LONG TERM FOLLOW-UP OF TOTAL KNEE REPLACEMENTS. IS IT NECESSARY?

Abstract

Introduction: Total Knee Replacement (TKR) is a routine and common orthopaedic operation. Approximately 600 TKRs are performed annually at Royal Bournemouth Hospital. Although contemporary advice is that these patients should have long-term follow-up, there is very little evidence to support this protocol that involves considerable resources. We have had a policy of early discharge from follow-up (6–12 weeks) for over 10 years.

Purposes of the study: To validate the efficacy of the policy of early discharge after total knee arthroplasty at 8–10 years post surgery and to identify whether this policy has made revision surgery more difficult or complex as a result of possible late presentation.

Methods: 798 consecutive patients who underwent primary Total and Unicompartmental knee arthroplasy at Royal Bournemouth Hospital during the period 1 April 1994 to 31 March 1996 were identified. Medical records and operative notes were analysed for all patients from this cohort who have had any further surgery on their index knee. The waiting lists were also checked to identify patients from this cohort waiting for further surgery.

Results: The mean age at index operation was 72 years (range 37 to 92 years). 39/798 patients (4.9%) have had revision surgery at 8–10 years follow-up. Many of the revisions were performed on patients with early problems and 15/39(38%) of the revisions were performed on patients who were rereferred to clinic. There was a 1.1% deep infection rate leading on to revision (9 knees).

8/39 of revisions were for resurfacing the patella (20%). One patient who had a complex patella fracture needing patellectomy later had further revision surgery for instability requiring posterior stabilised components. In no patient was the revision surgery compromised or made reconstructable due to delayed presentation. In total 3 patients required bone grafting of contained cavities and only 5 knees with aseptic loosening required revision implants with stems.

Conclusion: We do not accept the need for long-term follow-up of successful implants especially whilst using prostheses with a proven track record in elderly patients.