Abstract. Introduction. Choosing a hinged implant in the revision knee arthroplasty (rTKA) setting is challenging and limited data on implant performance exists. We present the survivorship and reason for failure in rTKA performed at our institution using the LINK hinge prosthesis, predominantly the cemented modular Endo-Model prosthesis. Methodology. 260 consecutive revision knee cases performed between 2012 and 2020 were reviewed retrospectively. Mean follow up was 27 months (range 0 to 107). Survivorship was analysed in Stata using a Log Rank test to compare performance in patients stratified according to age (≥80 years old (76 cases), 70–79 years (104 cases) and ≤70 years (80 cases). Results. 53 patients died and 48/207 (23%) cases in 40 patients underwent re-revision. Reasons for re-revision were aseptic loosening (21), infection (12), instability (4), extensor failure (1), stiffness (1), fracture (1) and other (8). Loosening was seen in the femur (8), tibia (5), and both the femur and tibia (8). Sub-group analysis of patients according to age showed a significantly higher failure rate in younger patients (6 failures (8%) in patients ≥80, 27 failures (26%) in 70–79 and 15 (19%) in ≤70 (p = 0.02). Failure in patients ≤70 was predominantly due to aseptic loosening (8/15). Conclusion. Here we report a significantly higher rate of LINK hinge prostheses failure in patients <70 undergoing rTKA. Consent should consider the risk of re-revision in this patient group

We analysed at a mean follow-up of 7.25 years the clinical and radiological outcome of 117 patients (125 knees) who had undergone a primary, cemented, modular Freeman-Samuelson total knee replacement. While the tibial and femoral components were cemented, the patellar component was uncemented. A surface-cementing technique was used to secure the tibial components. A total of 82 knees was available for radiological assessment. Radiolucent lines were seen in 41 knees (50%) and osteolytic lesions were seen in 13 knees (16%). Asymptomatic, rotational loosening of the patellar implant was seen in four patients and osteolysis was more common in patients with a patellar resurfacing. Functional outcome scores were available for 41 patients (41 knees, 35%) and the mean Western Ontario McMasters Universities score was 77.5 (. sd. 19.5) and the cumulative survival was 93.4% at ten years with revision for aseptic loosening as an endpoint. Increased polyethylene wear from modular components, a rotationally-loose patella, and the surface-cementing technique may have contributed to the high rate of osteolysis seen in our study

We evaluated the survival of moulded monoblock and modular tibial components of the AGC total knee replacement in patients with rheumatoid arthritis. Between 1985 and 1995, 751 knees with this diagnosis were replaced at our institution. A total of 256 tibial components were of the moulded design and 495 of the modular design. The mean follow-up of the moulded subgroup was 9.6 years (0.5 to 14.7), and that of the modular group 7.0 years (0.1 to 14.7). The groups differed significantly from each other in Larsen grade, cementing of components and patellar resurfacing, but no statistically significant difference between the survival of the components was found (Log rank test, p = 0.91). The cumulative success rate of the moulded group was 96.8% (95% confidence interval 93.6% to 98.4%) at five years and 94.4% (95% confidence interval 90.4% to 96.7%) at ten years, and of the modular group 96.2% (95% confidence interval 94% to 97.6%) and 93.6% (95% confidence interval 89.7% to 96%), respectively. Revision was required in 37 total knee replacements, the main causes were infection, pain, loosening of the tibial component and patellar problems. Survival rates for both components were satisfactory

Aims

This study compared the cobalt and chromium serum ion concentration of patients treated with two different metal-on-metal (MoM) hinged total knee arthroplasty (TKA) systems, as well as a titanium nitride (TiN)-coated variant.

Aims

To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period.

Background

There are case series of debonding of the ATTUNE® tibial component introduced in 2013. We studied the early clinical results of this total knee arthroplasty (TKA) and compared it to other designs at one hospital.

This retrospective study evaluated the midterm clinical and radiographic outcomes of a second-generation total knee replacement system. In a multicentre consecutive series of 1512 patients, 1970 knees were treated with the PFC Sigma knee system (Depuy, Warsaw, Indiana). The patients were reviewed for functional outcome, and underwent independent radiographic evaluation at a mean follow-up of 7.3 years (5 to 10). A total of 40 knees (2%) required revision, 17 (0.9%) for infection. The incidence of osteolysis was 2.2%. The ten-year survival with revision for any cause other than infection as the endpoint was 97.2% (95% CI 95.4 to 99.1).

The PFC Sigma knee system appears to provide excellent results in the medium term.

Aims. The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes. Methods. A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years. Results. Overall, 69 consecutive patients (69 knees) were included with a median age of 78 years (interquartile range 69 to 84), and there were 46 females (66.7%). Indications were septic revisions in 26 (37.7%), and aseptic aetiology in the remining 43 (62.3%). The mean follow-up was 9.7 years (4 to 18), and the overall complication was rate was 7.24%, all with patellofemoral complications. Failure rate with ‘any cause revision’ was 5.8%. There was one case of aseptic loosening of the femoral component. At ten years, 17/69 patients (24.63%) had died, and implant survivorship was 92.2%. Conclusion. In our experience, the SMILES rotating hinge prosthesis achieves satisfactory long-term outcomes with ten-year implant survivorship of 92.2% and a patellofemoral complication rate of 7.24%. Cite this article: Bone Jt Open 2023;4(10):776–781

Aims. Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. Methods. An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate. Results. Five patient-specific variables and seven implant-specific variables were evaluated for significant association with lower insert wear rate. Six were significant when controlling for other factors: greater patient age, female sex, shorter duration in vivo, polished tray, highly cross-linked PE (HXLPE), and constrained knee design. Conclusion. This study confirmed that knee wear rate increased with duration in vivo. Older patients and females had significantly lower wear rates. Polished modular tibial tray surfaces, HXLPE, and constrained TKA designs were device design factors associated with significantly reduced wear rate. Cite this article: Bone Joint J 2021;103-B(11):1695–1701

Introduction. Mechanical or corrosive failure of total knee arthroplasties (TKAs) is difficult to diagnose with current laboratory and radiographic analyses. As such, the goal of this study was to determine the mean blood concentration of cobalt, chromium, and titanium in a series of revision TKAs with mechanical implant failure and evaluate whether they facilitated identification of the underlying TKA failure mechanism. Methods. Serum cobalt, chromium, and titanium levels and synovial fluid characteristics were evaluated in 12 patients (13 aseptic revision TKAs) who underwent revision TKA between 2000 and 2020 at a single academic institution for mechanical implant failure or corrosion. Seventy-five percent were re-revisions of previously revised TKAs. Mean time to revision was 6 years. Modular metallic junctions were present in 100%. Twenty-five percent did not have another in situ total joint arthroplasty, and the remaining patients did not have a metal-on-metal articulation that could lead to elevation in serum metal ion levels. Mean follow-up after the revision TKA was 8 months. Results. Mean serum cobalt, chromium, and titanium concentrations were 11 ng/mL, 6 ng/mL, and 3 ng/mL, respectively. Serum metal ion levels facilitated failure mechanism identification in 75%, which included modular junction failure (6 cases), constraint locking mechanism failure (3 cases), corrosion of modular metallic interfaces (2 cases), and implant fracture (1 case). Arthrocentesis was performed in 75%. Mean synovial fluid cell count was 950 cells/mcL. Monocytes were the predominant mean cell type (41%), followed by neutrophils (35%), and lymphocytes (22%). Conclusion. Serum metal ion assessment should be considered when the etiology of painful primary or revision TKAs, particularly those with modular metallic junctions, remains elusive after routine evaluation

Abstract. Introduction. Medial fix bearing unicompartmental knee replacement (UKR) designs are consider safe and effective implants with many registries data and big cohort series showing excellent survivorship and clinical outcome comparable to that reported for the most expensive and surgically challenging medial UKR mobile bearing designs. However, whether all polyethylene tibial components (all-poly) provided comparable results to metal-backed modular components during medial fix bearing UKR remains unclear. There have been previous suggestions that all-poly tibia UKR implants might show unacceptable higher rates of early failure due to tibial component early loosening especially in high body max index (BMI) patients. This study aims to find out the short and long-term survival rate of all-poly tibia UKR and its relationship with implant thickness and patient demographics including sex, age, ASA and BMI. Material and Methods. we present the results of a series of 388 medial fixed bearing all-polly tibia UKR done in our institution by a single surgeon between 2007–2019. Results. We found out excellent implant survival with this all-poly tibia UKR design with 5 years survival rate: 96.42%, 7 years survival rate: 95.33%, and 10 years survival rate: 91.87%. Only 1.28% had early revision within 2 years. Conclusion. Fixed bearing medial all-poly tibia UKR shows excellent survivor rate at 2, 5, 7 and 10 years follow up and the survival rate is not related with sex, age, BMI, ASA grade or implant thickness. Contrary to the popular belief, we found out that only 1.71% of all implants was revised due to implant loosening

Aims. There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. Patients and Methods. This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions. Results. Osteolysis was present in four TKAs (3.3%) in the SP group, and no knees in the XLP group (p = 0.06). There were no significant differences between the Knee Society total score, change in total score, knee function score, change in function score, LEAS, and change in LEAS in the two groups. There was a significant difference in the presence of an effusion (10/122 with SP liners, 1/123 with XLP liners; p = 0.02). There was no significant difference in the rate of re-operation between the two groups (p = 0.36). There were no complications related to the XLP liner. Conclusion. At this length of follow-up, there were no advantages and no complications related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions was more frequent with SP than XLP liners, but of unknown clinical significance. Cite this article: Bone Joint J 2019;101-B(7 Supple C):33–39

Introduction. Maintaining posterior stability in total knee arthroplasty (TKA) may be achieved by using a posterior stabilized TKA, retaining and balancing the posterior cruciate ligament (PCL) using a traditional cruciate-retaining design (CR), or by increasing the sagittal plane conformity of the tibial insert. In the latter case, stability is achieved by the addition of an anterior buildup on the tibial polyethylene creating the so-called “anterior stabilized” (AS) design. We hypothesized that using an AS tibial insert would provide similar function and survivorship as compared to using a more traditional CR bearing when the PCL is either recessed or balanced. Methods. Between 2004 and 2016, 1,731 modular CR TKAs were implanted in 1,509 patients using the same CR TKA design. The diagnosis was osteoarthritis in 98%. 58% of patients were female. Average age of 64.9 years. Within this group, 868 TKAs (50.1%) had a standard CR tibial bearing (3-degree posterior slope and no posterior lip) implanted (CR-S). 480 TKAs (27.8%) had a lipped CR modular tibial bearing (2.5 mm elevated posterior lip) implanted (CR-L). Starting in 2013, 383 TKAs (22.1%) were implanted with an AS modular tibial bearing (9–11 mm anterior lip and a 5 mm posterior lip). If the PCL was considered non-functional or absent, an AS bearing was placed. If the PCL was considered functional, a standard bearing or lipped bearing was used. Clinical and radiographic analysis was performed according to the Knee Society (KS) grading system. The most recent clinical and radiographic evaluation was used for post-operative analysis. The average follow-up in the entire cohort of TKAs was 5.5 years (range 2 to 14.3 years). Kaplan-Meier analysis was used to determine prosthesis survivorship with failure defined as aseptic loosening of the prosthesis (with or without revision) or tibial insert exchange. Results. At final follow-up, there were no significant differences in knee flexion, pain, function, or stair scores. Walking scores were significantly lower in the AS group. Posterior instability was higher in the CR-S group, whereas the manipulation rate was highest in the CR-L group (1.7% versus 1.3% and 0% in the CR-S and AS groups, respectively). Kaplan-Meier survivorship at five years, excluding infection, demonstrated no significant difference between the three groups (CR-S, CR-L, and AS tibial insert groups, 99% 100% and 99% respectively). Conclusion. When the PCL is considered non-functional at operation, the AS insert provided similar final flexion, function, stair score, and five-year survivorship when compared to using the standard and lipped CR tibial insert when the PCL was balanced. Using an ultra-congruent AS dished tibial component appears to be a reasonable option when the PCL is completely released or found deficient at operation. For figures, tables, or references, please contact authors directly

Aims

In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility.

Aims

Micromotion of the polyethylene (PE) inlay may contribute to backside PE wear in addition to articulate wear of total knee arthroplasty (TKA). Using radiostereometric analysis (RSA) with tantalum beads in the PE inlay, we evaluated PE micromotion and its relationship to PE wear.

We compared the results of 146 patients who received an anatomic modular knee fixed-bearing total knee replacement (TKR) in one knee and a low contact stress rotating platform mobile-bearing TKR in the other. There were 138 women and eight men with a mean age of 69.8 years (42 to 80). The mean follow-up was 13.2 years (11.0 to 14.5). The patients were assessed clinically and radiologically using the rating systems of the Hospital for Special Surgery and the Knee Society at three months, six months, one year, and annually thereafter. The assessment scores of both rating systems pre-operatively and at the final review did not show any statistically significant differences between the two designs of implant. In the anatomic modular knee group, one knee was revised because of aseptic loosening of the tibial component and one because of infection. In addition, three knees were revised because of wear of the polyethylene tibial bearing. In the low contact stress group, two knees were revised because of instability requiring exchange of the polyethylene insert and one because of infection. The radiological analysis found no statistical difference in the incidence of radiolucent lines at the final review (Student’s t-test, p = 0.08), most of which occurred at tibial zone 1. The Kaplan-Meier survivorship for aseptic loosening of the anatomic modular knee and the low contact stress implants at 14.5 years was 99% and 100%, respectively, with a 95% confidence interval of 94% to 100% for both designs. We found no evidence of the superiority of one design over the other at long-term follow-up

Introduction. Polyethylene wear and osteolysis remain a concern with the use of modular, fixed bearing total knee arthroplasty (TKA). A variety of highly cross-linked polyethylenes (XLPs) have been introduced to address this problem, but there are few data on the results and complications of this polyethylene in posterior-stabilized knee prosthesis. We have previously reported an interim analysis of a study comparing polyethylene tibial liners. Methods. This is a prospective randomized study of one modular posterior-stabilized total knee arthroplasty by a single surgeon. 265 patients (329 knees) were randomized to receive a standard compression molded liner (SP) or a highly cross-linked (6.5 CGy electron-beam irradiated and remelted) polyethylene liner (XLP). Patients were evaluated clinically using the classic Knee Society scores, LEAS score, presence of a knee effusion, and by standard radiographs for radiolucent lines and osteolytic lesions. The analysis was performed at a mean of 6 years (range, 2–11 years). Results. There were no clinical differences between 122 knees with SP and 123 knees with XLP in Knee Society total score; change in total score; knee function score; change in function score; LEAS score; and change in LEAS score. There was a difference in the presence of effusion (one of 123 XLP, and 10 of 122 SP; p=0.02). There was no difference in the frequency of radiolucent lines (21 knees with SP and 22 with XLP). Osteolysis was present in 4 knees (3.3%) with SP, and no knees with XLP (p=0.06). There was no difference in frequency of reoperation between the two groups (3 infection in 123 knees allocated to XLP group and six (3 infection, 1 femoral loosening, 1 instability, 1 fracture plating) in 122 knees allocated to SP group. There were no complications related to the XLP liner. Conclusion. At this length of follow-up time, with the numbers available, there were no complications, but no advantages, related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions are more frequent with SP than XLP, but of unknown clinical importance

Background. The modern modular implants allow surgeons to combine different combinations of components within the same brand of which some may have completely different design. During 1999–2012 the same cemented femur component was used together with a cemented stemmed tibia baseplate and also against a cemented pegged tibia baseplate. We decided to compare the revision rate of total knee arthroplasties (TKAs) using these two tibia baseplates. Methods. This is a register study. During 1999–2012, 32,429 cemented, CR TKA's of a specific brand were reported to the Swedish Knee Arthroplasty Register (SKAR). The part numbers for the femur, tibia and insert (in modular implants) were available in 99.2% of cases. The most common combination used the cemented CR femur against a cemented stemmed baseplate in 50.3% of cases while the same CR femur was used against a cemented pegged baseplate in 8.3% of cases, mainly at two hospitals. In order to make the material more comparable, only patients having osteoarthritis (OA) were included and only TKAs using two types of regular constraint inserts and in which the patella had been left un-resurfaced. Chi-Square test was used to investigate gender distribution in the groups and t-test for the mean age at surgery. Kaplan Meier analysis and the log-rank test were used to evaluate the risk of revision until the end of 2016. A p-value <0.05 was considered statistically significant. Results. After exclusions, there were 15,287 knees with the stemmed and 2,479 with the pegged tibia baseplate. The mean follow-up time was 8.1 years (range 0–18). The proportion of women in the stemmed group was 59% and 60% in the pegged group (p=0.32) and the mean age at surgery for the groups was 69.9 years and 70.0 years, respectively (p=0.41). The cumulative revision rate (CRR) at 15 years for TKAs using the stemmed baseplate was 3.0% (95% CI: 2.6–3.5) as compared to 5.8% (95% CI: 4.0–8.3) for the pegged baseplate (p=0.003). When only revisions for loosening were considered, the CRR was respectively 0.6% (95% CI: 0.4–0. 9) and 3. 8% (95% CI: 2.3–6.3) (p<0.001). Conclusion. We found that TKAs using the pegged base plate had significantly higher risk for revision, both for all reasons as well as for only loosening. As the pegged baseplate surgeries were performed mostly at only two hospitals it is possible that local factors are to blame. However, considering that after stopping using the pegged baseplate, the two hospitals performed least as well as other hospitals using the same brand we think it is likely that the pegged plate has a higher risk of loosening and that our observation warrants that the performance of pegged plates is investigated in other registers

Aims. Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. Methods. Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m. 2. (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. Results. At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001). Conclusion. Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025–1032

Aims

The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery.