 2020 | 51 (0) | Sleeves | Cementless |
33.3% TC3 (DePuy) 66.7% LCCK (Zimmer) |
Cy | 2 | N/A | N/A | 14.7% | N/A |
| Lee et al. | 2020 | 65 (0) | Cementless | NexGen LCCK (Zimmer) | Cy | > 2 | N/A | 26% | N/A |
RF for f AL: males, bone defect RF for t AL: malalignment |
|
| Panesar et al. | 2021 | 99 (33) | Cementless | S-ROM Noiles RHK (DePuy) | Cy | 7 |
7y-survival 81% Aseptic survival 90% |
2% | 10% | 18.2% ReRTKA, 26% Compli | |
| Gurel et al. | 2021 | 30 (8) | Sleeves | Cementless | Sigma TC3 (DePuy) | Cy | 6.9 | N/A | 0% | 0% | 13.3% ReOP |
| Manopoulos et al. | 2012 | 46 (22) | Sleeves | Cementless | Sigma TC3 (DePuy) | Cy | 8.5 | 10y-survival 90% | 2.2% (RLL 24%) | N/A | 4.3% failures |
| von Hintze et al. | 2021 | 125 (26) |
10% cones |
N/A | NexGen RHK (Zimmer) | Cy | 7.3 median |
10y-survival 82.4% (excl. patella revisions) |
0.8% | 7.2% | 12% failure |
| Müller et al. | 2008 | 89 | N/A | RT-PLUS Solution (Smith&Nephew) | Cy (Co)* | 6.3 | 1y-, 5y-survival 96.2%, 93% | 0.75% | 4.6% | 0% failure | |
| Gililland et al. | 2014 | 82 (0) |
12% Cones/sleeves |
60% cemented |
N/A Constraint: cemented 27%, cementless 94% |
N/A | 6–10 | N/A |
Cemented: 4% Cementless: 3–6% |
Cemented: 0% Cementless: 2.4% |
Failure: 6–8% (cemented), 9–10% (cementless) |
| Fleischman et al. | 2017 | 223 (57) |
36,8% Cones/sleeves |
25% cemented | N/A | N/A | 5.1 |
5y-, 10y- survival 96.5%, 83% (cemented) 95%, 77.2% (cementless) |
Cemented: 6.5% (4.6% clinical, 1.9% radiographic) Cementless: 4.4% (1.9% clinical, 2.5% radiographic) |
Cemented: 7.4% Cementless: 5.7% |
N/A |
| Chalmers et al. | 2021 | 163 (46) | Cones | 26% cemented | VVC (65%) or hinged systems (32%) | N/A | 2.5 | 2y-survival 96% | 1.3% | 10% | 14% ReOP |
| Leta et al. | 2015 | 1016 (0) | 86% cemented | Profix, NexGen, LCS, Genesis, LCS Complete, Duracon | N/A |
4.5 median |
5y-, 10y-, 15y-survival 85%, 78%, 71% |
9% f, 17% t | 28% |
14.3% failure Cemented vs. cementless: no diff |
|
| Kamath et al. | 2015 | 66 (26) | Cones | 94% cemented | 11% PS, 50% VVC, 38% hinged | N/A | 5.7 | Survival 93.9% | 3% (RLL 12%) | 11% | 27% Compli, 24% ReOP |
| Nelson et al. | 2015 | 67 (0) | 95% cemented | N/A | N/A | > 2 | N/A | N/A | N/A | 9% ReRTKA, 9% failure | |
| Howard et al. | 2011 | 24 (7) | Cones | Cemented | Various PS, CCK, RH systems | N/A | 2.8 | N/A | 0% | 0% | 0% ReRTKA, 21% ReOP |
| Potter et al. | 2016 | 157 (47) | Cones | Cemented | 60% CCK, 35% Hinged, 4% PS | N/A | 5 | Survival 70% | 6.4% | 13.4% | 28.7% ReOP |
| Hernandez et al. | 2021 | 62 | Cones | Cemented | 3% UC, 23% PS, 66% VVC, 8% Hinged | N/A | 7.6 | 8y-survival 62% | 12.9% (RLL 30%) | 17.7% | 40.3% ReOP |
| Bohl et al. | 2018 | 98 (24) |
50% Cones |
Cementless | N/A | N/A | 3.5 | N/A | 2% (non-cone) |
8.2% 10% (non-cone) 6% (cone) |
Non-cone: 31% Compli, 28% ReOP Cone: 39% Compli, 32.7% ReOP |
| Vince and Long | 1995 | 44 | N/A | N/A | N/A | 2–6 | N/A | 4.5% | N/A | N/A | |
| Suarez et al. | 2008 | 566 (123) | N/A | N/A | N/A | 3.3 | 12y-survival 82% | 19% | 46% |
12% failure 4.3% vs. 21% ReRTKA (after aseptic vs. septic) |
|
| Aggarwal et al. | 2014 |
(a) age < 50: 84 (19) (b) age > 60: 84 (25) |
N/A | N/A | N/A | 5.6 | 6y-survival 71%a, 66.1%b |
2nd RTKA: 8%a, 13%b 3-5th RTKA: 38%a, 50%b |
2nd RTKA: 32%a, 50%b 3-5th RTKA: 63%a, 50%b |
30% ReOPa 31% ReOPb |
|
| Agarwal et al. | 2019 | 95 (27) | N/A | N/A | N/A | 5.2 | N/A | 30.5% | 32.6% | N/A | |
| Geary et al. | 2020 | 1632 (361) | N/A | N/A | N/A | 5.1 | N/A | 20.9% | 38.5% | 22.8% failure |
FU follow-up, AL aseptic loosening, PJI periprosthetic joint infection, TKA total knee arthroplasty, RTKA revision total knee arthroplasty, f femoral, t tibial, N/A not available, Co conical, Cy cylindrical, Cy-Co cylindrical–conical combined design, y years, RLL radiolucent lines, ReRTKA re-revision of TKA implants, Compli = complications, ReOP re-operation