Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Abstract

a b s t r a c tBackground: There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). Methods: We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. Results: Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n ¼ 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. Conclusion: Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.

Decreased Implant Survival is Associated With Younger Patients Undergoing Total Knee Arthroplasty

“…Our study shows significantly lower rates of revision-free implant survival at 5 years in patients less than age 40 years (77.2%), 40 to 49 years (88.9%), and 50 to 59 years (91.7%) when compared with population aged 60 to 79 years (>95%). These implant-survival rates are markedly lower in the less than 40 years and 40 to 49 years groups compared to the general TKA population in the literature, which show 5-year implant survival greater than 96.5% [13,22,27,29,30]. Five-year implant-survival rates in patients above 60 years of age in our study are consistent with those previously reported.…”

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

“…Continued advancements in technology and improvement in surgical techniques have made TKA surgery a very successful operation [ 25 ]. However, approximately one-third of early TKA revisions are related to unbalanced soft tissue presenting as stiffness, instability, or early component loosening [ 8 , 26 – 31 ]. The ligament balancing "feeling" is affected by factors such as patient generalized laxity, degree of joint contracture, BMI, gender, the depth of anesthesia, surgical experience, and even the surgeon's favorite method of balancing(spacer blocks or ligament tensioners) [ 32 , 33 ].…”

Wear Assessment of Tibial Inserts Made of Highly Cross-Linked Polyethylene Supplemented with Dodecyl Gallate in the Total Knee Arthroplasty

“…Total knee arthroplasty (TKA) is considered to be an effective surgical treatment for knee osteoarthritis that can result in substantial improvements in knee function and patient quality of life [ 1 ]. However, the polymeric tibial insert is prone to wear due to the considerable loads placed upon it, which can lead to the generation of wear particles and subsequent loosening of the implant due to bone resorption [ 2 , 3 ]. Many methods have been used to improve the wear resistance in the previous reports [ 4 , 5 , 6 ].…”