Total Knee Arthroplasty in Patients 40 Years of Age and Younger With Osteoarthritis

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

“…The postoperative mean KS functional score was 81.6 points (95% CI, 70.2-89.8 points) with an average improvement of 37 points (range, . Four studies documented preoperative and postoperative ROM with mean improvements from 102°to 109°flexion [9,11,22,35]. Radiographic assessments reported in the studies noted nonprogressive radiolucencies Duffy et al [9] 1987-1994 observed in between 3.8% and 30% of cases (mean, 14.5%) with the patella and tibia being the most common locations (Table 3).…”

“…Two studies (91 TKAs) reporting exclusively on patients with inflammatory arthritis, [4,34] noted a mean improvement in KS clinical score of 40.8 points (range, 32-48 points). Six studies (402 TKAs) reported specifically on patients with a diagnosis of either osteoarthritis or posttraumatic arthritis [7,9,22,24,32,35], and noted a mean improvement in clinical scores for this group of 42.9 points (range, 37-56 points). Cementless fixation was used in only one study in this group (118 TKAs) [35] with a KS clinical score improvement of 47 points.…”

“…First, the majority of studies are small, retrospective, single-surgeon case series reporting on a heterogeneous group of patients with respect to diagnosis, activity levels, and surgical technique. Only six of the 13 articles that met our inclusion criteria focused specifically on patients with posttraumatic arthritis or osteoarthritis [7,9,22,24,32,35]. Five studies included patients with a predominance of rheumatoid arthritis without distinguishing clinical outcomes on the basis of diagnosis or other potential considerations [5,10,11,16,28], and two studies exclusively reported on patients with rheumatoid arthritis [4,34].…”

“…Five studies included patients with a predominance of rheumatoid arthritis without distinguishing clinical outcomes on the basis of diagnosis or other potential considerations [5,10,11,16,28], and two studies exclusively reported on patients with rheumatoid arthritis [4,34]. Second, although variations in surgical technique occurred in most studies, clinical scores were not reported specific to the techniques used, including posterior cruciate ligament management [4,16,32], fixation choice [22,24], tibial component modularity [5,10], and patellar management [11,16]. Third, defining TKA performance may not be determined accurately from measurement tools traditionally reported in the literature.…”

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

“…Most mid-and longterm studies on knee arthroplasty in younger patients have a relatively large percentage of rheumatoid patients who were somewhat inactive (Table 2) [4,7,12,13]. There is comparatively little information on cohorts of younger patients with only OA [5,6,17,19,[22][23][24] although this young OA group has the largest growth projections in the future [16]. The purpose of this study was to evaluate the minimum 10-year followup of TKA performed in more active patients with osteoarthritis, using modular tibial components, to determine (1) survivorship; (2) revision rates; (3) functional scores; and (4) rates of radiographic failure.…”