Twenty-Year Survival Analysis in Total Knee Arthroplasty by a Single Surgeon

doi:10.1016/j.arth.2011.10.027

The Journal of Arthroplasty

Volume 27, Issue 7, August 2012, Pages 1297-1304.e1

https://doi.org/10.1016/j.arth.2011.10.027 Get rights and content

Abstract

Between January 1988 and December 2006, a total of 3014 primary total knee arthroplasties (TKAs) in 2042 patients were performed, and survivorship analysis was performed. Survivorship analysis showed a 10-year survival of 93.8% and a 20-year survival of 70.9%. There was no significant difference in the survival rate according to sex and diagnosis (P = .142 and .443, respectively). The survival rate was higher in the patients older than 60 years (P < .001). The survival rate of Total Condylar IV (TC-IV) was higher than that of Ortholoc (Dow Corning Wright Medical, Arlington, Tenn) (P < .001). Total knee arthroplasty results in satisfactory long-term survival rates. However, the survival rate decreases over time. The risk of requiring revision TKA was related to age and type of implants. Careful consideration is necessary to decide the time for TKA and select type of implants.

Section snippets

Materials

Between January 1988 and December 2006, a total of 3014 primary TKAs in 2042 patients were performed, and survivorship analysis was performed. Causes for TKA included osteoarthritis in 2640 knees, rheumatoid arthritis in 313 knees, and secondary (postinfectious or posttraumatic) arthritis in 61 knees. Types of implants included Press fit condylar (Johnson & Johnson, Raynham, Mass) in 951 knees, NexGen (Zimmer, Warsaw, Ind) in 799 knees, Ortholoc (Dow Corning Wright Medical, Arlington, Tenn) in

Clinical Results

The HSS score increased from 59.8 ± 13.7 preoperatively to 91.2 ± 5.4 at the final follow-up (P < .001). The HSS scores increased more in rheumatoid arthritis compared with degenerative osteoarthritis (P = .001) (Table 1). The ROM increased from 116.1° ± 25.9° preoperatively to 123.8° ± 17.1° at the final follow-up (P < .001). Although secondary arthritis showed the greatest increase in ROM (P < .001), the actual ROM at the final follow-up was the lowest (P < .001) (Table 1). Flexion

Discussion

The life-table and Kaplan-Meier methods for survival analysis provide a statistically useful tool in assessing long-term survival rate of implants with different follow-up periods. However, these methods require the clarified definition of primary end point and have the limitation of standard error [19]. There have been several studies about survivorship analysis of implants with variable definitions of primary end point. One definition of end point is revision TKA or removal of the original

References (26)

F.G. Attar et al.
Survivorship analysis at 15 years of cemented press-fit condylar total knee arthroplasty
J Arthroplasty
(2008)
C. Delaunay et al.
Survival analysis of an asymmetric primary total knee replacement: a European multicenter prospective study
Orthop Trauma Surg Res
(2010)
N.R. Pradhan et al.
Survivorship analysis of 3234 primary knee arthroplasties implanted over a 26-year period: a study of eight different implant designs
Knee
(2006)
D.K. Bae et al.
Survival and functional analysis of implants in total knee replacement
J Korean Orthop Assoc
(2000)
J.A. Rand et al.
Factors affecting the durability of primary total knee prostheses
J Bone Joint Surg Am
(2003)
M.A. Ritter
The anatomical graduated component total knee replacement: a long-term evaluation with 20-year survival analysis
J Bone Joint Surg Br
(2009)
K. Knutson et al.
Survival of knee arthroplasties. A nation-wide multicentre investigation of 8000 cases
J Bone Joint Surg Br
(1986)
M. Tew et al.
Estimating the survival time of knee replacement
J Bone Joint Surg Br
(1982)
J.H. Bargren et al.
Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations
Clin Orthop Relat Res
(1983)
H.S. Dobbs
Survivorship of total hip replacements
J Bone Joint Surg Br
(1980)

J.H. Eickhoff

The design of clinical graft studies

Acta Chir Scand

(1985)

P.N. Baker et al.

A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis

J Bone Joint Surg Br

(2007)

G. Petrou et al.

Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up

J Bone Joint Surg Br

(2004)

Cited by (57)

Clinical outcomes of a canal-sparing shoulder arthroplasty system at a minimum of 2-year follow-up
2024, Seminars in Arthroplasty JSES
Stemless implants in anatomic total shoulder arthroplasty (TSA) have demonstrated comparable results to stemmed implants with both spherical and elliptical humeral heads. The primary purpose of this study is to report the 2-year clinical outcomes of a new cohort of patients that underwent anatomic TSA using an elliptical humeral head and multiplanar osteotomy system.
Patients who underwent anatomic TSA with the Catalyst total shoulder system (OrthoScience) from 2017 to 2019 by a single surgeon were included in this study. Preoperative shoulder radiographs, computer tomography scans, and/or magnetic resonance imagings were reviewed and classified according to the Walch Classification. At a minimum of 2-year follow-up, patient-reported outcome measurements (PROMs) were obtained, including the Western Ontario Osteoarthritis Shoulder index, American Shoulder and Elbow Surgeons score, Patient-Reported Outcomes Measurement Information System upper extremity, and the Single Assessment Numerical Evaluation (SANE) score. PROMs were stratified by age, body mass index, and medical comorbidities. Revisions, secondary surgeries, and any radiographic notes of hardware loosening were also recorded.
Forty anatomic TSAs in 38 patients met inclusion criteria for the study. The average age of the cohort was 66.1 year old, 45% male, and with a mean body mass index of 31.5. PROMs were available for 27 out of 40 patients (70%) with a mean follow-up time of 33.9 ± 5.2 months. Radiographic analysis demonstrated that 6/27 (22%) were Walch A2 type glenoids while 21/27 (78%) were Walch B2 type glenoids. The mean PROMs for the cohort were as follows: Western Ontario Osteoarthritis Shoulder index (91.2 ± 8.8), American Shoulder and Elbow Surgeons score (85.4 ± 14.7), Patient-Reported Outcomes Measurement Information System upper extremity (31.5 ± 3.6), SANE ipsilateral (83.8 ± 15.9), and SANE contralateral (85.7 ± 10.3). Three patients (11%) required revision surgery, including 2 subscapularis repairs, and 1 revision to a reverse TSA.
The present study demonstrated clinical outcomes using an ellipsoid anatomic TSA system on a high percentage of patients with B2 type glenoids at a minimum of 2-year follow-up. Further study is warranted to evaluate long-term outcomes of this new stemless ellipsoid anatomic TSA system.
Twenty-year survivorship cohort study of total knee arthroplasty in Asian patient using a single posterior-stabilized implant performed by a single surgeon
2023, Orthopaedics and Traumatology: Surgery and Research
As life expectancy has improved, the potential number of revision candidates is also expected to increase among patients who have undergone a total knee arthroplasty (TKA). The longevity of modern posterior stabilized knee prostheses after 20 years of use has not been well documented, especially in Asian populations that require a deeper flexion range due to a floor-based lifestyle.
Firstly, the implant longevity regarding mechanical failures such as aseptic loosening and polyethylene (PE) wear would vary over a longer follow-up depending on the age groups; and secondly there would be unique risk factors for revision surgery in an Asian TKA cohort.
We conducted this age-stratified survival analysis in a consecutive series of 368 NexGen Legacy Posterior Stabilized (LPS) TKAs performed by a single surgeon. These cases were divided into four age groups (< 60 years, early 60s, late 60s, and ≥ 70 years). The implant longevity against aseptic mechanical failures was calculated using the Kaplan-Meier method. The revision surgery risk was evaluated using postoperative factors including a deep flexion capability (> 135̊), and postoperative mechanical alignments.
Overall survivorship was significantly lower in the youngest groups than other groups (Log-rank test, p = 0.001). The cumulative 20-year implant longevity was more than 95% in the two oldest groups, but less than 60% in the youngest group. It was notable that the post-TKA implant longevity was not apparent up to 10 years between the age groups (p = 0.073∼0.458). Aseptic loosening was observed with an earlier onset (3.1 to 18.9 years) trend than PE wear (9.8∼17.9 years), with most cases arising in the youngest groups. Flexion limitation and varus alignment were significant risks to aseptic loosening and PE wear (Cox proportional hazard regression: p = 0.001 and 0.045, respectively).
A younger age (< 60 years), inability of postoperative deep flexion, and varus alignment were significant risk factors for aseptic loosening and PE wear after modern PS design in this Asian cohort. The difference in postoperative longevity affected by these factors was not obvious during the first 10 years but emerged over a second decade.
III; retrospective cohort study.
Comparison of the effect of total knee arthroplasty and high tibial osteotomy on coronal pelvic and ankle–hindfoot alignment
2023, Knee
Total knee arthroplasty (TKA) and high tibial osteotomy (HTO) are different procedures on the continuous spectrum of osteoarthritic knee treatments. TKA aims for neutral alignment and HTO aims for slight valgus.
2:2:2:1 propensity score matching yielded 100, 100, 100, and 50 patients with unilateral TKA, bilateral TKA, unilateral HTO, and bilateral HTO, respectively. Radiological evaluations of pelvis, knee, ankle, and hindfoot were performed. The important factors affecting the alignment change of the adjacent joints were identified, and subgroup analyses were performed using the identified parameters. The clinical outcomes were also compared.
The coronal alignments of the adjacent joints were corrected to the neutral position after TKA and HTO. The tibiotalar tilt angle (TTTA) was a common factor that affected changes in the ankle and hindfoot alignment. Patients with larger preoperative TTTA showed larger changes in TTTA in both TKA and HTO groups (P < 0.001). Patients with larger preoperative hindfoot alignment angle (HAA) showed larger changes in tibial plafond inclination, talar inclination, and HAA in both TKA and HTO groups (P < 0.001). TKA groups showed negative pelvic tilt values in the horizontal plane, and HTO groups showed a larger weight-bearing line ratio.
Even more severe deformities including adjacent joints were observed in TKA patients, both TKA and HTO patients showed improved alignment of the adjacent joints. However, HTO patients showed closer normal alignment than patients who underwent TKA. The preoperative TTTA and HAA were important factors for restoration of ankle and hindfoot alignment after knee surgery.
Surgical Trends for Managing Knee Osteonecrosis: A 2010 to 2020 United States Nationwide Study
2023, Journal of Arthroplasty
Knee osteonecrosis (ON) is rare, with an estimated incidence of 0.01-0.17 per 1,000 person years. Our study aimed to do the following: 1) quantify total operative procedures with rates normalized to the United States population; 2) compare arthroplasty versus joint-preserving procedural trends; and 3) determine rates of specific operative techniques/demographics in patients aged <50 versus >50 years.
Using a nationwide database, 8,269 patients diagnosed with knee ON underwent surgical treatment from 2010 to 2020. Documented surgical procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and core decompression. Primary outcomes included procedural utilization with subanalyses comparing arthroplasty versus joint-preserving procedures, and age-stratified by under/over 50 years. Linear regressions were evaluated for trends in procedural volumes over time.
From 2010 to 2014, 0.54% of all knee procedures were to treat ON compared to 0.71% from 2015 to 2020 (P < .001). Overall rates of TKA (85.4%) and UKA (10.3%) far exceeded rates of joint preserving procedures (4.3%). Comparing 2010-2014 with 2015-2019, joint-preserving procedures proportionally increased (0.7 to 5.0%, P < .001). Patients <50 years had significantly more joint-preserving procedures (19.5 versus 2.7%). Overall, TKA was the most common procedure (7,062; 85.40%), following by UKA 853; 10.32%) and core decompression (354; 4.28%).
To our knowledge, this is the first study to characterize surgical trends in management of knee ON. Overall surgical volume for knee ON has continued to increase, outpacing population growth. Patients who have knee ON are most commonly managed with arthroplasty procedures, specifically TKA. Younger aged patients (<50 years) are more likely to undergo joint-preserving procedures, namely core decompression.
Similar 20-year survivorship for single and bilateral total knee arthroplasty
2022, Knee
Citation Excerpt :
A diagnosis of primary osteoarthritis has also been associated with longer implant survival compared to rheumatoid arthritis due to lower rates of PJI in patients with osteoarthritis [8]. There is also literature to suggest that implant design also affects TKA survivorship [7,9–11]. With the variety of TKA implants currently available on the market combined with multiple patient factors and surgical techniques, further research is needed to evaluate the multifactorial impact of patient factors on implant function and long-term survivorship.
Long-term follow-up after total knee arthroplasty (TKA) is crucial to providing survivorship updates on available TKA implants to guide patient expectations when undergoing TKA. The purpose of this study was to compare implant survivorship between patients undergoing primary single, simultaneous bilateral, and staged bilateral TKA with 15-year minimum follow-up.
This retrospective study included 826 patients (n = 1089) who underwent primary single (n = 454), simultaneous bilateral (n = 266), or staged bilateral (n = 369) TKA using a single TKA system by a single surgeon from 1991-2005 with 15-year minimum follow-up. Demographics, clinical variables, and surgical outcomes were collected and compared using Student’s t-test, chi-squared tests, or Kaplan-Meier analyses. Reoperation was defined as all surgeries performed on the knee after the index procedure; revision TKA was defined as complete implant exchange. p < 0.05 significant.
Patients in the staged TKA cohort were younger (65.4 years = staged, 67.8 = simultaneous, 67.1 = single, p < 0.019). Women were less likely to receive simultaneous TKAs (22 %vs.29%, p < 0.001). Postoperative range of motion was similar (116.8° = simultaneous, 114.9° = staged, 114.8° = single, p = 0.11). Overall 15-year implant survival based on revision TKA was similar (97.7% = simultaneous, 97.2% = staged, 96.7% = single, p = 0.45). The estimated 15-year reoperation rate was 7.0% (95% CI, 5.5–8.7%). Reoperations were secondary to infection (35.5%), implant wear (26.3%), arthrofibrosis (18.4%), traumatic injuries (10.5%), pain (6.6%), pathologic lesion (1.3%), and avascular necrosis (1.3%).
This study demonstrated a high implant survival rate of 95–97% at 20-years after primary single, staged bilateral and simultaneous bilateral TKA. Furthermore, simultaneous bilateral TKAs exhibited similar range of motion, implant survival, and rates of reoperation to staged bilateral and single TKA.
Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages
2021, Journal of Shoulder and Elbow Surgery
Stem-free shoulder arthroplasty has recently been shown to have comparable results to stemmed arthroplasty, though stemless designs are typically used in a younger patient population. Additionally, although the native humeral head is elliptical in shape, clinical results with ellipsoid implants in shoulder arthroplasty have not been reported on previously. This case series reports on the outcomes of a recently introduced anatomic total shoulder arthroplasty with an ellipsoid-shaped articular surface and unique multiplanar platform type of stemless fixation.
This retrospective case series examines the initial cohort of patients who received an anatomic total shoulder arthroplasty using an ellipsoid stem-free humeral prosthesis and an all-polyethylene glenoid component from the Catalyst CSR Total Shoulder System (Catalyst OrthoScience) over a 1-year period. Inclusion criteria were patients with a diagnosis of advanced glenohumeral joint arthritis with an intact rotator cuff, regardless of patient age. Clinical outcomes including shoulder range of motion and patient-reported outcome measures, as well as radiographs, were evaluated at multiple time points postoperatively, with minimum 2-year follow-up.
Sixty-three shoulders in 57 patients with a mean age of 73.0 years (range 60-85 years) were included in the study with a mean follow-up period of 30.5 months (range 24-41 months). Forward elevation improved from 121° to 150° (P < .0001), external rotation improved from 28° to 48° (P < .0001), and internal rotation improved from L3 to L1 (P < .001). There were statistically significant improvements exceeding the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score (37 to 94, P < .001), Single Assessment Numeric Evaluation (SANE) (40 to 93, P < .001), visual analog scale (6.3 to 0.4, P < .001), and Patient-Reported Outcomes Measurement Information System physical domain T score (44 to 57, P < .001). The improvement in the ASES score also exceeded the threshold for the substantial clinical benefit. Age, sex, and preoperative glenoid morphology did not appear to have an effect on the clinical outcome scores. There were no implant failures or evidence of radiographic loosening of the humerus component in any patients.
At 2-year minimum follow-up, this stem-free ellipsoid humerus total shoulder arthroplasty provides very good results with high patient satisfaction, clinical improvement in all outcome measures studied, and no signs of loosening.

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: Supplementary material available at www.arthroplastyjournal.org.

: The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.10.027.

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Twenty-Year Survival Analysis in Total Knee Arthroplasty by a Single Surgeon

Abstract

Section snippets

Materials

Clinical Results

Discussion

J Arthroplasty

Orthop Trauma Surg Res

Knee

Survival and functional analysis of implants in total knee replacement

J Korean Orthop Assoc

Factors affecting the durability of primary total knee prostheses

J Bone Joint Surg Am

The anatomical graduated component total knee replacement: a long-term evaluation with 20-year survival analysis

J Bone Joint Surg Br

Survival of knee arthroplasties. A nation-wide multicentre investigation of 8000 cases

J Bone Joint Surg Br

Estimating the survival time of knee replacement

J Bone Joint Surg Br

Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations

Clin Orthop Relat Res

Survivorship of total hip replacements

J Bone Joint Surg Br

The design of clinical graft studies

Acta Chir Scand

A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis

J Bone Joint Surg Br

Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up

J Bone Joint Surg Br