J R A Phillips1, L Al-Mouazzen2, R Morgan-Jones3, J R Murray2, A J Porteous2, A D Toms4. 1. Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK. jonphillips@nhs.net. 2. Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, UK. 3. University Hospital Llandough, Penlan Road, Cardiff, UK. 4. Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK.
Abstract
PURPOSE: There is considerable variation in practice throughout Europe in both the services provided and in the outcomes of Revision Knee Surgery. In the UK, a recent report published called get it right first time (GIRFT) aims to improve patient outcomes through providing high quality, cost-effective care, and reducing complications. This has led to the development of a classification system that attempts to classify the complexity of revision knee surgery, aiming to encourage and support regional clinical networking. METHODS: The revision knee classification system (RKCC) incorporates not only complexity, but also patient factors, the presence of infection, the integrity of the extensor mechanism, and the soft tissues. It then provides guidance for clinical network discussion. Reliability and reproducibility testing have been performed to establish the inter- and intra-observer variabilities using this classification. RESULTS: Good correlation between first attempt non-expert and experts, good intra-observer variability of non-expert, and an excellent correlation between second attempt non-expert and experts has been achieved. This supports the use of RKCC by both inexperienced and experienced surgeons. CONCLUSIONS: The revision knee complexity classification has been proposed that offers a common-sense approach to recognize the increasing complexity in revision TKR cases. It provides a methodological assessment of revision knee cases and support regional clinical networking and triage of appropriate cases to revision units or specialist centres. LEVEL OF EVIDENCE: Expert opinion, Level V.
PURPOSE: There is considerable variation in practice throughout Europe in both the services provided and in the outcomes of Revision Knee Surgery. In the UK, a recent report published called get it right first time (GIRFT) aims to improve patient outcomes through providing high quality, cost-effective care, and reducing complications. This has led to the development of a classification system that attempts to classify the complexity of revision knee surgery, aiming to encourage and support regional clinical networking. METHODS: The revision knee classification system (RKCC) incorporates not only complexity, but also patient factors, the presence of infection, the integrity of the extensor mechanism, and the soft tissues. It then provides guidance for clinical network discussion. Reliability and reproducibility testing have been performed to establish the inter- and intra-observer variabilities using this classification. RESULTS: Good correlation between first attempt non-expert and experts, good intra-observer variability of non-expert, and an excellent correlation between second attempt non-expert and experts has been achieved. This supports the use of RKCC by both inexperienced and experienced surgeons. CONCLUSIONS: The revision knee complexity classification has been proposed that offers a common-sense approach to recognize the increasing complexity in revision TKR cases. It provides a methodological assessment of revision knee cases and support regional clinical networking and triage of appropriate cases to revision units or specialist centres. LEVEL OF EVIDENCE: Expert opinion, Level V.
Authors: M R Stephens; W G Lewis; A E Brewster; I Lord; G R J C Blackshaw; I Hodzovic; G V Thomas; S A Roberts; T D L Crosby; C Gent; M C Allison; K Shute Journal: Dis Esophagus Date: 2006 Impact factor: 3.429
Authors: Steven M Kurtz; Kevin L Ong; Jordana Schmier; Fionna Mowat; Khaled Saleh; Eva Dybvik; Johan Kärrholm; Göran Garellick; Leif I Havelin; Ove Furnes; Henrik Malchau; Edmund Lau Journal: J Bone Joint Surg Am Date: 2007-10 Impact factor: 5.284
Authors: Nicholas E Marlow; Bruce Barraclough; Neil A Collier; Ian C Dickinson; Jonathon Fawcett; John C Graham; Guy J Maddern Journal: ANZ J Surg Date: 2010-04 Impact factor: 1.872
Authors: Kayode O Oduwole; Diarmuid C Molony; Ray J Walls; Simi P Bashir; Kevin J Mulhall Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-02-11 Impact factor: 4.342
Authors: Curtis L Cetrulo; Travis Shiba; Michael T Friel; Brian Davis; Rudolph F Buntic; Gregory M Buncke; Darrell Brooks Journal: Microsurgery Date: 2008 Impact factor: 2.425
Authors: Edward J McPherson; Chris Woodson; Paul Holtom; Nikolaos Roidis; Chrissandra Shufelt; Michael Patzakis Journal: Clin Orthop Relat Res Date: 2002-10 Impact factor: 4.176
Authors: Jonathan R A Phillips; Andrew D Toms; Roland Becker; Michael T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-03-09 Impact factor: 4.342
Authors: Justin W Y Leong; Rohit Singhal; Michael R Whitehouse; Jonathan R Howell; Andrew Hamer; Vikas Khanduja; Tim N Board Journal: Bone Jt Open Date: 2022-05
Authors: Shiraz A Sabah; Lennart von Fritsch; Tanvir Khan; Alexander D Shearman; Raja Bhaskara Rajasekaran; David J Beard; Andrew J Price; Abtin Alvand Journal: J Exp Orthop Date: 2022-04-14