62 – MID TO LONG-TERM SURVIVORSHIP OF THE AMK TOTAL KNEE ARTHROPLASTY SYSTEM. A COMPARISON OF METHODS OF FIXATION

Abstract

Purpose: The purpose of this study was to investigate the mid to long term (minimum 10 years follow-up) survivorship of the AMK total knee arthroplasty (TKA), as well as determine the effect of implant fixation on outcome.

Method: Between 1988 and 2000, 1074 AMK primary total knee arthroplasties were preformed on 843 patients. All diagnosis included, the distribution was 90% osteoarthritis (971), 7% inflammatory arthritis (76) and 3% other diagnoses (27). Average time from surgery was 15 years (range 10–21 years). Average age at primary procedure was 68 years (range 22–99). Fifty-six percent were female (599) and 44% male (475). Preoperative alignment consisted of 56% varus (601) and 17% valgus (182). Ninety percent (968) had patella resurfacing performed, 62% (661) received cemented TKA fixation, on 32% hybrid fixation (cemented femoral component, cementless tibial tray) was performed and 6% (66) had cementless fixation. Two hundred thirty-seven cases were deceased before 20 years follow-up (22%).

Results: At 10 to 21 years follow-up, 129 revisions were performed (12%). The most common reasons for revision were polyethylene wear, particle induced osteolysis, instability and pain (43% of revisions). Implant fixation significantly influenced the rate of revision with cemented fixation having a 6.7% rate of revision (44/661), hybrid fixation a 14% revision rate (47/336) and cementless a 36.4% revision rate (24/66). Excluding infections (11 cases), overall Kaplan-Meier survivorship at five, 10 and 15 years was 96.4%, 91.9% and 85.8%, respectively. At 20 years the predicted Kaplan-Meier survivorship was estimated at 83.5% (no revisions beyond 17.5 years). Cemented fixation was associated with significantly better survivorship than hybrid and cementless fixation (p< 0.0001). At 5, 10 and 15 years cemented AMK TKA survivorship was 97.5%, 94.9% and 91.9% respectively (no revision performed beyond 13.5 years). For hybrid fixation the survival at 5, 10 and 15 years was 97.8%, 92.2% and 85.1% respectively. Cementless AMK THA had a Kaplan-Meier survivor-ship of 88.9%, 78.2% and 57.4% at 5, 10 and 15 years respectively.

Conclusion: Cemented fixation had superior outcomes compared to cementless and hybrid fixation with the most common reasons for revision being polyethylene wear and osteolysis. To our knowledge this the first medium to long term follow-up of the AMK TKA and it demonstrates that method of fixation had a major influence on revision rates and survivorship.