Long-Term Results of Total Condylar Knee Arthroplasty

Background Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones. Questions/purposes We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate.Methods We systematically reviewed the literature for clinical studies comparing all-polyethylene and metalbacked tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason. Results Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Metaregression showed strong evidence that the all-polyethylene design has improved with time compared with the metalbacked design. Conclusions The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Section: Discussionmentioning

confidence: 99%

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

Nouta

Verra

Pijls

et al. 2012

“…Long-term followup studies have suggested implant survivorship of as much as 96% between 15 and 20 years after surgery [20,23,31]. Although the majority of TKAs performed in the United States have been for patients older than 65 years, a substantial number of TKAs are being performed on younger patients [17].…”

Section: Introductionmentioning

confidence: 99%

What is the Evidence for Total Knee Arthroplasty in Young Patients?: A Systematic Review of the Literature

Keeney

Eunice

Pashos

et al. 2011

Background TKA is commonly performed to treat advanced inflammatory and degenerative knee arthritis. With increasing use in younger patients, it is important to define the best practices to enhance clinical performance and implant longevity. Questions/purposes We systematically reviewed the literature to assess: (1) how TKAs perform in young patients; (2) whether the TKA is a durable procedure for young patients, and (3) what guidance the literature outlines for TKA in young patients. Methods We searched the literature between 1950 and 2009 for all studies reporting on TKAs for patients younger than 55 years that documented clinical and radiographic assessments with a minimum 2-year followup. Thirteen studies, reporting on 908 TKAs performed for 671 patients, met these criteria. Results Mean Knee Society clinical and functional scores increased by 47 and 37 points, respectively. Implant survivorship was reported between 90.6% and 99% during the first decade and between 85% and 96.5% during the second decade of followup. The literature does not direct specific techniques for TKA for young patients.Conclusions TKA provides surgeon-measured clinical and functional improvements with a moderate increase in second-decade implant failures.

“…Relatively few studies report 20-year followup of TKA [4,11,16,[21][22][23]25]. Three of these studies include the cemented Total Condylar knee design (Howmedica) [16,21,25].…”

Section: Discussionmentioning

confidence: 99%

“…Three of these studies include the cemented Total Condylar knee design (Howmedica) [16,21,25]. Others report on the LCS 1 (DePuy Orthopaedics, Inc, Warsaw, IN, USA) [4], cemented AGC [22], uncemented AGC [23], and the Kinematic TM Condylar (Howmedica) [11].…”

Section: Discussionmentioning

confidence: 99%

“…The long-term reports of TKA demonstrate prosthetic survival between 85% [25] and 99% [11] 20 years or more after the index arthroplasty [4,6,10,11,16,[21][22][23]25]. These studies give evidence that, with the proper indications, surgical technique, and patient compliance, prosthetic durability may continue well into the third decade after implantation.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Pain Relief and Functional Improvement Remain 20 Years After Knee Arthroplasty

Meding

Ritter

et al. 2012

Background TKA provides demonstrable pain relief and improved health-related quality of life. Yet, a decline in physical function may occur over the long term despite the absence of implant-related problems. Questions/purposes (1) Does pain relief diminish over 20 years after TKA? (2) Does function decline over 20 years in terms of Knee Society function, knee, and walking scores? And (3) Results Pain scores did not diminish over time (average, 49; range, 20-50). Average knee score was 78 (range, 39-97). Function, stair, and walking scores diminished over time. Average function score was 70 (range, 5-100), primarily due to an average stair score of 35 (range, 0-50); average walking score was 37 (range, 10-50). All but two patients (two TKAs) could negotiate stairs; 95 patients (124 TKAs) could walk at least five blocks; three patients (three TKAs) were housebound. Of the 62 patients still living (98 TKAs), the average UCLA activity score was 8.3 (range, 5-10).