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The 4-year outcomes of a prospective study of patients undergoing Triathlon total knee arthroplasty (TKA) are presented. There were 2035 consecutive cemented TKAs performed on 1688 patients. Mean followup was 21 months, including 713 knees with a follow-up of >2 years. In a subgroup of 239 patients, the coverage of the patella cut surface by the patella component was analyzed. To our knowledge, this is the first article to study this issue. Mean Knee Society pain scores improved from 48 to 96, function improved from 63 to 85, and range of motion improved from a mean of 25° to 104° to a mean of 22° to 126°. Coverage of the patella by the prosthesis was full from medial to lateral in 88% and full from proximal to distal in 91% of knees. The implant system has performed well within the follow-up period, with no implant-or design-related failures.[J Knee Surg. 2008;21:320-326.]

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Improper femoral component size remains a source of multiple postoperative complications following total knee arthroplasty (TKA). However, the use of a flexible intramedullary (IM) rod may help optimize femoral component size and therefore improve outcomes. The purpose of this study was to assess (1) patient-reported functional outcomes, (2) overall quality of life, and (3) changes in implant sizing associated with total knee arthroplasties performed with a flexible IM rod compared to a conventional, rigid rod. We reviewed 277 patients who had surgery using the rigid rod and 364 using the flexible rod to determine the tendency of each rod for selecting particular component sizes. Additionally, 100 patients were prospectively randomized (1:1) to the flexible or the conventional rigid IM rod cohorts. Outcomes were assessed using Knee Society scores (KSSs), SF-36 physical scores, and SF-36 mental scores preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. The retrospective arm of the study showed that the flexible IM rod cohort tends to have smaller component sizes than their conventional counterparts. In the prospective phase of the study, the increase in clinical KSSs from preoperative levels was better in the flexible rod cohort (160% vs. 143% increases, respectively). The functional KSSs had slightly higher increases in the flexible rod cohort from their preoperative levels (68% vs. 62% increases, respectively). With both clinical and functional KSSs, the flexible rod cohort had a higher score than the rigid rod cohort at all follow-up points. There was better postoperative range of motion (ROM) in the flexible rod cohort (28% vs. 22% increases, respectively). The SF-36 physical scores were slightly different, with the flexible IM rod cohort having a more marked improvement in scores (64% vs. 46% increases, respectively). The SF-36 mental score had a slightly better improvement at latest follow-up in the flexible IM rod cohort (12% vs. 6% increases, respectively). Those patients who underwent TKA using a flexible IM rod had better improvements in their patient-reported outcomes and decreased risk of oversizing the femoral component. The use of such a rod is not detrimental to outcomes and may have a positive impact on outcomes. Future studies should focus on alignment and long-term outcomes associated with the use of a flexible rod.