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Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: A multicenter French nationwide study including 846 cases - 06/06/13

Doi : 10.1016/j.otsr.2013.03.014 
J.-N. Argenson a, , S. Boisgard b, S. Parratte a, S. Descamps b, M. Bercovy c, P. Bonnevialle d, J.-L. Briard e, J. Brilhault f, g, J. Chouteau h, R. Nizard i, D. Saragaglia j, E. Servien k

French Society of Orthopedic and Traumatologic Surgery (SOFCOT)l

a Orthopedic Surgery Department, Sainte-Marguerite Hospital, Marseille University Hospitals, 270, boulevard Sainte-Marguerite, 13009 Marseille, France 
b Orthopedic Surgery Department, Gabriel-Montpied Hospital, Clermont-Ferrand University Hospitals, 56, rue Montalembert, 63000 Clermont-Ferrand, France 
c Les Fontaines Private Hospital, 54, boulevard Aristide-Briand, 77000 Melun, France 
d Musculo-skeletal Institute, Toulouse University Hospitals, Purpan Traumatologic Orthopedic Unit, place Baylac, 31052 Toulouse cedex, France 
e Du Cèdre Private Hospital, 950, rue de la Haie, 76230 Bois-Guillaume, France 
f Orthopedic Surgery Departments 1 & 2, Tours Regional University Hospitals, 37044 Tours cedex, France 
g Tours Medical Faculty, 3, boulevard Tonnelé, 37000 Tours, France 
h Orthopedic and Sports Traumatology Surgery Department Service, Lyon Sud Hospital Center, 69495 Pierre-Bénite, France 
i Orthopedic Surgery Department, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France 
j University Orthopedic and Sports Traumatology Surgery Clinic, Grenoble University Hospitals, Southern Hospital, avenue de Kimberley, 38130 Échirolles, France 
k Orthopedic Surgery Department, Albert-Trillat Center, Croix-Rousse Hospital, 103, boulevard de la Croix-Rousse, 69000 Lyon, France 
l French Society of Orthopedic and Trauma Surgery, 56, rue Boissonade, 75014 Paris, France 

*Corresponding author. Tel.: +33 04 91 74 49 97; fax: +33 04 91 74 50 14.

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Summary

Introduction

Survivorship for modern total knee arthroplasties (TKA) is not precisely known from large series, other than registries. The present retrospective study therefore analyzed 846 TKAs at a minimum 10years’ follow-up.

Hypothesis

Ten-year survivorship for TKAs in a multicenter study exceeds 90%, independently of design and level of prosthetic constraint.

Materials and methods

Eight hundred and twenty-eight patients (846 TKAs) were assessed on the Knee Society score. Mean age was 71years (range, 41–93years); 274 males and 554 females (67%); 496 patients (60%) were active; diagnosis was principally osteoarthritis (n=752 [89%]). Most TKAs were cemented (n=704 [83%]), replacing the patella (n=668 [79%]) and sacrificed the posterior cruciate ligament (PCL) (n=707 [84%]), 65% being posterior-stabilized and 35% ultracongruent, with fixed (39%) or mobile bearing (61%).

Results

At a minimum 10years’ follow-up, mean knee score rose from 35 (15–55) to 83 points (74–95), and functional score from 24 (5–45) to 74 points (60–90); mean flexion rose from 105° (25–125°) to 112° (25–125°). Mean hip-knee-ankle angle was 179.5° (169–189°). Sixty-three (7.5%) revision surgeries were required, mainly for loosening (n=18 [2%]) or infection (n=18 [1.8%]). Overall 10-year survivorship was 92% (95% CI: 0.90–0.94). There was no significant difference in survivorship according to implant design or PCL retention. Activity level correlated with revision rate; mechanical complications were more frequent in active and infectious complications in sedentary subjects. Revision was not more frequent in TKA aligned outside the 177–183° range.

Discussion

Ten-year TKA survivorship was 92%, independently of design and level of mechanical stress. Revision was mainly for infection or loosening, and not for greater than 3° axis misalignment. Mechanical complications were more frequent in younger and more active subjects, for whom therefore other treatment options or technical improvements should be sought.

Level of evidence

Level IV. Retrospective study.

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Keywords : Total knee arthroplasty, Minimum 10-year follow-up, Clinical results, Implant survivorship, Adult


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Vol 99 - N° 4

P. 385-390 - juin 2013 Retour au numéro
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