Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: A multicenter French nationwide study including 846 cases - 04/05/13

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.