Revision total knee arthroplasty using a fully cemented single-radius condylar constrained prosthesis has excellent ten-year survival and improvements in outcome measures
Bibliographic record
Abstract
Aims: The aim of this study was to describe the long-term outcomes following revision total knee arthroplasty (RTKA) using a fully cemented condylar constrained knee (CCK) arthroplasty. Methods: This retrospective study included a consecutive series of patients who underwent RTKA using CCK components (Triathlon Total Stabilizer) in a non-designer centre, between 1 January 2008 and 31 December 2019. There were 344 patients, who underwent 358 revision procedures (330 unilateral and 14 staged bilateral). Their median age was 70.5 years (IQR 63 to 77) and 197 (55.0%) were female. The SPECIFIC criteria were used to define the mode of failure. The median follow-up was 9.8 years (IQR 6.7 to 13.4). Patient-reported outcome measures (PROMs) were collected prospectively (preoperatively, at one year, and at final follow-up (mean 9 years (4 to 16)), using the Oxford Knee Score (OKS) and the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Results: The indications for RTKA were loosening (n = 131, 36.6%), instability (n = 124, 34.6%), or infection (n = 54, 15.1%). At final follow-up, 102 patients (28.5%) had died, and 30 patients (30 RTKAs; 8.4%) had undergone at least one re-revision, which consisted of secondary patellar resurfacing and/or polyethylene exchange in ten patients (33.3%). The overall ten-year survival was 91.7% (95% CI 88.6 to 94.9); however, this differed significantly (p = 0.029) according to the indication for revision: aseptic loosening, 96.0% (95% CI 92.6 to 99.5); infection, 86.6% (95% CI 77.8 to 96.4); and instability, 85.3% (95% CI 77.4 to 93.9). There were significant (p < 0.001) improvements in PROMs at one year (OKS mean change (MC), 12 (95% CI 11 to 14); and EQ-5D-3L MC, 0.214 (95% CI 0.11 to 0.31)), which were sustained at the final follow-up (OKS MC, 9 (95% CI 7 to 11); and EQ-5D-3L MC, 0.172 (95% CI 0.09 to 0.23)). The patients who underwent revision for aseptic loosening had significantly better OKSs compared with those who underwent revision for infection or instability at both one year (p = 0.008) and at the final follow-up (p = 0.024). Conclusion: RTKA using a cemented CCK arthroplasty had excellent ten-year survival and clinically meaningful improvements in PROMs. However, revision for instability or infection was associated with significantly worse survival and PROMs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".