Two research teams, one from NYU Langone Health in New York City and Tel-Aviv University in Israel designed a head-to-head study, pitting partial knee arthroplasty against full-component arthroplasty exchange in cases of aseptic revision total knee arthroplasty (TKA).
Reducing TKA Re-Revision Rates
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Their work, “Comparison of Aseptic Partial- and Full-Component Revision Total Knee Arthroplasty,” was published in the November 8, 2022, edition of The Journal of Arthroplasty.
“As revision TKA becomes more prevalent,” explained co-author Ran Schwarzkopf, M.D., M.Sc. to OTW, “due to the total increase in TKAs done, it is important to understand the differences in outcomes between partial and full TKA revision. A one component revision can carry less morbidity, decreased costs, and possible quicker recovery.”
The Associate Chief Division of Adult Reconstruction at NYU Langone Health Dr. Schwarzkopf and his colleagues collected data for patients who were treated with aseptic revision TKA (rTKA) between September 23, 2011, and December 6, 2019—18 adult reconstruction fellowship-trained surgeons performed the cases.
The final study group—293 patients—were separated into two cohorts.
Patients in one group underwent full-revision TKA (revision of the femoral component, tibial baseplate, and polyethylene liner with or without revision of the patellar button), while those in the partial revision group required revision of either the femoral component or tibial baseplate (in addition to exchange of the polyethylene liner).
The team found significantly shorter surgical time for partial revision TKA patients (109 ± 37 versus 141 ± 44 minutes). At mean follow-up of 4.2 years, re-revision rates did not significantly differ between groups (11.8 % vs 16.1%). The research team also found similar improvements in postoperative Visual Analogue Scale pain and Knee Injury and Osteoarthritis Scale, and Joint Replacement scores.
The researchers found that for those undergoing rTKA due to aseptic loosening, freedom from re-revision due to aseptic loosening was similar between groups (100% vs 97.8%). For patients undergoing rTKA due to instability, freedom from re-revision due to instability did not significantly differ (100% vs 98.1%). In the partial rTKA cohort, freedom from all-cause and aseptic revision of preserved components was 96.1% and 98.7% at two years.
“It is important to note that this was not a randomized study but an observational one,” said Dr. Schwarzkopf to OTW, “and as such it can be biased based on surgeon preference. But we do feel that well indicated cases that can be treated with a partial component revision can have equally favorable results when compared to full component revision.”
Concerning future related work, he added, “We will continue and follow, with our revision TJA registry, all cases of TKA revision and try and help guide surgeons as to the best revision option for each etiology with the goal of improving outcomes and decreasing costs.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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