The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty
Amy J. Garner, BMBCh (Oxon), MRCS, MA (Oxon), PGDipLATHE (Dist. Oxon), Orthopaedic and Trauma Higher Specialty Trainee and PhD Candidate, 1 , 2 , 3 Thomas C. Edwards, BSc, MRCS, Orthopaedic and Trauma Higher Specialty Trainee and PhD Candidate, 1 Alexander D. Liddle, PhD, FRCS (Tr&Orth), Orthopaedic and Trauma Consultant and Senior Lecturer, 1 Gareth G. Jones, PhD, FRCS (Tr&Orth), Orthopaedic and Trauma Consultant and Senior Lecturer, 1 and Justin P. Cobb, PhD, FRCS (Tr&Orth), Professor of Orthopaedic Surgery 1Knee
Aims
Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics.
Methods
Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system.
Results
Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall’s W 0.97; p < 0.005), rising to 93% in round two (Kendall’s W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall’s W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall’s W 0.92; p < 0.001).
Conclusion
The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It has been shown to be reliable, repeatable and pragmatic. The implications for patient care and health economics are discussed.
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