Abstract
Introduction
Primary total knee arthroplasties (TKA) performed in younger patients raise concerns regarding the potential for accelerated polyethylene wear, aseptic loosening, and thus revision TKA at a younger age. The purpose of this study was to determine the long-term implant survivorship, functional outcomes, and pain relief of primary TKA performed in patients under 35 years of age.
Methods
A retrospective review of our institutional registry identified 185 TKAs performed in 119 patients under the age of 35 between 1985 and 2010. Medical records and radiographs were reviewed. Patients were contacted for two serial questionnaires in 2011–2012 and again in 2018. Implant survivorship was calculated using Kaplan-Meier survivorship curves and Cox proportional hazard model. The median age was 26.1 (21.5–30.1) years, with a BMI of 23.5 (20.4–26.6) kg/m2. Median follow-up was 13.9 (8.5–19.8) years.
Results
Implant survivorship at 5, 10, 15, and 20 years were 83%, 72%, 52%, and 39% respectively. Inflammatory diagnoses had improved survivorship relative to osteoarthritis (p=0.028). Increasing age at primary TKA (HR 1.3), varus-valgus constrained devices (HR 1.7), and hinge-type prostheses (HR 6.4) were associated with revision TKA. The most common indications for revision were periprosthetic joint infection (26%), aseptic loosening (22%), and instability (22%). Median time to revision was 4.3 (1.2–11.0) years. Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores were 76.3 (63.8–92.0) points at most recent follow-up. 74% of patients reported mild or no pain, 73% ambulated without assistive devices, and 51% could ambulate unlimited distances at most recent follow-up.
Conclusions
Patients under the age of 35 years who underwent primary TKA had significant pain relief and continued functional ability in the long-term. However, implant survivorship was 52% at 15 years. The use of constrained implants, non-inflammatory diagnoses, and increasing age at primary TKA were risk factors for revision surgery.
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