Hydroxyapatite-coated, cementless total knee replacement in patients aged 75 years and over

Dixon, Paul; Parish, E. N.; Chan, Brian W; Chitnavis, Jai; Cross, Marita

doi:10.1302/0301-620x.86b2.14341

Cited by 37 publications

(42 citation statements)

References 19 publications

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“…This prosthesis has been previously shown to produce similar results in patients over the age of 75 years when compared with those younger patients. 20 Function after surgery has already been reported, with a number of Survival curve using revision as an end-point.…”

Section: Discussionmentioning

confidence: 99%

A hydroxyapatite-coated total knee replacement

Cross¹,

Parish²

2005

The Journal of Bone and Joint Surgery. British volume

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We prospectively reviewed 1000 consecutive patients who underwent a cementless, hydroxyapatite-coated, stemless, total knee replacement over a period of nine years. Regular post-operative clinical follow-up was performed using the Knee Society score. The mean pre-operative score was 96, improving to 182 and 180 at five and ten years, respectively. To date, there have been seven (0.5%) cases which required revision, primarily for septic loosening (four cases), with low rates of other post-operative complications. The cumulative survival at ten years with revision as the end-point, was 99.14% (95% confidence interval 92.5 to 99.8). These results support the use of hydroxyapatite in a cementless total knee replacement since it can give reliable fixation with an excellent clinical and functional outcome.

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Section: Discussionmentioning

confidence: 99%

A hydroxyapatite-coated total knee replacement

Cross¹,

Parish²

2005

The Journal of Bone and Joint Surgery. British volume

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“…3 Survival analyses alone do not accurately reflect the true clinical outcome. 8 Several other studies have concluded that a good outcome can be anticipated following replacement in both younger [4][5][6]11,21 and older patient cohorts, 7,9,10,12,13,22 as defined by objective clinical outcome measures. However, there are a number of limitations to these studies.…”

Section: Discussionmentioning

confidence: 99%

“…8 Objective clinical measures suggest that functional improvements are less impressive in the elderly, but the overall outcome is comparable across all ages. 4,[9][10][11][12][13] Objective clinical measures are increasingly considered less representative of the outcome from the patient's perspective. 14 As a result, growing emphasis is now placed on PROMs to define success following joint replacement surgery in England.…”

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confidence: 99%

The effects of age on patient-reported outcome measures in total knee replacements

Williams

Price

Beard

et al. 2013

The Bone & Joint Journal

126

109

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We present a comparison of patient-reported outcomes (PROMs) in relation to patient age, in patients who had received a total (TKR) or unicompartmental knee replacement (UKR). The outcome was evaluated using the Oxford knee score (OKS), EuroQol (EQ-5D) and satisfaction scores. Patients aged 65 to 84 years demonstrated better pre-operative function scores than those aged < 65 years (OKS, p = 0.03; EQ-5D, p = 0.048) and those aged ≥ 85 years (OKS, p = 0.03). Post-operative scores were comparable across age groups, but a linear trend for greater post-operative improvement in OKS and EQ-5D was seen with decreasing age (p < 0.033). The overall mean satisfaction score at six months was 84.9, but those aged < 55 years exhibited a lower mean level of satisfaction (78.3) compared with all other age groups (all p < 0.031). The cumulative overall two-year revision rate was 1.3%. This study demonstrates that good early outcomes, as measured by the OKS and EQ-5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern, and suggests that outcome is not fully encapsulated by the OKS and EQ-5D evaluation, and raises the question whether the OKS alone is an appropriate measure of pain and function in younger, more active individuals.

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“…31 Cross and Parish 32 described outcomes in 1000 patients with very satisfactory results with a mean total KSS of 180 and survival of 99.14% (95% CI 92.5 to 99.8) at ten years. The favourable long-term survivorship of this TKR further supports the use of HA-coating of uncemented implants.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome in an uncemented, hydroxyapatite-coated total knee replacement

Melton

Mayahi

Baxter

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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A consecutive series of patients with a hydroxyapatite-coated uncemented total knee replacement (TKR) performed by a single surgeon between 1992 and 1995 was analysed. All patients were invited for clinical review and radiological assessment. Revision for aseptic loosening was the primary outcome. Assessment was based on the Knee Society clinical score (KSS) and an independent radiological analysis. Of 471 TKRs performed in 356 patients, 432 TKRs in 325 patients were followed for a mean of 16.4 years (15 to 18). The 39 TKRs in 31 patients lost to follow-up had a mean KSS of 176 (148 to 198) at a mean of ten years. There were revisions in 26 TKRs (5.5%), of which 11 (2.3%) were for aseptic loosening. Other further surgery was carried out on 49 TKRs (10.4%) including patellar resurfacing in 20, arthrolysis in 19, manipulation under anaesthetic in nine and extensor mechanism reconstruction in one. Survivorship at up to 18 years without aseptic loosening was 96% (95% confidence interval 91.9 to 98.1), at which point the mean KSS was 176 (134 to 200). Of 110 knees that underwent radiological evaluation, osteolysis was observed in five (4.5%), one of which was revised. These data indicate that uncemented hydroxyapatite-coated TKR can achieve favourable long-term survivorship, at least as good as that of cemented designs.

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Hydroxyapatite-coated, cementless total knee replacement in patients aged 75 years and over

Cited by 37 publications

References 19 publications

A hydroxyapatite-coated total knee replacement

A hydroxyapatite-coated total knee replacement

The effects of age on patient-reported outcome measures in total knee replacements

Long-term outcome in an uncemented, hydroxyapatite-coated total knee replacement

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