scholarly journals Total Knee Arthroplasty in the 21st century: Why Do They Fail? A Fifteen-Year Analysis of 11, 135 Knees

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0020
Author(s):  
Simon W Young ◽  
Chuan Kong Koh ◽  
Saiprasad Ravi ◽  
Mark Zhu ◽  
Kelly G Vince
Keyword(s):  
Total Knee Arthroplasty ◽  
New Zealand ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Tertiary Referral ◽  
Long Term Follow Up ◽  
Total Knee

Introduction and Aims: As national total knee arthroplasty (TKA) registries evolve, there is an increasing trend towards publication of hospital and surgeon-level outcome data, with the goal of stimulating efforts to optimise the results of TKA. Such efforts first require understanding of the current mechanisms of TKA failure. Previous reports on revision TKA from tertiary referral centres lack data on the overall denominator, thus the relative importance of each failure mechanism leading to TKA revision over long term follow up remains unclear. The aim of this study was to analyse reasons for revision following primary TKA, and assess their relative frequencies over long-term follow-up. Methodology: 11,134 primary TKA performed between 2000-2015 at one of three tertiary referral hospitals were identified. ‘Failure’ was defined as patients undergoing subsequent revision surgery involving change of of one or more components or reoperation for deep periprosthetic joint infection (PJI). Patients were identified from a combination of the New Zealand National Joint Registry and individual search of patient records and clinical coding (ICD-9 and ICD-10). All relevant clinical records, radiographs, and lab results were obtained from all New Zealand hospitals to identify the primary reason for revision according to a standardised protocol. Results: A total of 357 (3.2%) failures over the 15 year period were identified. Of these, 36% were revised within one year and 56% were revised within 2 years of primary TKA. Periprosthetic joint infection (PJI) encompassed 48% of all reasons for revision, followed by aseptic loosening (15%), secondary patella resurfacing (14%), tibio-femoral instability (9%), stiffness (5%), polyethylene wear (2.5%), periprosthetic fracture (2.3%), patella maltracking (1.9%) and extensor mechanism discontinuity (0.9%). In the first 5 years following primary TKA, the most common reason for revision was PJI (52%), from 5-10 years PJI and aseptic loosening (35% each), and from 10-15 years aseptic loosening (41%). Conclusion: In this large cohort of patients with comprehensive follow up, PJI was the dominant reason for failure particularly in the first 10 years. Aseptic loosening becomes more important after 10 years follow up. Efforts to improve outcomes following primary TKA should focus on these areas, particularly prevention of PJI.

scholarly journals Titanium-Nitride Coating Does Not Result in a Better Clinical Outcome Compared to Conventional Cobalt-Chromium Total Knee Arthroplasty after a Long-Term Follow-Up: A Propensity Score Matching Analysis

Coatings ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 442 ◽  
Author(s):  
Georg Hauer ◽  
Lukas Leitner ◽  
Marc C. Ackerl ◽  
Sebastian Klim ◽  
Ines Vielgut ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Cobalt Chromium ◽  
Tin Coating ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Cocr Alloy

Background: The impact of titanium nitride (TiN) coating on implant components is controversial. TiN coating is proposed as having superior biomechanical properties compared to conventional cobalt-chromium (CoCr) alloy. This study compared long-term clinical data as well as meteoro-sensitivity in patients who underwent total knee arthroplasty (TKA), with either CoCr alloy or TiN coating. Methods: In this retrospective observational study, the clinically approved cemented “low contact stress” (LCS) TKA with conventional CoCr coating, was compared to un-cemented TiN-coated “advanced coated system” (ACS) TKA. Propensity score matching identified comparable patients based on their characteristics in a one-to-one ratio using the nearest-neighbor method. The final cohort comprised 260 knees in each cohort, with a mean follow-up of 10.1 ± 1.0 years for ACS patients and 14.9 ± 3.0 years for the LCS group. Physical examinations, meteoro-sensitivity, and knee scoring were assessed. Results: The clinical and functional Knee Society Score (KSS) (82.6 vs. 70.8; p < 0.001 and 61.9 vs. 71.1; p = 0.011), the postoperative Visual Analogue Scale (VAS) (2.9 vs. 1.4; p = 0.002), and the postoperative Tegner Score (2.6 vs. 2.2; p = 0.001) showed significant intergroup differences. The postoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was similar (79.9 vs. 81.3; p = 0.453) between groups. Meteoro-sensitivity of the artificial joint was significantly more prevalent in the ACS patient cohort (56% vs. 23%; p < 0.001). Conclusion: This study suggests that TiN coating does not provide improved clinical outcomes in this patient cohort after a long-term follow-up. Interestingly, sensitivity to weather changes were more correlated with un-cemented ACS implants.

scholarly journals Long-term follow up of Navigation TKA using multi directional mobile bearing design

10.29007/3724 ◽  
2018 ◽  
Author(s):  
Eun-Kyoo Song ◽  
Jong-Keun Seon ◽  
Dong-Hyun Lee ◽  
Je-Hyoung Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Survival Rates ◽  
Mobile Bearing ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Bearing Design

Total knee arthroplasty using navigation system is known to be more effective than conventional methods in achieving more accurate bone resection and neutral alignment.1 Mobile bearing is also known to reduce wear and automatically correct rotational malalignment of the tibia but the long-term follow-up results of more than 10 years are extremely rare.2, 3 The purpose of this study is to investigate the results of clinical and radiologic long-term follow-up and complications of total knee arthroplasty using navigation and multi-directional mobile bearing.From 2003 to 2006, a total of 111 navigation TKAs using multi-directional mobile bearing design were carried out and reviewed retrospectively. TKAs were performed by two experienced surgeons at one institute. Of the 111 patients, 102 were women and 9 were men. The mean duration of follow-up was 11.4 ± 1.0 years (range, 10.1 to 14.08 years). Clinical outcomes were evaluated in terms of Knee Society Score, Hospital for Special Surgery score, Western Ontario and McMaster University (WOMAC) score, range of motion and complications. Long-term radiological outcomes and survival rates were evaluated at least 10 years.Average preoperative HSS score was 66.5 ± 9.8 and KSS pain and function score were 25.0 ± 11.8 and 44.5 ± 12.3, respectively. Scores improved to 94.1 ± 8.2, 46.6 ± 11.6 and 88.2 ± 14.6 at the last follow up, respectively. Mean preoperative WOMAC scores of 75.8 ± 16.5 improved to 13.8 ± 16.0 at last follow-up. Five knees required re-operation, two for liner breakage, one for liner wear, one for distal femoral fracture and one for infection. The estimated 10-year prosthesis survival rates for any reason and for prosthesis-related problems were 95.5% and 97.4% , respectively.TKAs using each techniques resulted in similar good clinical outcomes and postoperative leg alignments. Robotic and navigation TKA appeared to reduce the number of postoperative leg alignment outliers and revision rate compared to conventional TKA.

Long-Term Follow-Up of Anatomic Graduated Component Total Knee Arthroplasty

2012 ◽  
Vol 27 (6) ◽  
pp. 1190-1195 ◽  
Author(s):  
Maarten R. Huizinga ◽  
Reinoud W. Brouwer ◽  
Roel Bisschop ◽  
Hugo C. van der Veen ◽  
Inge van den Akker-Scheek ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Long Term Follow Up ◽  
Total Knee

scholarly journals Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Ines Vielgut ◽  
Lukas Leitner ◽  
Norbert Kastner ◽  
Roman Radl ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Contact Stress ◽  
Knee Arthroplasty ◽  
Sports Activity ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Low Contact Stress

Long-term follow-up and survivorship of single-radius, posterior-stabilized total knee arthroplasty

2018 ◽  
Vol 23 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Moon Jong Chang ◽  
Sangyeon So ◽  
Chan-Deok Park ◽  
Jai Gon Seo ◽  
Young-Wan Moon
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Single Radius

scholarly journals Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

2020 ◽  
Vol 35 (1) ◽  
pp. 272-277 ◽  
Author(s):  
Jordan S. Broberg ◽  
Silvio Ndoja ◽  
Steven J. MacDonald ◽  
Brent A. Lanting ◽  
Matthew G. Teeter
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Contact Kinematics ◽  
Long Term Follow Up ◽  
Total Knee

scholarly journals Multiple joint procedures in haemophilia: benefit of self-reported activities

2016 ◽  
Vol 3 (2) ◽  
pp. 55-61
Author(s):  
Piet de Kleijn ◽  
David Sluiter ◽  
Kathelijn Fischer ◽  
Charles Vogely ◽  
Eveline P. Mauser-Bunschoten ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Ankle Arthrodesis ◽  
Post Surgery ◽  
Activity Measurements ◽  
Long Term Follow Up ◽  
Total Knee

Abstract This paper presents a long-term follow-up (mean 6 years) of three cases, providing insight into individual changes in self-reported activities of persons with haemophilia (PWH) who underwent multiple joint procedures (MJP). The procedures include one bilateral ankle pan arthrodesis by means of an ankle arthrodesis nail (case 1) and two times bilateral total knee arthroplasty (TKA), both type Genesis II (cases 2 and 3). MJP are defined as any combination of total hip arthroplasty (THA), total knee arthroplasty (TKA) and ankle arthrodesis (AA) during one hospital admission (one session or staged). The results of MJP need meticulous long-term follow-up, including tools with the capacity to provide detailed measurements for levels of activity. Measurements performed before and after surgery included active range of motion (AROM), the Hemophilia Activities List (HAL) sub-scores for basic and complex lower extremity and the McMaster Toronto Arthritis patient disability questionnaire (MACTAR). Pain scores were only available post-surgery and were by means of a visual analogue scale (VAS), 0 indicating no pain and 10 maximum pain. Post-operative VAS scores were 0.3 on average (range 0-1), indicating only minimal pain. Pre-operative pain was the actual indication for MJP. However, it was measured with a different score, the WFH score. Regarding post-operative AROM, case 1 showed a decreased ankle plantar flexion averaging 15˚ (range 10-20˚) and dorsiflexion averaging 7.5˚ (range 5-10˚), results expected after surgical fixation of the tibiotalar joint. Cases 2 and 3 showed an increased active flexion of both knee joints, on average 6° (range 5-10˚), and extension of 11° (range 0-20˚). From these two cases the HAL showed improvement in both basic (Δ 40 and Δ 30) and complex lower extremity (Δ 40 and Δ 3,5) activities. When considering the standard deviations of the HAL normalised total score of 18, it can be appreciated that these improvements are clinically relevant (effect size Δ 1). The MACTAR showed individual progress, with emphasis on walking, standing, riding a bicycle and walking stairs. These MJP cases provide insight on the benefits of self-reported activities, as well as the relationship between body and activity of the ICF. For the long-term follow-up of this very specific population, self-reported activities should be included.

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