How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Abstract

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.

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

“…Longer-term implant survivorship was 83% at 15 years and 62% at 20 years in our cohort. This varies substantially compared to a recent comprehensive systematic review and meta-analysis of case series and national registry reports from Australia and Finland which demonstrated 15-year and 20-year TKA survivorship of 93% and 90% in the registry data vs 96% and 92% in the case series data, respectively [22]. Differences in patient population may contribute to limits in the generalizability of the findings of this study to ours as the Finnish and Australian registry patients may not be representative of our cohort.…”

Trends in knee magnetic resonance imaging, arthroscopies and joint replacements in older Australians: still too much low‐value care?

“…Complications of knee replacement surgery are similar to those of arthroscopy, including infection (seven per 1000) and pulmonary embolism (four per 1000) . Additionally, up to 18% of total knee replacements fail within 25 years, potentially requiring revision, and up to one in five patients who undergo total knee replacement are unsatisfied with the procedure . The risk of adverse events may be acceptable to many patients given the potential benefits from effective treatment, especially for those with more severe symptoms.…”

Reduced survival of total knee arthroplasty after previous unicompartmental knee arthroplasty compared with previous high tibial osteotomy: a propensity-score weighted mid-term cohort study based on 2,133 observations from the Danish Knee Arthroplasty Registry

“…In isolated osteoarthritis of the medial knee compartment, both medial unicompartmental knee arthroplasties (UKA) and high tibial osteotomies (HTO) are solutions with reliable clinical outcomes (Cao et al 2018). The survival of UKA is secondary to that of total knee arthroplasties (TKA) with a recent meta-analysis reporting 15-year survival of 76% and 93%, respectively (Evans et al 2019). The long-term survival of HTO seems inferior to both UKA and TKA with a declining survival from 75% at 10 years to 55% at 15 years (van Wulfften Palthe et al 2018).…”