Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

Abstract

BACKGROUND New implants for total knee arthroplasty (TKA) are continuously introduced with the proposed benefit of increased performance and improved outcome. Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation. AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system. METHODS A novel TKA system was introduced at our institution on 30th November 2015. Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons (25 TKAs/surgeon) were identified as the Introduction Group. Moreover, the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group. A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period. Demographics, surgery-related factors and alignment data were recorded, and intergroup differences compared. RESULTS Following introduction of the novel implant, Persona TKA was utilized in 69% (71%), 53% (54%), and 45% (75%) of primary TKA procedures by the three surgeons, respectively (Follow-up Group). Mean surgery time was increased by 28% ( P < 0.0001) and mean intra-operative blood loss by 25% ( P = 0.002) in the Introduction Group, while only the mean surgery time was increased in the Follow-up Group by 18% ( P < 0.0001). Overall alignment was similar between the groups apart from femoral flexion (FF) and tibial slope (TS). The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group. CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction. These differences diminished one year after introduction of the new implant. Fewer outliers with respect to FF and TS were seen when using the novel TKA implant. Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.

Anatomical knee endoprostheses – does a better-fit lead to better outcomes? A review article

“…However, this problem occurs at the initial stage of surgeons' contact with the system. The mentioned problems cease to be relevant after a year of surgeons' experience with the system [17].…”