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Major Aseptic Revision Following Total Knee Replacement

A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry

Jorgensen, Nicholas B., MBBS, BSc1; McAuliffe, Michael, FRACS, MBBS1,2; Orschulok, Thomas, MBBS, BPthy(Hons)1; Lorimer, Michelle F., BSc(Hons)3; de Steiger, Richard, MBBS, DipBiom, FRACS, FAOrthA4,5

doi: 10.2106/JBJS.17.01528
Scientific Articles
Supplementary Content

Background: Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).

Methods: The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.

Results: There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.

Conclusions: Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics, Ipswich General Hospital, Ipswich, Queensland, Australia

2St Andrews Hospital, Ipswich, Queensland, Australia

3South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia

4Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia

5Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia

E-mail address for N.B. Jorgensen:

Investigation performed at the Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia

Disclosure: No external funding was received for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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