Pain Relief and Functional Improvement Remain 20 Years After Knee Arthroplasty

Abstract

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).

Highly Crosslinked-remelted versus Less-crosslinked Polyethylene in Posterior Cruciate-retaining TKAs in the Same Patients

“…Although TKAs have provided durable, long-term results [16,18], some patients experience polyethylene wear and osteolysis 5 to 12 years after surgery [3, 6, 11, 13, 24-26, 30, 32]. Collier et al [5] suggested that polyethylene wear is a major risk factor affecting long-term survival of TKA implants.…”

“…Conclusions With the numbers available, we found no clinically important differences between HXLPE and lesscrosslinked polyethylene inserts in posterior cruciateEach author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. [16,18,28], some patients experience polyethylene wear and osteolysis 5 to 12 years after surgery [3, 6, 11, 13, 23-26, 30, 32]. Collier et al [5] suggested that polyethylene wear is a major risk factor affecting long-term survival of TKA implants.…”

“…Studies of HXLPE bearings have detected a higherthan-ordinary percentage of wear particles smaller than 1 lm, and these particles could induce relatively more inflammation or osteolysis at a given volume of polyethylene debris [7]. Use of HXLPE in TKAs could increase the risk of fracture of the tibial polyethylene insert at an articular or nonarticular region given the lower material toughness that stems from more polymer crosslinks [17][18][19]. However, the polyethylene of these HXLPE implants customarily is treated to make the material more resistant to mechanical failure secondary to oxidative degradation [14,17,19].…”

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

“…Total joint arthroplasty is a high-volume and high-cost procedure that can reduce pain and restore function in patients with osteoarthritis [8,29,36]. Although most joint arthroplasties can last 15 to 20 years, some fail earlier because of wear and osteolysis, instability, infection, or other causes [1,10,32,34].…”

Modern Total Knee Arthroplasty Designs: Are we Improving Outcomes?

“…Surgeons have traditionally emphasized knee flexion as a hallmark of clinical success [6]. As a result, in the last ten years, manufacturers have introduced novel designs with specific features targeting high flexion.…”