Abstract
Revision total knee arthroplasty (TKA) is becoming increasingly common as the population ages and the number of existing primary TKAs continues to increase. Revision TKA systems use a greater range of component modularity than primary TKA systems, including stems, augments, and varying levels of constraint. The purpose of this study was to retrospectively review the authors' institution's use of one specific revision knee implant system and its midterm results. The Vanguard SSK Revision Knee System (Biomet, Warsaw, Indiana) was implanted 297 times in 272 patients between 2005 and 2013. Average patient age was 67.2 years, average body mass index was 33 kg/m2, and average follow-up was 4.8 years. The most common diagnoses leading to use of this system were failed previous TKA (45.5%) and periprosthetic infection (23.2%). The SSK system was used in 78 (26.3%) complex primary TKAs at the discretion of the operating surgeon. There were 22 failures: 12 septic and 10 aseptic. Of the 12 infections, 6 occurred after 2-staged treatment of periprosthetic joint infection, with all 6 of these reinfections having a different causative organism. Aseptic failures included aseptic loosening (n=3), periprosthetic fracture (n=2), patellar maltracking (n=2), instability (n=1), arthrofibrosis (n=1), and extensor mechanism disruption (n=1). Aseptic implant survivorship was 97.2%, 95.6%, 93.1%, and 93.1% at 1, 3, 5, and 7 years postoperatively, respectively. The Vanguard SSK demonstrates excellent performance at medium-range follow-up with respect to complications, clinical scores, and prosthesis survivorship. [Orthopedics.2016; 39(5):e833–e837.]
- 1.Bourne RB, Crawford HA. Principles of revision total knee arthroplasty. Orthop Clin North Am. 1998; 29(2):331–337.
10.1016/S0030-5898(05)70331-X Crossref Medline, Google Scholar - 2.Riaz S, Umar M. Revision knee arthroplasty. J Pak Med Assoc. 2006; 56(10):456–460. Medline, Google Scholar
- 3.Bohl DD, Samuel AM, Basques BA, Della Valle CJ, Levine BR, Grauer JN. How much do adverse event rates differ between primary and revision total joint arthroplasty?J Arthroplasty. 2016; 31(3):596–602.
10.1016/j.arth.2015.09.033 Crossref Medline, Google Scholar - 4.Stambough JB, Clohisy JC, Barrack RL, Nunley RM, Keeney JA. Increased risk of failure following revision total knee replacement in patients aged 55 years and younger. Bone Joint J. 2014; 96(12):1657–1662.
10.1302/0301-620X.96B12.34486 Crossref Medline, Google Scholar - 5.Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH. Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res. 2002; 404:158–168.
10.1097/00003086-200211000-00028 Crossref, Google Scholar - 6.Rodríguez-Merchán EC, Gómez-Cardero P, Martínez-Lloreda Á. Revision knee arthroplasty with a rotating-hinge design in elderly patients with instability following total knee arthroplasty. J Clin Orthop Trauma. 2015; 6(1):19–23.
10.1016/j.jcot.2014.11.001 Crossref Medline, Google Scholar - 7.Camera A, Biggi S, Cattaneo G, Brusaferri G. Ten-year results of primary and revision condylar-constrained total knee arthroplasty in patients with severe coronal plane instability. Open Orthop J. 2015; 9:379–389.
10.2174/1874325001509010379 Crossref Medline, Google Scholar - 8.De Martino I, De Santis V, Sculco PK, D'Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res. 2015; 473(10):3176–3182.
10.1007/s11999-015-4338-2 Crossref Medline, Google Scholar - 9.Kamath AF, Lewallen DG, Hanssen AD. Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am. 2015; 97(3):216–223.
10.2106/JBJS.N.00540 Crossref Medline, Google Scholar - 10.Indelli PF, Giori N, Maloney W. Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med. 2015; 8(4):390–397.
10.1007/s12178-015-9295-6 Crossref Medline, Google Scholar - 11.Bugbee WD, Ammeen DJ, Engh GA. Does implant selection affect outcome of revision knee arthroplasty?J Arthroplasty. 2001; 16(5):581–585.
10.1054/arth.2001.23722 Crossref Medline, Google Scholar - 12.Ritter MA, Davis KE, Davis P, Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg Am. 2013; 95(2):126–131.
10.2106/JBJS.K.00607 Crossref Medline, Google Scholar - 13.Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res. 2010; 468(11):3070–3076.
10.1007/s11999-010-1399-0 Crossref Medline, Google Scholar - 14.Mabry TM, Vessely MB, Schleck CD, Harmsen WS, Berry DJ. Revision total knee arthroplasty with modular cemented stems: long-term follow-up. J Arthroplasty. 2007; 22(6 suppl 2):100–105.
10.1016/j.arth.2007.03.025 Crossref Medline, Google Scholar - 15.Sheng PY, Konttinen L, Lehto M, Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2006; 88(7):1425–1430.
10.2106/JBJS.E.00737 Crossref Medline, Google Scholar - 16.Meding JB, Ritter MA, Davis KE, Farris A. Meeting increased demand for total knee replacement and follow-up: determining optimal follow-up. Bone Joint J. 2013; 95(11):1484–1489.
10.1302/0301-620X.95B11.32467 Crossref Medline, Google Scholar - 17.Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009; 24(suppl 6):84–88.
10.1016/j.arth.2009.05.016 Crossref Medline, Google Scholar - 18.Goldman RT, Scuderi GR, Insall JN. Two-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res. 1996; 331:118–124.
10.1097/00003086-199610000-00016 Crossref, Google Scholar - 19.Haleem AA, Berry DJ, Hanssen AD. Midterm to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res. 2004; 428:35–39.
10.1097/01.blo.0000147713.64235.73 Crossref, Google Scholar - 20.Whaley AL, Trousdale RT, Rand JA, Hanssen AD. Cemented long-stem revision total knee arthroplasty. J Arthroplasty. 2003; 18(5):592–599.
10.1016/S0883-5403(03)00200-6 Crossref Medline, Google Scholar - 21.Vince KG, Long W. Revision knee arthroplasty: the limits of press fit medullary fixation. Clin Orthop Relat Res. 1995; 317:172–177 Google Scholar
- 22.Gililland JM, Gaffney CJ, Odum SM, Fehring TK, Peters CL, Beaver WB. Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA. J Arthroplasty. 2014; 29(suppl 9):224–228.
10.1016/j.arth.2014.03.049 Crossref Medline, Google Scholar

