Original Research

Implant Survivorship and Complication Rates After Total Knee Arthroplasty With a Third-Generation Cemented System: 15-Year Follow-Up

Publish date: March 28, 2018

References

1. Lützner J, Hübel U, Kirschner S, Günther KP, Krummenauer F. Langzeitergebnisse in der Knieendoprothetik. Chirurg. 2011;82(7):618-624. doi:10.1007/s00104-010-2001-8.

2. Font-Rodriguez DE, Scuderi GR, Insall J. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79-86.

3. Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res. 2001;388:10-17.

4. Van Loon CJM, Wisse MA, de Waal Malefijt MC, Jansen RH, Veth RPH. The kinematic total knee arthroplasty. Arch Orth Traum Surg. 2000;120(1-2):48-52. doi:10.1007/PL00021215.

5. Buechel FFS. Long-term followup after mobile-bearing total knee replacement. Clin Orthop Relat Res. 2002;404:40-50.

6. Ito J, Koshino T, Okamoto R, Saito T. 15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty. 2003;18(8):984-992. doi:10.1016/S0883-5403(03)00262-6.

7. Dixon MC, Brown RR, Parsch D, Scott RD. Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. J Bone Joint Surg. 2005;87(3):598-603. doi:10.2106/JBJS.C.00591.

8. Duffy GP, Crowder AR, Trousdale RR, Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty. 2007;22(6 Suppl 2):67-70. doi:10.1016/j.arth.2007.05.001.

9. Baker PN, Khaw FM, Kirk LMG, Esler CNA, Gregg PJ. A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis. J Bone Joint Surg. 2007;89-B(12):1608-1614. doi:10.1302/0301-620x.89b12.19363.

10. Bozic KJ, Kinder J, Menegini M, Zurakowski D, Rosenberg AG, Galante JO. Implant survivorship and complication rates after total knee arthroplasty with a third-generation cemented system: 5 to 8 years followup. Clin Orthop Relat Res. 2005;430:117-124. doi:10.1097/01.blo.0000146539.23869.14.

11. Effenberger H, Berka J, Hilzensauer G, Ramsauer T, Dorn U, Kißlinger E. Miller-Galante total knee arthroplasty: the importance of material and design on the revision rate. Int Orthop. 2001;25(6):378-381. doi:10.1007/s002640100294.

12. Kirk PG, Rorabeck CH, Bourne RB. Clinical comparison of the Miller Galante I and AMK total knee systems. J Arthroplasty. 1994;9(2):131-136. doi:10.1016/0883-5403(94)90061-2.

13. Kobori M, Kamisato S, Yoshida M, Kobori K. Revision of failed metal-backed patellar component of Miller/Galante-I total knee prosthesis. J Orthop Sci. 2000;5(5):436-438. doi:10.1007/s007760070020.

14. Larson CM, Lachiewicz PF. Patellofemoral complications with the insall-burstein II posterior-stabilized total knee arthroplasty. J Arthroplasty. 1999;14(3):288-292. doi:http://dx.doi.org/10.1016/S0883-5403(99)90053-0.

15. Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y. Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg. 2001;14(3):152-156.

16. Miyagi T, Matsuda S, Miura H, Nagamine R, Urabe K. Changes in patellar tracking after total knee arthroplasty: 10-year follow-up of Miller-Balante I knees. Orthopedics. 2002;25(8):811-813. doi:10.3928/0147-7447-20020801-10.

17. Rao AR, Engh GA, Collier MB, Lounici S. Tibial interface wear in retrieved total knee components and correlations with modular insert motion. J Bone Joint Surg. 2002;84(10):1849-1855.

18. Anand R, Graves SE, de Steiger RN, et al. What is the benefit of introducing new hip and knee prostheses? J Bone Joint Surg. 2011;93(3):51-54. doi:10.2106/JBJS.K.00867.

Patients reported 2 complications since the previous 5- to 8-year follow-up, 1 in each group. The first case underwent a PS TKA that required open reduction internal fixation for a bilateral supracondylar peri-prosthesis femur fracture following a fall, which was subsequently complicated with infection and ultimately led to above-the-knee amputation. In the second case, a CR TKA patient experienced persistent swelling and knee instability. The patient followed up with a local orthopaedist, but to date, no reoperations on the knee have been reported.

Spearman correlations between the patients’ self-reported knee scores (as a percentage of normal) and physician-based knee scores were moderately correlated with physician-based knee scores (r_s = 0.42; P < .001).

Reoperation rates were 2% for PS and 0% for CR (P = .38). Kaplan-Meier analysis was performed to evaluate time-related freedom from reoperation and no significance difference between the PS and CR groups was revealed (log-rank test = 1.40, P = .24, Figure 2).

DISCUSSION

The success of TKA in pain relief and restoration of function has led to increased demands for this surgery.¹ Such demand has enabled the introduction of a new joint replacement prosthesis to the market.¹⁸ Considering the increased incidence of osteoarthritis in the younger population (<55 years of age), critically reviewing the longevity and durability of TKA implant designs is of great importance. Compared with other TKA implant designs, the NexGen Zimmer Biomet Knee system has shown excellent longevity at the 15-year follow-up.^5,6,9,11-15 Our study began with 136 patients, and, after eliminating the deceased, those lost to follow-up, and non-responders, a total of 99 patients were available for the 15-year follow-up. At this time-point, 80% of the PS implants and 89% of the CR implants were associated with no or mild pain. Survivorship at the 15-year follow-up was similar in both groups: 98% for PS TKAs and 100% for CR TKAs. The reoperation rate was low in both groups, and no evidence of aseptic loosening was found. Based on our results, the NexGen Zimmer Biomet Knee system can be concluded to show excellent longevity and functional outcomes at the 15-year follow-up.

Our study includes several limiting factors that were taken into consideration during the analysis of the results. One of the main limitations of this work is that it required a 15-year follow-up of predominantly elderly patients; many of the participants may be expected to be deceased at this time-point. In our study, a total of 7 patients were confirmed to be deceased by a first-degree relative or the Social Security Death Index. In addition, unlike Bozic and colleagues’¹⁰ previous 5-year follow-up study, radiographic imaging data were not collected at the 15-year follow-up. However, given that this study aimed to assess the functional knee scores and reoperation rates of the PS and CR NexGen Zimmer Biomet Knee system, radiographic information did not appear to be necessary.

CONCLUSION

This study found no significant differences in functional outcomes between the PS and CR NexGen knee implants. Patients who received these implants showed excellent longevity and survivorship at their 15-year follow-up.