Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review

• Published in: Systematic reviews 2023-08, Vol.12 (1), p.133-133, Article 133
• Main Authors: Sabah, Shiraz A, Hedge, Elizabeth A, von Fritsch, Lennart, Xu, Joshua, Rajasekaran, Raja Bhaskara, Hamilton, Thomas W, Shearman, Alexander D, Alvand, Abtin, Beard, David J, Hopewell, Sally, Price, Andrew J
• Format: Article
• Language: English
• Subjects: Arthritis; Arthroplasty; Arthroplasty, Replacement, Knee - adverse effects; Comorbidity; Complications; Decision making; Estimates; Hospitals; Humans; Infections; Joint replacement surgery; Knee; Knee Joint - surgery; Mortality; Patient reported outcome measures; Patients; Prosthesis Failure; Quality of Life; Reoperation - adverse effects; Reporting requirements; Revision/reoperation; Surgeons; Systematic review; Total knee replacement; Treatment Outcome
• ISSN: 2046-4053; 2046-4053
• DOI: 10.1186/s13643-023-02290-6

The aim of this systematic review was to summarise the evidence for the clinical effectiveness of revision knee arthroplasty (rKA) compared to non-operative treatment for the management of patients with elective, aseptic causes for a failed knee arthroplasty. MEDLINE, Embase, AMED and PsychINFO were searched from inception to 1st December 2020 for studies on patients considering elective, aseptic rKA. Patient-relevant outcomes (PROs) were defined as implant survivorship, joint function, quality of life (QoL), complications and hospital admission impact. No studies compared elective, aseptic rKA to non-operative management. Forty uncontrolled studies reported on PROs following elective, aseptic rKA (434434 rKA). Pooled estimates for implant survivorship were: 95.5% (95% CI 93.2-97.7%) at 1 year [seven studies (5524 rKA)], 90.8% (95% CI 87.6-94.0%) at 5 years [13 studies (5754 rKA)], 87.4% (95% CI 81.7-93.1%) at 10 years [nine studies (2188 rKA)], and 83.2% (95% CI 76.7-89.7%) at 15 years [two studies (452 rKA)]. Twelve studies (2382 rKA) reported joint function and/or QoL: all found large improvements from baseline to follow-up. Mortality rates were low (0.16% to 2% within 1 year) [four studies (353064 rKA)]. Post-operative complications were common (9.1 to 37.2% at 90 days). Higher-quality evidence is needed to support patients with decision-making in elective, aseptic rKA. This should include studies comparing operative and non-operative management. Implant survivorship following elective, aseptic rKA was ~ 96% at 1 year, ~ 91% at 5 years and ~ 87% at 10 years. Early complications were common after elective, aseptic rKA and the rates summarised here can be shared with patients during informed consent. PROSPERO CRD42020196922.