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

Abstract

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.

“Forgotten knee” after total knee replacement: A pragmatic study from a single-centre cohort

“…Over the last 3 decades, long-term follow-up studies reported constant improvement in implant survival [2][3][4][5][6][7][8]. In parallel, several prospective studies highlighted significant clinical and functional improvement on composite scores such as Knee injury and Osteoarthritis Outcome Score (KOOS) [9,10], Knee society score (KSS) [11,12], and Western Ontario and McMaster osteoarthritis index (WOMAC) [13,14], or reported satisfaction rates exceeding 80% [14][15][16], confirming that TKR outcomes are generally good.…”

Mid and Long Term Functional Outcome of Total Knee Arthroplasty

“…All patients were invited for a clinical outcome review which was based on the Knee Society clinical score (KSS) and an independent radiological analysis. Of 471 TKAs performed on 356 patients, 432 TKAs on 325 patients were followed for a mean of 16.4 years (15-18) [ 15 ]. Long et al [ 16 ] also evaluated functional outcome after TKA in young and active patients.…”

The biological response to orthopaedic implants for joint replacement: Part I: Metals

“…Briefly, the goals of total joint replacement (TJR) implants are to relieve pain and restore function, with limited impact on the surrounding tissues. Studies focusing on long‐term outcomes of total knee replacement have shown survivorship after 15 years ranging from 81.7 to 98.14% . Similarly, studies for total hip replacement showed survivorship after 15 years ranging above 90% .…”