Total Knee Replacement in Young, Active Patients. Long-Term Follow-up and Functional Outcome*

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

“…Survivorship at 10 years was lower in our series than in other reports ( Table 2). Two series having comparable average followup reported a revision rate for polyethylene wear and osteolysis of 11.5% in 52 knees [6], and 0% revision rate for wear, osteolysis and loosening in 108 knees [5]. The first cohort [6] is the most comparable to the present series in terms of minimum 10 year followup and the use of a similar PFC device; however, all were posterior cruciate retaining and most were performed before 1994.…”

“…Most mid-and longterm studies on knee arthroplasty in younger patients have a relatively large percentage of rheumatoid patients who were somewhat inactive (Table 2) [4,7,12,13]. There is comparatively little information on cohorts of younger patients with only OA [5,6,17,19,[22][23][24] although this young OA group has the largest growth projections in the future [16]. The purpose of this study was to evaluate the minimum 10-year followup of TKA performed in more active patients with osteoarthritis, using modular tibial components, to determine (1) survivorship; (2) revision rates; (3) functional scores; and (4) rates of radiographic failure.…”

“…The first cohort [6] is the most comparable to the present series in terms of minimum 10 year followup and the use of a similar PFC device; however, all were posterior cruciate retaining and most were performed before 1994. The second cohort had a large percentage of monolithic metal backed or all polyethylene tibial components with a substantially lower revision rate of 0%, although not all cases were followed for 10 years, with a range of followup from 3 to 18 years [5].…”

“…Proper technique, component design, and materials for long-term durability in this age group are paramount due to the magnitude of the loads and the cycles of service these knees will be required to perform. Although there has been a dramatic rise in the numbers of TKAs performed in this population, there are very few long-term studies [4,7,12,13] in this younger population, especially in patients with OA [5,6]. The longest term studies of younger patients have reported survivorship up to 93.7% at 20 years [4], and survivorship of 96% and 85% at 10 and 15 years, respectively, for cohorts consisting entirely of patients with OA [6].…”

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

“…Surgeons' recommendations are based on subjective opinions without quantitative measurements of knee forces and are not always consistent [20,37]. The results of clinical outcomes are mixed, with some studies reporting increased component failure in more active patients and others reporting no difference [8,22,30,35,37,38]. We directly measured tibial forces in vivo during exercise and various recreational activities at 1 year postoperatively ( Fig.…”