Evidence map›Paper›PMID 34392701›Full record

ArticleBone & joint open2021

The revision partial knee classification system: understanding the causative pathology and magnitude of further surgery following partial knee arthroplasty.

Amy J Garner, Thomas C Edwards, Alexander D Liddle, Gareth G Jones, Justin P Cobb

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bone & joint open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. AI classification of knee prostheses from plain radiographs and real-world applications.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
    Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Amy J GarnerMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.ORCID https://orcid.org/0000-0001-7839-0641
Thomas C EdwardsMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.
Alexander D LiddleMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.
Gareth G JonesMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.
Justin P CobbMSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsJoint 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.

methodsClassification 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.

resultsFour 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).

conclusionThe 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. Cite this article:

Indexed as

anterior cruciate ligamentarthroplastyArthroplastybone-implantClassificationCompartmentalComplexitycorrelation coefficientKneekneesPartialpartial knee arthroplastyPatient SafetyRevisionrevision surgerytibial componentstotal knee arthroplasty (TKA)total knee prosthesis

Identifiers

PMID34392701
PMCPMC8384450

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.