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Purpose: The number of Revision TKAs performed continues to increase; however there is limited data on risk factors for failure. Additionally, clinical decisions regarding when and how to revise a failed TKA may be as important as the technical aspects of the procedure. The purpose of this study was to analyze factors predicting repeat revision following aseptic revision TKA.Methods: Of 85,769 primary TKAs recorded on the New Zealand National Joint Registry, 1720 patients undergoing subsequent revision for aseptic indications between January 1999 and December 2015 were identified. Re-revision was recorded in 208 patients (12.1%). The analysis included demographic characteristics, surgeon revision case volume, surgical time, surgical ownership of index TKA as independent variables using logistic and linear regression. The primary outcome measure was incidence of subsequent re-revision and Oxford Knee Scores of revised TKAs (OKS). The secondary outcome measure was the influence of component exchange in major revisions on re-revision rate.Results: Younger patients undergoing a revision (HR 0.974) and male gender (HR 0.666) were predictors of re-revision. Elapsed time since index surgery (unstandardized coefficient 0.060) and lower ASA score (UC - 2.749) were significant predictors of OKS. Femoral component revision was a predictor of re-revision (HR 1.696) and had the lowest OKS, compared to tibial and all component revision (p = 0.003).Conclusions: Repeat revision TKA is a rare and complex procedure influenced by a number of confounding factors. Using raw registry data, younger and male patients were found to be at a higher risk of re-revision after aseptic revision TKA. A longer time between primary TKA and revision was associated with better clinical outcomes. Isolated femoral component exchange led to worse outcomes both in terms of survivorship and functional scores.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the effects of different disinfectants in preventing pin-site infection. A total of 32 healthy New Zealand white rabbits were selected as the research subjects. The rabbits were placed in an Ilizarov 3/4 circular external fixator for a period of time after feeding. They were then divided into four groups of eight animals each. After surgery, pin-site nursing was performed twice a day with a different disinfectant for each group (chlorhexidine gluconate alcohol disinfectant, Maokang iodine, 75% alcohol and physiological saline). Each pin site's surrounding conditions were visually observed daily, and bacterial culture of the pin-site secretions was promptly performed. The changes of C-reactive protein (CRP) and white blood cell upon the first day, first week, second week, fourth week, and sixth week after the operation were compared, as were infection statuses and morphological changes in the surrounding tissue at the sixth week post operation. The differences in the CRP and white blood cell values and infection rates among the four groups were found to be statistically significant (P < 0.05), but the difference in infection levels among the four groups was not statistically significant (P>0.05). In addition, the difference in the pathologically inflammatory cells among the four groups at the sixth week post operation was statistically significant (P < 0.05).It was concluded that the effect of chlorhexidine gluconate alcohol disinfectant in preventing pin-site infection was superior compared to the other three disinfectants. [ABSTRACT FROM AUTHOR]