Patterns of functional improvement after revision knee arthroplasty

Hassan M.K. Ghomrawi, Robert L. Kane, Lynn E. Eberly, Boris Bershadsky, Khaled J. Saleh, Robert Bourne, Charles Clark, Gerard Engh, Terence Gioe, Steven Haas, David Heck, Richard Iorio, Craig Israelite, William Healy, Kenneth Krackow, Paul Lotke, Charles Nelson, William Macaulay, Steve MacDonald, William Mihalko & 8 others Michael Mont, Cecil Rorabeck, Sean Scully, Giles Scuderi, Russell Windsor, Mathias Bostrom, Thomas Sculco, Marc Swiontkowski

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Despite the increase in the number of total knee arthroplasty revisions, outcomes of such surgery and their correlates are poorly understood. The aim of this study was to characterize patterns of functional improvement after revision total knee arthroplasty over a two-year period and to investigate factors that affect such improvement patterns. Methods: Three hundred and eight patients in need of revision surgery were enrolled into the study, conducted at seventeen centers, and 221 (71.8%) were followed for two years. Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lower-Extremity Activity Scale (LEAS) scores were collected at baseline and every six months for two years postoperatively. A piecewise general linear mixed model, which models correlation between repeated measures and estimates separate slopes for different follow-up time periods, was employed to examine functional improvement patterns. Results: Separate regression slopes were estimated for the zero to twelve-month and the twelve to twenty-four-month periods. The slopes for zero to twelve months showed significant improvement in all measures in the first year. The slopes for twelve to twenty-four months showed deterioration in the scores of the WOMAC pain subscale (slope = 0.67 ± 0.21, p < 0.01) and function subscale (slope = 1.66 ± 0.63, p < 0.05), whereas the slopes of the other measures had plateaued. A higher number of comorbidities was consistently the strongest deterrent of functional improvement across measures. The modes of failure of the primary total knee arthroplasty were instrument-specific predictors of outcome (for example, tibial bone lysis affected only the SF-36 physical component score [coefficient =25.46 ± 1.91, p < 0.01], while malalignment affected both the SF-36 physical component score [coefficient = 5.41 ± 2.35, p < 0.05] and the LEAS score [coefficient = 1.42 ± 0.69, p < 0.05]). Factors related to the surgical technique did not predict outcomes. Conclusions: The onset of worsening pain and knee-specific function in the second year following revision total knee arthroplasty indicates the need to closely monitor patients, irrespective of the mode of failure of the primary procedure or the surgical technique for the revision. This information may be especially important for patients with multiple comorbidities. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2838-2845
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume91
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Knee Replacement Arthroplasties
Reoperation
Comorbidity
Lower Extremity
Pain
Ontario
Osteoarthritis
Linear Models
Knee
Bone and Bones

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Ghomrawi, H. M. K., Kane, R. L., Eberly, L. E., Bershadsky, B., Saleh, K. J., Bourne, R., ... Swiontkowski, M. (2009). Patterns of functional improvement after revision knee arthroplasty. Journal of Bone and Joint Surgery - Series A, 91(12), 2838-2845. https://doi.org/10.2106/JBJS.H.00782

Patterns of functional improvement after revision knee arthroplasty. / Ghomrawi, Hassan M.K.; Kane, Robert L.; Eberly, Lynn E.; Bershadsky, Boris; Saleh, Khaled J.; Bourne, Robert; Clark, Charles; Engh, Gerard; Gioe, Terence; Haas, Steven; Heck, David; Iorio, Richard; Israelite, Craig; Healy, William; Krackow, Kenneth; Lotke, Paul; Nelson, Charles; Macaulay, William; MacDonald, Steve; Mihalko, William; Mont, Michael; Rorabeck, Cecil; Scully, Sean; Scuderi, Giles; Windsor, Russell; Bostrom, Mathias; Sculco, Thomas; Swiontkowski, Marc.

In: Journal of Bone and Joint Surgery - Series A, Vol. 91, No. 12, 01.12.2009, p. 2838-2845.

Research output: Contribution to journalArticle

Ghomrawi, HMK, Kane, RL, Eberly, LE, Bershadsky, B, Saleh, KJ, Bourne, R, Clark, C, Engh, G, Gioe, T, Haas, S, Heck, D, Iorio, R, Israelite, C, Healy, W, Krackow, K, Lotke, P, Nelson, C, Macaulay, W, MacDonald, S, Mihalko, W, Mont, M, Rorabeck, C, Scully, S, Scuderi, G, Windsor, R, Bostrom, M, Sculco, T & Swiontkowski, M 2009, 'Patterns of functional improvement after revision knee arthroplasty', Journal of Bone and Joint Surgery - Series A, vol. 91, no. 12, pp. 2838-2845. https://doi.org/10.2106/JBJS.H.00782
Ghomrawi HMK, Kane RL, Eberly LE, Bershadsky B, Saleh KJ, Bourne R et al. Patterns of functional improvement after revision knee arthroplasty. Journal of Bone and Joint Surgery - Series A. 2009 Dec 1;91(12):2838-2845. https://doi.org/10.2106/JBJS.H.00782
Ghomrawi, Hassan M.K. ; Kane, Robert L. ; Eberly, Lynn E. ; Bershadsky, Boris ; Saleh, Khaled J. ; Bourne, Robert ; Clark, Charles ; Engh, Gerard ; Gioe, Terence ; Haas, Steven ; Heck, David ; Iorio, Richard ; Israelite, Craig ; Healy, William ; Krackow, Kenneth ; Lotke, Paul ; Nelson, Charles ; Macaulay, William ; MacDonald, Steve ; Mihalko, William ; Mont, Michael ; Rorabeck, Cecil ; Scully, Sean ; Scuderi, Giles ; Windsor, Russell ; Bostrom, Mathias ; Sculco, Thomas ; Swiontkowski, Marc. / Patterns of functional improvement after revision knee arthroplasty. In: Journal of Bone and Joint Surgery - Series A. 2009 ; Vol. 91, No. 12. pp. 2838-2845.
@article{7fdd3f0712564066a4f7f5d5708e4857,
title = "Patterns of functional improvement after revision knee arthroplasty",
abstract = "Background: Despite the increase in the number of total knee arthroplasty revisions, outcomes of such surgery and their correlates are poorly understood. The aim of this study was to characterize patterns of functional improvement after revision total knee arthroplasty over a two-year period and to investigate factors that affect such improvement patterns. Methods: Three hundred and eight patients in need of revision surgery were enrolled into the study, conducted at seventeen centers, and 221 (71.8{\%}) were followed for two years. Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lower-Extremity Activity Scale (LEAS) scores were collected at baseline and every six months for two years postoperatively. A piecewise general linear mixed model, which models correlation between repeated measures and estimates separate slopes for different follow-up time periods, was employed to examine functional improvement patterns. Results: Separate regression slopes were estimated for the zero to twelve-month and the twelve to twenty-four-month periods. The slopes for zero to twelve months showed significant improvement in all measures in the first year. The slopes for twelve to twenty-four months showed deterioration in the scores of the WOMAC pain subscale (slope = 0.67 ± 0.21, p < 0.01) and function subscale (slope = 1.66 ± 0.63, p < 0.05), whereas the slopes of the other measures had plateaued. A higher number of comorbidities was consistently the strongest deterrent of functional improvement across measures. The modes of failure of the primary total knee arthroplasty were instrument-specific predictors of outcome (for example, tibial bone lysis affected only the SF-36 physical component score [coefficient =25.46 ± 1.91, p < 0.01], while malalignment affected both the SF-36 physical component score [coefficient = 5.41 ± 2.35, p < 0.05] and the LEAS score [coefficient = 1.42 ± 0.69, p < 0.05]). Factors related to the surgical technique did not predict outcomes. Conclusions: The onset of worsening pain and knee-specific function in the second year following revision total knee arthroplasty indicates the need to closely monitor patients, irrespective of the mode of failure of the primary procedure or the surgical technique for the revision. This information may be especially important for patients with multiple comorbidities. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.",
author = "Ghomrawi, {Hassan M.K.} and Kane, {Robert L.} and Eberly, {Lynn E.} and Boris Bershadsky and Saleh, {Khaled J.} and Robert Bourne and Charles Clark and Gerard Engh and Terence Gioe and Steven Haas and David Heck and Richard Iorio and Craig Israelite and William Healy and Kenneth Krackow and Paul Lotke and Charles Nelson and William Macaulay and Steve MacDonald and William Mihalko and Michael Mont and Cecil Rorabeck and Sean Scully and Giles Scuderi and Russell Windsor and Mathias Bostrom and Thomas Sculco and Marc Swiontkowski",
year = "2009",
month = "12",
day = "1",
doi = "10.2106/JBJS.H.00782",
language = "English (US)",
volume = "91",
pages = "2838--2845",
journal = "Journal of Bone and Joint Surgery - Series A",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "12",

}

TY - JOUR

T1 - Patterns of functional improvement after revision knee arthroplasty

AU - Ghomrawi, Hassan M.K.

AU - Kane, Robert L.

AU - Eberly, Lynn E.

AU - Bershadsky, Boris

AU - Saleh, Khaled J.

AU - Bourne, Robert

AU - Clark, Charles

AU - Engh, Gerard

AU - Gioe, Terence

AU - Haas, Steven

AU - Heck, David

AU - Iorio, Richard

AU - Israelite, Craig

AU - Healy, William

AU - Krackow, Kenneth

AU - Lotke, Paul

AU - Nelson, Charles

AU - Macaulay, William

AU - MacDonald, Steve

AU - Mihalko, William

AU - Mont, Michael

AU - Rorabeck, Cecil

AU - Scully, Sean

AU - Scuderi, Giles

AU - Windsor, Russell

AU - Bostrom, Mathias

AU - Sculco, Thomas

AU - Swiontkowski, Marc

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background: Despite the increase in the number of total knee arthroplasty revisions, outcomes of such surgery and their correlates are poorly understood. The aim of this study was to characterize patterns of functional improvement after revision total knee arthroplasty over a two-year period and to investigate factors that affect such improvement patterns. Methods: Three hundred and eight patients in need of revision surgery were enrolled into the study, conducted at seventeen centers, and 221 (71.8%) were followed for two years. Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lower-Extremity Activity Scale (LEAS) scores were collected at baseline and every six months for two years postoperatively. A piecewise general linear mixed model, which models correlation between repeated measures and estimates separate slopes for different follow-up time periods, was employed to examine functional improvement patterns. Results: Separate regression slopes were estimated for the zero to twelve-month and the twelve to twenty-four-month periods. The slopes for zero to twelve months showed significant improvement in all measures in the first year. The slopes for twelve to twenty-four months showed deterioration in the scores of the WOMAC pain subscale (slope = 0.67 ± 0.21, p < 0.01) and function subscale (slope = 1.66 ± 0.63, p < 0.05), whereas the slopes of the other measures had plateaued. A higher number of comorbidities was consistently the strongest deterrent of functional improvement across measures. The modes of failure of the primary total knee arthroplasty were instrument-specific predictors of outcome (for example, tibial bone lysis affected only the SF-36 physical component score [coefficient =25.46 ± 1.91, p < 0.01], while malalignment affected both the SF-36 physical component score [coefficient = 5.41 ± 2.35, p < 0.05] and the LEAS score [coefficient = 1.42 ± 0.69, p < 0.05]). Factors related to the surgical technique did not predict outcomes. Conclusions: The onset of worsening pain and knee-specific function in the second year following revision total knee arthroplasty indicates the need to closely monitor patients, irrespective of the mode of failure of the primary procedure or the surgical technique for the revision. This information may be especially important for patients with multiple comorbidities. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

AB - Background: Despite the increase in the number of total knee arthroplasty revisions, outcomes of such surgery and their correlates are poorly understood. The aim of this study was to characterize patterns of functional improvement after revision total knee arthroplasty over a two-year period and to investigate factors that affect such improvement patterns. Methods: Three hundred and eight patients in need of revision surgery were enrolled into the study, conducted at seventeen centers, and 221 (71.8%) were followed for two years. Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lower-Extremity Activity Scale (LEAS) scores were collected at baseline and every six months for two years postoperatively. A piecewise general linear mixed model, which models correlation between repeated measures and estimates separate slopes for different follow-up time periods, was employed to examine functional improvement patterns. Results: Separate regression slopes were estimated for the zero to twelve-month and the twelve to twenty-four-month periods. The slopes for zero to twelve months showed significant improvement in all measures in the first year. The slopes for twelve to twenty-four months showed deterioration in the scores of the WOMAC pain subscale (slope = 0.67 ± 0.21, p < 0.01) and function subscale (slope = 1.66 ± 0.63, p < 0.05), whereas the slopes of the other measures had plateaued. A higher number of comorbidities was consistently the strongest deterrent of functional improvement across measures. The modes of failure of the primary total knee arthroplasty were instrument-specific predictors of outcome (for example, tibial bone lysis affected only the SF-36 physical component score [coefficient =25.46 ± 1.91, p < 0.01], while malalignment affected both the SF-36 physical component score [coefficient = 5.41 ± 2.35, p < 0.05] and the LEAS score [coefficient = 1.42 ± 0.69, p < 0.05]). Factors related to the surgical technique did not predict outcomes. Conclusions: The onset of worsening pain and knee-specific function in the second year following revision total knee arthroplasty indicates the need to closely monitor patients, irrespective of the mode of failure of the primary procedure or the surgical technique for the revision. This information may be especially important for patients with multiple comorbidities. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=73349103463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73349103463&partnerID=8YFLogxK

U2 - 10.2106/JBJS.H.00782

DO - 10.2106/JBJS.H.00782

M3 - Article

VL - 91

SP - 2838

EP - 2845

JO - Journal of Bone and Joint Surgery - Series A

JF - Journal of Bone and Joint Surgery - Series A

SN - 0021-9355

IS - 12

ER -