Purpose: Unicompartmental knee arthroplasty remains a viable treatment modality for arthrosis confined to the medial compartment of the knee. Few studies have reported survivorship of this procedure into the second decade. The purpose of this study was to report our long-term experience with this procedure at a mean follow-up of fifteen years.

Method: Between 1989 and 2000, 113 medial unicompartmental knee arthroplasties in 84 patients were performed using the Miller-Galante prosthesis. The 84 patients had an average age of 68 years old at the time of surgery; 45 of which were male and 39 female. At a mean of fifteen-year follow-up, 22 patients (25 arthroplasties) had died, and the remaining 62 patients (88 arthroplasties) were reviewed and evaluated. No patient was lost to follow-up.

Results: The mean Knee Society knee and function scores had an improvement from 53 and 48 points pre-operatively to 77 and 90 points respectively at time of most recent evaluation. Twenty unicompartmental knee arthroplasties were revised, at an average of seven years (one to fourteen) following index procedure. The five, ten and fifteen-year rates of survival were 94%, 90%, and 86% respectively with revision to tricompartmental knee arthroplasty as the end point.

Conclusion: The Miller-Galante medial unicompartmental knee arthroplasty provided excellent pain relief and restoration of function in carefully selected patients and demonstrated durable implant survival at fifteen years. Progression of arthrosis is the primary mode of failure.

This study reports the survivorship free of revision or radiographic loosening of one hundred and eight consecutive cemented Miller-Galante unicompartmental knee arthroplasties at a mean ten-year follow-up.

The purpose of this study was to report our experience with the Miller-Galante (MG) unicompartmental knee arthroplasty (UKA) at a mean ten-year follow-up in order to determine if this procedure can provide durable long-term clinical results.

One hundred and eight cemented MG-UKAs in eighty-two patients performed by two surgeons between 1988 and 1997 were reviewed. There were one hundred and six medial and two lateral MG-UKAs performed. Mean age at surgery was sixty-seven years (range, thirty-nine to eighty-seven). There were forty-four males and thirty-eight females. Mean follow-up was ten years (range, five to thirteen). A Kaplan-Meier survivorship analysis using an end-point of revision surgery or radiographic loosening was employed to determine probability of survival at five and ten years.

Of the eighty-two patients (one hundred and eight knees), nine patients (eleven knees) died and one patient (two knees) was lost to follow-up. Eleven patients (eleven knees) were revised at a mean of four years (range, one to nine), and one patient demonstrated radiographic loosening of the tibial component at seven years. Of the eleven revisions, only two required use of revision components. Mean pre-operative and final follow-up Knee Society clinical and functional scores were forty-seven and fifty-three, and ninety and seventy-nine points, respectively. Kaplan-Meier survivorship analysis revealed a probability of survival free of revision or radiographic loosening of 93% at five years and 88% at ten years.

The results of this study demonstrate that the MG-UKA can provide reliable pain relief and restoration of function in selected patients. Our experience has shown that the survivorship of the MG-UKA approaches that of tricompartmental knee arthroplasty, and suggests that UKA may offer the advantage of ease of revision.

The Genesis II total knee prosthesis was a successor to the Genesis I TKR in which three degrees of external rotation was built into the femoral component to improve patellofemoral tracking and eliminate rotational incongruity. The midterm (minimum five year) results of three hundred and forty-three Genesis II cemented components were reviewed in three hundred and twenty-four patients. Kaplan-Meier survivorship was 98% at a mean 7.6 years.

The focus of this study was to analyze the minimum five- year results of patients receiving either a cruciate-retaining, posterior stabilizing, or mobile bearing Genesis II TKR. Further analysis was performed to delineate differences between subsets of this population.

Data from a consecutive series of three hundred and twenty-four patients receiving three hundred and sixty-seven Genesis II TKR’s between February 1996 and July 1999 was collected. Patients were evaluated pre-operatively, at six weeks, three months, six months and annually thereafter, using the Knee Society Clinical Rating System and the Western Ontario MacMaster Osteoarthritis Index. A Kaplan-Meier Survivorship was performed on the consecutive series. Statistical analyses were used to delineate significant differences between subsets of patients.

There were three hundred and sixty-seven procedures (one hundred and sixty-nine cruciate-retaining, one hundred and sixty-six posterior stabilized and six mobile bearing designs) performed on three hundred and twenty-four patients. At the time of evaluation, forty-five (13%) patients were deceased, twenty-four (7%) patients were unavailable for evaluation and nine (2%) knees had been revised. A 98% implant survivor-ship was calculated at a mean time of 7.6 years.

These are the first mid-term (minimum five year) clinical results of the Genesis II TKR, which continues to function well. Kaplan-Meier survivorship was 98% at a mean 7.6 years.

Introduction and Aims: The use of porous coated femoral stems in revision hip arthroplasty has been associated with a high rate of complications including femoral fracture, femoral perforation and eccentric reaming. The purpose is to determine if using a distally slotted-fluted femoral stem is associated with lower incidence of the above three intra-operative complications.

Method: The intra-operative complications of 175 cementless revision total hip arthropasties (THA) using a distally slotted-fluted femoral stem were reviewed. Three categories of complications were recorded: femoral fracture, femoral perforation and eccentric reaming. Radiographic evaluation was based on standard antero-posterior and lateral views of the hip joint performed in the intra-operative or immediate post-operative period. Statistical analysis for factors associated with complications was performed using the chi-square test.

Results: Intra-operative complications occurred in 16 patients (9.1%). There was no statistically significant association between complication rate and type of surgical approach, stem length, stem diameter, or host bone quality. The complication rate was significantly lower than the 44% total complication rate previously reported utilising a long, solid, extensively coated revision stem without a slot or flute (p< .01). These results are consistent with laboratory testing, which revealed significantly lower bone strains at the isthmus when inserting a long cementless revision stem with a slot and flute compared to a solid fully coated stem of identical geometry.

Conclusion: The use of a distally slotted fluted porous coated femoral stem in revision hip arthroplasty results in a dramatically lower complication rate compared to rates previously reported for solid porous stems. These results strongly support the continued use of such a prosthesis for revision THA.

We report the five- to-ten year results of Anderson Orthopaedic Research Institute type-2 bone defects treated with modular metal augments in revision knee surgery.

A total of 102 revision knee arthroplasties in patients with type-2 defects treated with augments and stems were prospectively studied. Seven patients (seven knees) had incomplete follow-up and 15 patients (16 knees) died with the arthroplasty in situ. The mean follow-up of the 79 remaining knees was 7 ± 2 years (5 to 11). The presence of non-progressive radiolucent lines around the augment in 14% of knees was not associated with poorer knee scores, the range of movement, survival of the component or the type of insert which was used (p > 0.05). The survival of the components was 92 ± 0.03% at 11 years (95% CI, 10.3 to 11.2).

We recommend the use of modular augmentation devices to treat type-2 defects in revision knee surgery.