Abstract:The Press-Fit Condylar Sigma total knee arthroplasty represents a durable, effective option for patients undergoing knee arthroplasty, with excellent survival and good clinical and radiographic outcomes at 15 years.
“…Comparison with the literature is difficult because no other studies have analyzed TKA following ipsilateral THA. The functional outcomes of TKA in the present study, as measured by the KSS, were comparable to those of the most recent studies published [9, 11, 16, 17]. Likewise, the survival in the present study for ipsilateral TKA following prior THA was comparable to that of other recent studies [5, 9, 11, 13, 16] in which TKA survival ranged between 92 and 98% at 8–15 years was reported.…”
Purpose To assess the influence of a prior well-functioning unilateral primary total hip arthroplasty (THA) on the functional outcome of a subsequent ipsilateral primary total knee arthroplasty (TKA). Methods A retrospective case-control study of 92 patients older than 60 years underwent unilateral primary TKA after a prior ipsilateral THA (THA-TKA group) and 92 matched patients underwent only TKA (TKA group). Clinical assessments were performed using the Knee Society Scores (KSS) and Harris Hip Score (HSS), quality of life by the Reduced Western Ontario and MacMaster Universities (WOMAC) and Short-Form 12 (SF-12) questionnaires. Radiological evaluation was also performed. Results Median follow-up after TKA was 7.2 (range 5-9) years. There were no significant differences between groups in baseline data at the TKA time. The mean gains in KSS were similar in both groups. At the last follow-up, there were no significant differences in WOMAC-pain or SF12-physical scores, but the WOMAC-function (p = 0.003) and SF12-mental (p = 0.018) scores were significantly better in the isolated TKA group. At the last follow-up, there were no significant differences in the radiological knee alignment or component positions. For aseptic reasons, the TKA survival at 8 years in the TKA group was 95.8 (95% CI 87.8-100%), and 96.6% (95% CI 91.8-100%) in the THA-TKA group (ns). Conclusion A well-functioning unilateral THA does not influence on the functional outcome of a subsequent ipsilateral TKA. This finding can help clinicians when counseling patients with hip and knee osteoarthritis. Level of evidence III.
“…Comparison with the literature is difficult because no other studies have analyzed TKA following ipsilateral THA. The functional outcomes of TKA in the present study, as measured by the KSS, were comparable to those of the most recent studies published [9, 11, 16, 17]. Likewise, the survival in the present study for ipsilateral TKA following prior THA was comparable to that of other recent studies [5, 9, 11, 13, 16] in which TKA survival ranged between 92 and 98% at 8–15 years was reported.…”
Purpose To assess the influence of a prior well-functioning unilateral primary total hip arthroplasty (THA) on the functional outcome of a subsequent ipsilateral primary total knee arthroplasty (TKA). Methods A retrospective case-control study of 92 patients older than 60 years underwent unilateral primary TKA after a prior ipsilateral THA (THA-TKA group) and 92 matched patients underwent only TKA (TKA group). Clinical assessments were performed using the Knee Society Scores (KSS) and Harris Hip Score (HSS), quality of life by the Reduced Western Ontario and MacMaster Universities (WOMAC) and Short-Form 12 (SF-12) questionnaires. Radiological evaluation was also performed. Results Median follow-up after TKA was 7.2 (range 5-9) years. There were no significant differences between groups in baseline data at the TKA time. The mean gains in KSS were similar in both groups. At the last follow-up, there were no significant differences in WOMAC-pain or SF12-physical scores, but the WOMAC-function (p = 0.003) and SF12-mental (p = 0.018) scores were significantly better in the isolated TKA group. At the last follow-up, there were no significant differences in the radiological knee alignment or component positions. For aseptic reasons, the TKA survival at 8 years in the TKA group was 95.8 (95% CI 87.8-100%), and 96.6% (95% CI 91.8-100%) in the THA-TKA group (ns). Conclusion A well-functioning unilateral THA does not influence on the functional outcome of a subsequent ipsilateral TKA. This finding can help clinicians when counseling patients with hip and knee osteoarthritis. Level of evidence III.
“…Pooled analysis of data derived from case series reported at exactly 15 years or 20 years showed an all-cause construct survivorship of 96·3% (95% CI 95·7–96·9) at 15 years and 94·8% (92·5–97·1) at 20 years. Figure 2A shows a forest plot for the meta-analysis of data on TKRs derived from case series at 15 years and 20 years.Figure 2Forest plot of estimates for reported survival of knee replacements from case series11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32(A) Total knee replacements at 15 years and 20 years. (B) Unicondylar knee replacements at 15 years, 20 years, and 25 years.…”
Summary
Background
Knee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We aimed to establish how long a knee replacement lasts.
Methods
In this systematic review and meta-analysis, we searched MEDLINE and Embase for case series and cohort studies published from database inception until July 21, 2018. Articles reporting 15 year or greater survival of primary total knee replacement (TKR), unicondylar knee replacement (UKR), and patellofemoral replacements in patients with osteoarthritis were included. Articles that reviewed specifically complex primary surgeries or revisions were excluded. Survival and implant data were extracted, with all-cause survival of the knee replacement construct being the primary outcome. We also reviewed national joint replacement registry reports and extracted the data to be analysed separately. In the meta-analysis, we weighted each series and calculated a pooled survival estimate for each data source at 15 years, 20 years, and 25 years, using a fixed-effects model. This study is registered with PROSPERO, number CRD42018105188.
Findings
From 4363 references found by our initial search, we identified 33 case series in 30 eligible articles, which reported all-cause survival for 6490 TKRs (26 case series) and 742 UKRs (seven case series). No case series reporting on patellofemoral replacements met our inclusion criteria, and no case series reported 25 year survival for TKR. The estimated 25 year survival for UKR (based on one case series) was 72·0% (95% CI 58·0–95·0). Registries contributed 299 291 TKRs (47 series) and 7714 UKRs (five series). The pooled registry 25 year survival of TKRs (14 registries) was 82·3% (95% CI 81·3–83·2) and of UKRs (four registries) was 69·8% (67·6–72·1).
Interpretation
Our pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last.
Funding
The National Joint Registry for England, Wales, Northern Ireland, and Isle of Man and the Royal College of Surgeons of England.
“…Total knee arthroplasty (TKA) is an orthopedic surgical approach that is widely applied for patients with severely painful joint diseases (e.g., degenerative arthritis, inflammatory arthritis, and avascular necrosis), with a high success rate of >90%. TKA survival rates reportedly exceed 95% at 10 years and 90% at 15 years [1,2]. The Fourth American Joint Replacement Registry reported that TKAs were performed for approximately 0.5 million people in the USA in 2016 and will be performed in approximately 3 million people annually worldwide after 2030 [3][4][5].…”
Four pairs of fresh-frozen cadaver knees (eight knees, four male knees) with a mean age of 72 ± 7 years were used for tests involving a customized simulator capable of controlling quadriceps loading conditions. The muscle force distribution of the quadriceps for the normal loading condition was applied on the basis of muscle cross-sectional area data, as previously reported (VM: 31 N; RF/VI: 49 N; VL: 45 N). To simulate vastus medialis (VM) impairment, we set the muscle force for VM in the muscle force distribution of the quadriceps at zero (VM: 0 N; RF/VI: 49 N; VL: 45 N). The joint reaction forces and moments on knee joints that underwent total knee arthroplasty (TKA) did not differ significantly according to VM impairment status for all flexion angles (p > 0.05). Nevertheless, the vectors of internal–external moments mostly showed a tendency for alteration from external to internal due to VM impairment. This tendency was evident in 9 cases in 12 total test pairs (with and without VM impairment). Furthermore, the vectors of the anterior–posterior reaction forces mostly showed a tendency to increase anteriorly due to VM impairment. This tendency was also evident in 9 cases in 12 total test pairs (with and without VM impairment). These results indicate that posterior dislocation of the tibia may be induced if VM impairment occurs after TKA. In conclusion, VM impairment in knee joints undergoing TKA may contribute to posterior dislocation of the tibia by a paradoxical roll-back with enhancements of the anterior joint reaction force and external moment during knee-joint flexion. Our findings may be valuable for understanding the mechanism of potential instability and malfunction due to VM impairment in knee joints after TKA, and may help to optimize clinical/rehabilitation training plans to improve the prognosis (stability and function) of knee joints undergoing TKA.
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