The first 101 posterior cruciate retaining modular tibial components of a single design performed by a single surgeon in 75 patients were evaluated at a minimum 20-year follow-up. All components were fixed with cement. These patients had been prospectively followed at five-year intervals and evaluated clinically using Knee Society ratings and documenting any need for reoperation. Serial radiographs were evaluated for radiolucencies, osteolysis or component migration until the time of patient death or at minimum 20-year follow-up.

At minimum 20-year follow-up, five knees (5%) had required a revision operation. All revisions occurred greater than 10 years following the index procedures. Benefits of modularity (i.e. retention of the tibial tray) were utilized in three of five cases in this closely followed cohort. Survivorship from any revision was 90.8% at 20 years. For the 16 living patients with 22 knees, the average Knee Society Clinical and Functional scores were 91 and 59, respectively, and the average range of motion was 115 degrees.

When considering gamma irradiated in air polyethylene and a first generation locking mechanism were utilized, these results encourage the authors to continue to use modular tibial trays.

Purpose: To our knowledge, there are no 35 year follow-up studies of the Charnley total hip arthroplasty in the United States. The purpose of the study was to evaluate the results of a single surgeon series of primary Charnley total hip arthroplasties performed with cement at a minimum 35 year follow-up interval.

Method: Between July 1970 and April 1972, the senior author performed 330 Charnley total hip replacements with cement using a hand-packing cement technique. At minimum 35 years post-operatively, 13 patients (16 hips) were alive, with 1 patient (1 hip) lost to follow-up. Living patients were evaluated clinically with a standard terminology questionnaire, and WOMAC. Radiographic evaluation included loosening, lysis, and need for reoperation.

Results: After a minimum 35 year follow-up, only 25 (8%) acetabular components and 10 (3%) femoral components revised for aseptic loosening. For the 16 hips in living patients, 7 acetabular components (44%) and 2 femoral component (12%) were revised for aseptic loosening. Overall, 87% of the original prosthesis remains intact at the time of final follow-up, or at the time of the patient’s death. The average linear wear rate for all patients with minimum 10 year radiographic follow-up was 0.09 mm/year.

Conclusion: Our follow-up study at a minimum 35 years following Charnley total hip arthroplasty with cement demonstrates the remarkable durability of the procedure. As demonstrated in this study, the long term challenge has been revisions associated with bearing surface wear. This study should provide a benchmark for comparison to follow-up studies of other procedures and devices as they reach this interval of follow-up.

Purpose: Few reports are available at minimum 15 year follow-up of cemented modular cruciate retaining TKA, especially where all polyethylene patella components were utilized. This paper addresses the questions “What is the durability of cemented modular cruciate retaining TKA with all polyethylene patella components at 15 years?” and “Did modular tibial trays demonstrate their utility in terms of the potential for less costly and less complex revisions?”

Method: 101 Press Fit Condylar TKA’s were performed consecutively over a 27 month interval and followed prospectively for a minimum of 15 years. The average age at surgery was 72 years. Clinical Knee Society scores, need for revision, radiographic evidence of loosening, and osteolysis were recorded. All patients were recalled at 5 year intervals.

Results: At minimum 15 year follow-up, 34 patients with 45 knees were living and 40 patients with 54 knees were deceased (one patient [2 knees] was lost to follow-up). 81% of living patients had 15 year radiographs. 6 knees were revised (all related to wear and osteolysis). Average Knee Society clinical scores only deteroriated from 92 points to 89 points between 10 and 15 years.

Conclusion: This cemented modular CR TKA performed well at 15 years with only 6% of knees requiring revision. All revisions occurred after 10 years and were related to wear and osteolysis. 2/3 of the revisions could be salvaged without tibial component revision in this closely followed series. Hopefully these results can be improved with better wear-resistant designs and better quality polyethylene. Especially into the second decade, patients with modular tibial tray TKA constructs should be closely followed to optimize their utility allowing less costly and less complex revisions in cases with polyethylene wear.

Patient postoperative outcome can be accurately predicted by the patient’s preoperative HHS or WOMAC score. Prospective, cohort studies of one hundred and seventy-five THAs. SF-36, WOMAC and Harris Hip Score (HHS)questionnaires were used to determine pre-operative and two year final outcome. Student’s t-test, 95% confidence intervals, receiver operator characteristic curves, simple regression analysis and probability were measured. Patients with a HHS = sixty-five pre-operatively had a 100% probability of having an excellent result postoperatively. A preoperative HHS value of thirty-four, and preoperative WOMAC (physical function) value of fifty were the best cutoff points to attain a significantly better postoperative functional outcome.

Total hip arthroplasty (THA) has been well documented to enhance patient function, but patient outcome is dependant on preoperative statuts. The exact timing of surgery to optimize patient outcome after THA remains unknown. This study determines the ideal timing for surgery to obtain the best possible functional outcome.

Prospective, multicenter, cohort studies of one hundred and seventy-five identical, cemented THAs. General health (SF-36) and disease specific (WOMAC and Harris Hip Score(HHS)) questionnaires were used to determine preoperative and two year final outcome. Student’s t-test, 95% confidence intervals, receiver operator characteristic curves, simple regression analysis and probabilty were measured.

All functional scores were improved significantly postoperatively (p< 0.001). Patients with a HHS = sixtyfive preoperatively had a 100% probability of having an excellent result postoperatively. A preoperative HHS value of thirty-four, and preoperative WOMAC (physical function) value of fifty were the best cutoff points to attain a significantly better postoperative functional outcome.

Patient postoperative outcome can be accurately predicted by the patient’s preoperative HHS or WOMAC score. Optimization of surgical timing, by prioritizing wait lists or deciding to treat the arthritis operatively, based on these preoperative score guidelines will help ensure an excellent outcome post THA.