A novel quantitative grading system for implant fixation in revision total knee arthroplasty.

Autor:	d'Amato M; Institute for Complex Arthroplasty and Revisions (ICAR), IFCA Clinic, Firenze, Italy., Flevas DA; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA., Salari P; Institute for Complex Arthroplasty and Revisions (ICAR), IFCA Clinic, Firenze, Italy., Bornes TD; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA.; Division of Orthopaedic Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada., Brenneis M; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA.; Department of Orthopedics (Friedrichsheim), Goethe University, University Hospital Frankfurt, Frankfurt, Germany., Boettner F; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA., Sculco PK; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA., Baldini A; Institute for Complex Arthroplasty and Revisions (ICAR), IFCA Clinic, Firenze, Italy.
Jazyk:	angličtina
Zdroj:	The bone & joint journal [Bone Joint J] 2024 May 01; Vol. 106-B (5), pp. 468-474. Date of Electronic Publication: 2024 May 01.
DOI:	10.1302/0301-620X.106B5.BJJ-2023-0944.R1
Abstrakt:	Aims: Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis). Methods: Based on pre-, intra-, and postoperative assessments, the novel grading system allocates a quantitative score (0, 0.5, or 1 point) for the quality of fixation achieved in each anatomical zone. The criteria used by the algorithm to assign the score include the bone quality, the size of the bone defect, and the type of fixation used. A consecutive cohort of 245 patients undergoing rTKA from 2012 to 2018 were evaluated using the current novel scoring system and followed prospectively. In addition, 100 first-time revision cases were assessed radiologically from the original cohort and graded by three observers to evaluate the intra- and inter-rater reliability of the novel radiological grading system. Results: At a mean follow-up of 90 months (64 to 130), only two out of 245 cases failed due to aseptic loosening. Intraoperative grading yielded mean scores of 1.87 (95% confidence interval (CI) 1.82 to 1.92) for the femur and 1.96 (95% CI 1.92 to 2.0) for the tibia. Only 3.7% of femoral and 1.7% of tibial reconstructions fell below the 1.5-point threshold, which included the two cases of aseptic loosening. Interobserver reliability for postoperative radiological grading was 0.97 for the femur and 0.85 for the tibia. Conclusion: A minimum score of 1.5 points for each skeletal segment appears to be a reasonable cut-off to define sufficient fixation in rTKA. There were no revisions for aseptic loosening at mid-term follow-up when this fixation threshold was achieved or exceeded. When assessing first-time revisions, this novel grading system has shown excellent intra- and interobserver reliability. Competing Interests: A. Baldini reports royalties or licenses from ZimmerBiomet, consulting fees from Permedica, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Convatec, Avanos, Molnlycke, and Ethicon, and a leadership or fiduciary role in the European Knee Society, all of which are unrelated to this study. M. d'Amato reports consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker, unrelated to this study. P. K. Sculco reports royalties or licenses from Lima Corporate, and consulting fees from Lima Corporate and Zimmer Biomet, all of which are unrelated to this study. (© 2024 The British Editorial Society of Bone & Joint Surgery.)
Databáze:	MEDLINE
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