International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Abstract

We retrospectively reviewed the experience of a large international multi-centre study of primary total knee arthroplasty with mobile bearing design and modifications of the tibial component to allow for bicruciate preservation, posterior cruciate retention, or sacrifice. Twenty-seven surgeons performed 4,743 total knee replacements between 1981 and 1997. Implants inserted were 324 that retained both cruciate ligaments, 2,165 that retained the posterior cruciate, and 2,254 that sacrificed both cruciates. The patella was resurfaced in 2,838 and unresurfaced in 1,905. With failure defined as revision or reoperation for any reason, the overall survivorship was 79% at 16 years' follow-up. Revision occurred in 259 (5.4%) knees out of the entire cohort. The risk adjusted rates of failure were higher in females, younger patients, osteoarthritis, posttraumatic arthritis, and in patients who had a meniscal bearing prosthesis or patellar resurfacing. The most common cause of revision was bearing-related issues including chronic instability, bearing subluxation, bearing dislocation, or bearing wear in 2.3%.Résumé Nous avons revu rétrospectivement une série multicentrique de prothèses totales primaires de genoux avec plateaux mobiles et pièce tibiale permettant le sacrifice ou la conservation d'un ou des deux ligaments croisés. Entre 1981Entre et 1997 prothèses ont été faite par 27 chirugiens. Les implants utilisés étaient pour 2254 sans ligaments croisés, pour 2165 avec croisé postérieur et pour 324 avec conservation des 2 croisés. La rotule a été resurfacée 2838 fois. Avec l'échec défini par la reprise chirurgicale, la survie était de 79% à 16 ans de recul. Une reprise a été faite 259 fois (5,4%). Le risque d'échec était plus grand chez les femmes, les patients jeunes, en cas d'arthrose primaire ou post traumatique et chez les patients avec une prothèse à ménisques mobiles ou avec une rotule prothèsée. Les causes les plus fréquentes de révision étaient l'instabilité chronique, la subluxation ou la luxation des plateaux mobiles et leur usure.

Total knee replacement with retention of both cruciate ligaments

“…[16][17][18] However, such degeneration should not be seen as a contraindication to preservation of the ACL during TKR, as long as the ligament is functional. Indeed, the results presented are strongly suggestive of a long-term survival rate for this bicruciate-retaining TKR similar to that of posterior cruciate-retaining and posteriorly stabilised TKRs, [19][20][21][22][23] even with 41% of the knees displaying a partially degenerated ACL at the initial surgery. The reported survival rate also compares favourably with those obtained with another bicruciate-preserving implant but with shorter follow-up periods.…”

Functionality and Safety of an Ultra-Congruent Rotating Platform Knee Prosthesis at 5.6 Years: More than 5- Year Follow-Up of the e.motion® UC-TKA

“…The prosthesis also showed good stability and alignment, as assessed by the surgeon for the clinical KSS. The most common cause of revision of mobile-bearing TKA is bearing-related issues, including chronic instability, bearing subluxation, bearing dislocation, or bearing wear [19]. The e.motion ® UC prosthesis was found to have good stability and no loosening at 5.6 years.…”

Peri-implant reactivity and osteoinductive potential of immobilized rhBMP-2 on titanium carriers

“…The success rates (see Ref. [7] for definitions thereof) still vary widely -between 70% and 98% -depending on methodology, implant type and implant residence times in patients [1][2][3]8,9]. Thus widespread efforts are being made to improve implants.…”

“…Macroimplants such as artificial hips or knees [1,2], mini-implants in the form of dental or oral devices [3] and microimplants applied as ossicular constructs [4] or stents [5,6], all made of biocompatible metals, have revolutionized implantology in the last 30 years. Worldwide, millions of such implants are placed each year.…”