Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model

Purpose The number of revision total knee arthroplasties (rTKA) is increasing. Unfortunately, not all patients benefit from revision surgery. The aim of this study was to develop a clinical prediction model that can be used to predict the functional outcome 5 years after rTKA. Methods Data of patients receiving rTKA at Sint Maartenskliniek, Nijmegen, The Netherlands, from 2004 onwards were prospectively collected. Demographic and clinical variables and patient-reported outcome scores were collected and considered as potential predictors. Beneficial outcome was defined as an increase of ≥ 20 points on the functional knee society scores (fKSS) or an absolute fKSS ≥ 80 points 5 years after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. Results Overall, 295 rTKA patients were included of whom 157 (53%) had beneficial fKSS 5 years later. Age, gender, femoral bone defects, preoperative fKSS, and stiffness as reason for revision were included in the model. Men had a higher chance of beneficial fKSS than women (OR 1.59, 95% CI 0.91–2.78). Patients with major bone defects (OR 0.44, 95% CI 0.22–0.85), higher age (IQR OR 0.39, 95% CI 0.26–0.58), higher preoperative fKSS (IQR OR 0.42, 95% CI 0.30–0.59), and severe stiffness (OR 0.48, 95% CI 0.20–1.15) had a lower chance of successful outcome. The model’s AUC was 0.76, 95% CI 0.70–0.81. Conclusion Easily determinable characteristics of patients who need rTKA can be used to predict future functional outcome. Young men with low preoperative fKSS without severe stiffness are more likely to achieve a beneficial outcome. Level of evidence IV.