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).

Background Large-diameter metal-on-metal articulations reportedly improve stability and wear in THAs. However, some reports suggest some patients have unexplained hip and early failures with these implants. Thus, the potential benefits may be offset by these concerns. However, the incidence of these problems is not clearly established. Questions/purposes We therefore assessed hip pain, function, osteolysis, and complications in patients with large-diameter metal-on-metal THA. Patients and Methods We retrospectively reviewed 611 patients who had 681 large-diameter metal-on-metal THAs with the same cup and head design. The average age at operation was 62 years, 53% of the THAs were in men, and the average body mass index was 32 kg/m 2 . The diagnosis was osteoarthritis in 92% of the THAs. The minimum followup was 24 months (mean, 37 months; range, 24-60 months). Results Nine of the 611 patients (1.5%) experienced moderate or severe pain in the hip region that we considered to be coming from an extraarticular source in each case. Harris hip scores for pain averaged 42 points. Total Harris hip scores averaged 93 points. Cup abduction averaged 42°, and cup anteversion averaged 26°. There were no infections. Three cups (0.4%) were considered radiographically loose. All were secondary to inadequate seating of the shell. Conclusion Our observations suggest with this implant the concerns of higher incidences of groin pain, early failures, and adverse tissue reactions were not confirmed. Early successes or failures with large-diameter metal-onmetal articulations may be implant specific.

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