A 4- to 10-year follow-up study of the Tricon-M noncemented total knee replacement.

This study reviews the clinical and radiographic results of 207 consecutive noncemented Tricon-M (Smith & Nephew Inc, Memphis, Tenn) total knee replacements (TKRs) in 189 patients. The patella was surfaced in 119 cases, and mean follow-up was 8 years (range: 4-10 years). At final follow-up, mean Hospital for Special Surgery score improved 45 points in 187 cases. Survivorship, with failure defined as the need for revision, was 98% at 4 years, 97% at 7 years, 94% at 8 years, and 90% at 10 years. Twenty-one (11.3%) patients went on to revision. Results for overweight and obese patients did not differ significantly from normal-weight patients. The noncemented Tricon-M TKR prosthesis yields acceptable results; however, patella surfacing and the use of a tibial polyethylene insert > or = 12 mm thick are recommended.     

Long-term results of Alpina Postero-stabilized total knee replacement: 10- to 16-year follow-up

One hundred and ninety-four primary knee arthroplasties were done between 1992 and 1998 with Alpina Postero-Stabilized prosthesis. Eighty-eight knees were available for the long-term follow-up at a mean of 12?years. The mean IKS score improved from 103.1?±?21.9 points preoperatively to 161.5?±?25.6 at the latest follow-up (P?<?0.001). Eighty-four percent of the knees were rated good and excellent. The mean flexion significantly improved from 110° preoperatively to 117.5° at the latest follow-up (P?<?0.001). Two knees were revised: 1 due to infection and 1 due to femorotibial malalignment. Eight other knees were revised: 7 for isolated patella addition, 1 for patella replacement. Excluding patella failure, the 12-year Kaplan-Meier survivorship for the entire cohort was 98.8 (95% CI, 97.2–100%). Alpina Postero-Stabilized TKA showed good long-term results.     

The total condylar prosthesis. 10- to 12-year results of a cemented knee replacement

Over a two-year period 104 patients had 130 knee arthroplasties performed with the total condylar prosthesis at the Hospital for Special Surgery. At a 10- to 12-year review 58 patients (74 knees) had survived and were available for detailed clinical and radiographic evaluation. Of these, 38 knees (51.3%) were rated as excellent and 27 (36.5%) good. There were three (4.0%) fair and six (8.2%) poor results. Five of the six had had revision operations. The success of this early pattern of prosthesis supports the continued use of methacrylate cement for knee arthroplasties.     

Kinematic total knee arthroplasty: a 10- to 14-year prospective follow-up review.

To understand better the type and incidence of long-term complications in total knee replacement, 306 primary Kinematic total knee arthroplasties performed between June 1978 and December 1982 were prospectively reviewed in detail. The Kinematic knee is a nonconstrained, posterior cruciate-retaining prosthesis that has right and left femoral components to afford anatomic tracking of the patella. The overall revision rate was 6.5%. The most common cause for revision surgery was patellar complications. Ten revisions (3.06%) were for patellar component loosening. Two knees were revised for patella subluxation (0.65%); 1 was in a resurfaced rheumatoid patella, and 1 in an unsurfaced osteoarthritic patella. Stair climbing was better with an unsurfaced patella. Anterior knee pain was 21.8% in the unsurfaced patella and 11.2% in the replaced patella. These data suggest patella replacement is not appropriate with this design.     

Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results

Patellar resurfacing in total knee arthroplasty is a topic debated in the literature. Concerns include fracture, dislocation, loosening, and extensor mechanism injury. Residual anterior knee pain has been reported when the patella is not resurfaced. One hundred patients with osteoarthritic knees were prospectively randomized to either have their patella resurfaced or left not resurfaced. All patients were treated with a single prosthesis that featured an anatomically designed patellofemoral articulation (Anatomic Medullary Knee, DePuy, Warsaw, IN) Two patients in the unresurfaced group and one in the resurfaced group required repeat surgery for patellofemoral complications. At 8- to 10-year follow-up evaluations, Knee Society Clinical Ratings scores were not different between the 2 groups. Rates of anterior knee pain with walking and stair climbing were significantly less in the resurfaced group. Eighty percent of patients with a resurfaced patella were extremely satisfied with their total knee arthroplasty versus 48% without patellar resurfacing. When satisfied and extremely satisfied patients were grouped together, there was no difference between the 2 groups.     

Unicompartmental knee replacement in osteoarthritis: An 8-year follow-up

Summary Between 1972 and 1974, 34 patients with medial osteoarthritis in the knee were operated on with unicompartmental femorotibial replacement. Four patients were reoperated on, three of whom had had a McIntosh inlay prior to the operation. Seven patients had died and two were lost at the follow-up which took place on average 8 years (7–10 years) after the operation. Of 21 re-examined knees, 14 were rated as successful or acceptable.

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Zusammenfassung Zwischen 1972 and 1974 wurden 34 Patienten mit medialer Knieosteoarthritis mit einem unikompartmentellen Femur-Tibia-Ersatz operiert. Vier Patienten wurden reoperiert (drei von diesen hatten vor der Operation eine McIntosh-Prothese). Sieben waren gestorben, and zwei waren unerreichbar bei der Kontrolle, welche ungefähr 8Jahre (7–10 Jahre) nach der Operation durchgeführt wurde. Von 21 wieder kontrollierten Knien konnten 14 als erfolgreich oder akzeptabel bezeichnet werden.

     

The press-fit condylar total knee system: 8- to 10-year results with a posterior cruciate-retaining design

A total of 108 consecutive Press-Fit Condylar total knee arthroplasties were performed in 94 patients. All patients had implantation with a cemented posterior cruciate-retaining design, which included resurfacing of the patella. Mean age at surgery was 70 years (range, 35-87 years). Patients were followed for a mean of 9 years (range, 8-10 years) with follow-up for all surviving patients. The average postoperative functional knee score was 96 points. Nonprogressive radiolucent lines were present in 59%. One patellar component was radiographically loose. Five knees underwent revision procedures, none for aseptic loosening. Survivorship was 93.4% at 9 years with revision for any reason as the endpoint and 98.7% with aseptic loosening as the endpoint. This knee arthroplasty shows excellent results at 8 to 10 years with no patients lost to follow-up.     

The Insall-Burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up.

A total of 99 Insall-Burstein posterior stabilized (IBPS) knee replacements were implanted in 86 osteoarthritic patients. We reviewed 60 knees with a 10- to 15-year follow-up. Using the Knee Society score, 35 knees (58%) were excellent, 15 (25%) good, 4 (7%) fair, and 6 (10%) poor. Flexion at follow-up was 106 degrees on average. Moderate patellofemoral crepitation was present in 5 knees (9%), and 11 knee required excision of a synovial nodule proximal to the patella. Radiographic analysis showed 5 osteolytic lesions (8%) around well-fixed tibial and femoral components and minimal (1 mm) narrowing of the medial polyethylene thickness in 7 knees (12%). There were 6 (10%) failures requiring reoperation because of aseptic loosening (4 knees), deep infection (1 knee), and recurrent patellar dislocation (1 knee). Survivorship analysis using revision as the endpoint showed a cumulative success rate of 92% at 10 years. In this study, the IBPS knee has shown good long-term results with low rates of aseptic loosening and no failures attributable to polyethylene wear.     

Five- to 8-year results of the uncemented Duracon total knee arthroplasty system

We report prospective clinical and radiographic outcomes of a series of 219 hydroxyapatite-coated Duracon (Stryker Howmedica Osteonics Corporation, Kalamazoo, Mich) total knee arthroplasties with a follow-up of 5 to 8 years. Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and SF-12 Health Status Questionnaire were used. Analysis of fluoroscopic radiographs was performed with the American Knee Society Score. All living patients (186 knees) were followed up. Twenty-eight patients (30 knees) had died. The preoperative Knee Society Score of 43.8 increased to 77.1 and the preoperative Function score of 20.3 increased to 63.4. WOMAC scores showed marked improvement (pain, 250 preoperatively to 157; stiffness, 115 preoperatively to 56; and function, 910 preoperatively to 588). There was no radiographic evidence of loosening or migration. Gaps visible at the bone-implant interface healed over the first year. Three prostheses were revised, 2 for deep infection and 1 for tibial tray subsidence. A survivorship of 98.6% has been achieved at 8 years. This intermediate-term study with 100% follow-up at 8 years demonstrates excellent clinical and radiographic outcomes. It is our opinion that these are comparable to the gold standard cemented total knee arthroplasties and may have advantages over other uncoated cementless designs.     

Instability after total knee arthroplasty with the Miller-Gallante II total knee: 5- to 7-year follow-up

A consecutive series of 64 posterior cruciate-retaining hybrid total knee arthroplasties in 50 patients were reviewed with an average 57-month follow-up. Seven patients died or were lost to follow-up. One patient was revised for infection in the early postoperative period, and there were no cases of aseptic loosening. Four revisions were performed for recurrent effusions and progressive instability at a mean of 55 months postoperatively. There were statistically significant correlations between manual stability testing (anteroposterior, mediolateral, and pivot shift) and Hospital for Special Surgery and Knee Society scores. At intermediate follow-up, the Miller-Gallante II total knee arthroplasty is functioning well except in a subgroup of patients with progressive instability resulting from a combination of patient and implant factors.     

Unicompartmental knee replacement in osteoarthritis: an 8-year follow-up

Between 1972 and 1974, 34 patients with medial osteoarthritis in the knee were operated on with unicompartmental femorotibial replacement. Four patients were reoperated on, three of whom had had a McIntosh inlay prior to the operation. Seven patients had died and two were lost at the follow-up which took place on average 8 years (7-10 years) after the operation. Of 21 re-examined knees, 14 were rated as successful or acceptable.     

Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up

Background and purpose — The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register.

Patients and methods — We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included. The groups (CAS, n = 3,665; CON, n = 20,019) were compared using a Cox regression analysis adjusted for age, sex, ASA category, prosthesis brand, fixation method, previous surgery, and diagnosis with the risk of revision for any reason as endpoint. Secondary outcomes were reasons for revision and effects of prosthesis brand, fixation method, age (± 65 years), and hospital volume.

Results — Prosthesis survival and risk of revision were similar for CAS and CON. CAS had significantly fewer revisions due to malalignment. Otherwise, no statistically significant difference was found between the groups in analyses of secondary outcomes. Mean operating time was 13?minutes longer in CAS.

Interpretation — At 8 years of follow-up, CAS and CON had similar rates of overall revision, but CAS had fewer revisions due to malalignment. According to our findings, the benefits of CAS at medium-term follow-up are limited. Further research may identify subgroups that benefit from CAS, and it should also emphasize patient-reported outcomes.     

Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up

We reviewed 100 cemented Endo-model rotating-hinge (Waldemar Link GMBH & Co, Hamburg, Germany) total knee replacements in 80 patients with a mean age of 70 years (56 to 85) at a mean post-operative follow-up of 11 years (7 to 15). Good or excellent results were seen in 91% of knees and survival at 15 years was 96.1%. There were two deep infections, one dislocation and one supracondylar fracture. There were no peri-operative deaths and there was no loosening, malalignment, migration or wear. We consider this prosthesis to be ideally suited for the replacement of the deformed knee when the use of an unconstrained design may be questionable.     

Hydroxyapatite-coated total knee replacement: clinical experience at 10 to 15 years

This study describes 146 primary total knee replacements, either fully or partially coated with hydroxyapatite of which 74 knees in 68 patients were available for clinical and radiological assessment at a mean of 11.2 years (10 to 15). The global failure rate was 1.37% and survival rate with mechanical failure as the end-point was 98.14%. Radiological assessment indicated intimate contact between bone and the hydroxyapatite coating. Over time the hydroxyapatite coating appears to encourage filling of interface gaps remaining after surgery. Our results compare favourably with those of series describing cemented or porous-coated knee replacements, and suggest that fixation with hydroxyapatite is a reliable option in primary total knee replacement.     

Infection in total knee replacement: a retrospective review of 6489 total knee replacements.

Six thousand four hundred eighty-nine knee replacements were done in 6120 patients at the authors' institution between 1993 and 1999. Operations were done in a theater with vertical laminar flow and with the surgical team using body exhaust suits. Of these knee replacements, 116 knees became infected and 113 were available for followup. One hundred of the infections occurred in patients undergoing primary knee replacement, whereas the remaining infections occurred in patients undergoing revision knee replacement. Ninety-seven of these knees (86%) had deep periprosthetic infections and the remaining 16 knees had superficial wound infections. One third of the deep infections occurred within the first 3 months after surgery and the remaining 2/3 occurred after 3 months. The overall early deep infection rate for patients undergoing a primary knee replacement was 0.39%, whereas the rate for patients undergoing a revision knee replacement was 0.97%. A cohort of noninfected knee replacements from patients matched for gender, age, and month of surgery was used as a control group. Those comorbidities that were statistically significant in increasing the risk of infection were prior open surgical procedures, immunosuppressive therapy, poor nutrition, hypokalemia, diabetes mellitus, obesity, and a history of smoking. Patients undergoing revision procedures had a statistically higher risk of infection than did patients undergoing primary surgeries. If the surgery took longer than 2.5 hours, the risk of infection was increased significantly. There was no change in the infection rate when the perioperative antibiotic prophylaxis was decreased from 48 to 24 hours after surgery. The predominant infectious organisms were gram-positive (Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus Group B). Twenty percent of the knees that were infected clinically had no organisms that could be identified. In each case, the patient had been treated empirically at another institution with antibiotics before a culture of the joint was obtained.     

A hydroxyapatite-coated Insall-Burstein II total knee replacement: 11-year results

We report the clinical and radiographic outcome of a consecutive series of 138 hydroxyapatite-coated total knee replacements with a mean follow-up of 11 years (10 to 13). The patients were entered into a prospective study and all living patients (76 knees) were evaluated. The Hospital for Special Surgery knee score was obtained for comparison with the pre-operative situation. No patient was lost to follow-up. Radiographic assessment revealed no loosening. Seven prostheses have been revised, giving a cumulative survival rate of 93% at 13 years. We believe this to be the longest follow-up report available for an hydroxyapatite-coated knee replacement and the first for this design of Insall-Burstein II knee.