Do refinements to original designs improve outcome of total knee replacement? A retrospective cohort study

Marieke J Piepers, Ruud P van Hove, Michel P J van den Bekerom, Peter A Nolte, Marieke J Piepers, Ruud P van Hove, Michel P J van den Bekerom, Peter A Nolte

Abstract

Background: Long-term results of the 'classic' low contact stress (LCS) total knee replacement (TKR) have been satisfactory; nonetheless, design changes have been made which resulted in the 'complete' LCS TKR. The aim of this study is to compare the 5-year incidence of revision and midterm clinical performance before and after introduction of the 'complete'.

Methods: A retrospective cohort analysis was conducted on 100 primary uncemented TKRs of both designs. At 5-year follow-up, revision and reoperation rates were determined for these 200 TKRs. Knee Society score (KSS), the Oxford Knee score (OKS) and range of motion were determined for 143 TKRs.

Results: In the 'classic' cohort, 3% of the TKRs were revised compared with 5% in the 'complete' cohort (p = 0.72).The mean KSS was 134.1 (SD 38.3) in the 'classic' cohort compared to 135.0 (SD 42.8) in the 'complete' cohort (p = 0.89). Of the 'complete' TKRs, 35.2% scored within the lowest quartile of the KSS knee compared to 16.7% of the 'classic' TKRs (p = 0.01). The OKS was 23.3 (SD 9.3) in the 'classic' cohort compared to 22.5 (SD 10.1) in the 'complete' cohort (p = 0.45). More than 5° flexion contracture was only found in four patients in the 'complete' cohort (p = 0.04).

Conclusions: No statistical difference in revision rate and average scores for midterm clinical performance was observed between the 'classic' and the 'complete'. However, the 'complete' cohort had a higher percentage of KSS Knee in the lowest quartile, which suggests a clinical relevant difference compared with the 'classic'. Further investigation in future studies with new designs is needed.

Figures

Figure 1
Figure 1
Lateral view of the 'classic’ and 'complete’ insert and femoral component. (a) Higher anterior lip of the insert of the 'complete’ compared with the 'classic’. (b) Cylindrical segment at the 'complete’ insert compared with the previously tapered 'classic’ insert stem. (c) Extended anterior flange of the 'complete’ femoral component compared with the anterior flange of the 'classic’ femoral component. (d) Flat interior surface of the 'complete’ femoral component compared with the curved interior surface of the 'classic’ femoral component.
Figure 2
Figure 2
Transverse view of the 'classic’ and 'complete’ tibial tray. (a) The difference in outline; anteriorly, the contour was straightened out. (b) Posteriorly, the indentation is more prominent in the 'complete’. (c) Rotation point of insert is slightly ventrally positioned in the 'complete’.
Figure 3
Figure 3
KSS Knee distribution for 'classic’ and 'complete’ TKR. The Y-axis represents the percentage of TKRs of the 'complete’ and 'classic’ cohort. A higher percentage of patients in the 'complete’ cohort is found in the lowest quartile. More specific, 13% of the 'complete’ TKRs score between 37.5 and 50 points compared with 3% of the 'classic’ TKRs. Q1, lowest quartile; Q2, second quartile; Q3, third quartile; Q4, highest quartile.
Figure 4
Figure 4
Series of KSS Knee of the 'classic’ and 'complete’ TKRs performed by a single surgeon. The surgeon performed >250 TKRs of which 41 were clinically evaluated 'classic’ TKR, before the introduction of the 'complete’ and 37 'complete’ TKRs thereafter. The body of the KKS Knee scores of the 'classic’ design TKRs were in highest three quartiles (>63 points). Of the first 20 'complete’ TKRs, two TKRs were revised and six TKRs scored within the lowest quartile (<63 points).

References

    1. Callaghan JJ, Insall JN, Greenwald AS, Dennis DA, Komistek RD, Murray DW, Bourne RB, Rorabeck CH, Dorr LD. Mobile-bearing knee replacement: concepts and results. Instr Course Lect. 2001;50:431–449.
    1. Carothers JT, Kim RH, Dennis DA, Southworth C. Mobile-bearing total knee arthroplasty: a meta-analysis. J Arthroplasty. 2011;26:537–542. doi: 10.1016/j.arth.2010.05.015.
    1. Bert JM. Dislocation/subluxation of meniscal bearing elements after New Jersey low-contact stress total knee arthroplasty. Clin Orthop Relat Res. 1990;254:211–215.
    1. Weaver JK, Derkash RS, Greenwald AS. Difficulties with bearing dislocation and breakage using a movable bearing total knee replacement system. Clin Orthop Relat Res. 1993;290:244–252.
    1. Beverland D, Jordan LR. In: LCS Mobile Bearing Knee Arthroplasty: A 25 Years Worldwide Review. 1. Hamelynck KJ, Stiehl JB, editor. New York: Springer; 2001. LCS rotating platform dislocations and spinout - etiology, diagnosis and management; pp. 235–240.
    1. Kilgus DJ. In: LCS Mobile Bearing Knee Arthroplasty: A 25 Years Worldwide Review. 1. Hamelynck KJ, Stiehl JB, editor. New York: Springer; 2001. Primary total knee replacement system; pp. 312–326.
    1. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.
    1. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69. doi: 10.1302/0301-620X.80B1.7859.
    1. Haverkamp D, Breugem SJ, Sierevelt IN, Blankevoort L, van Dijk CN. Translation and validation of the Dutch version of the oxford 12-item knee questionnaire for knee arthroplasty. Acta Orthop. 2005;76:347–352.
    1. Price AJ, Longino D, Rees J, Rout R, Pandit H, Javaid K, Arden N, Cooper C, Carr AJ, Dodd CA, Murray DW, Beard DJ. Are pain and function better measures of outcome than revision rates after TKR in the younger patient? Knee. 2010;17:196–199. doi: 10.1016/j.knee.2009.09.003.
    1. Lequesne MG, Mery C, Samson M, Gerard P. Indexes of severity for osteoarthritis of the hip and knee. Validation–value in comparison with other assessment tests. Scand J Rheumatol Suppl. 1987;65:85–89.
    1. Hoenig JM, Heisey DM. The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat. 2001;55:19–24. doi: 10.1198/000313001300339897.
    1. Abram SG, Nicol F, Hullin MG, Spencer SJ. The long-term outcome of uncemented low contact stress total knee replacement in patients with rheumatoid arthritis: results at a mean of 22 years. Bone Joint J. 2013;95-B:1497–1499. doi: 10.1302/0301-620X.95B11.32257.
    1. Garling EH, Valstar ER, Nelissen RG. Comparison of micromotion in mobile bearing and posterior stabilized total knee prostheses: a randomized RSA study of 40 knees followed for 2 years. Acta Orthop. 2005;76:353–361.
    1. Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings. Clin Orthop Relat Res. 1990;260:162–169.
    1. Gandhi R, Tsvetkov D, Davey JR, Mahomed NN. Survival and clinical function of cemented and uncemented prostheses in total knee replacement: a meta-analysis. J Bone Joint Surg Br. 2009;91:889–895.
    1. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.
    1. Wolterbeek N, Nelissen RG, Valstar ER. No differences in in vivo kinematics between six different types of knee prostheses. Knee Surg Sports Traumatol Arthrosc. 2012;20:559–564. doi: 10.1007/s00167-011-1605-y.
    1. Didden K, Luyckx T, Bellemans J, Labey L, Innocenti B, Vandenneucker H. Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact. J Bone Joint Surg Br. 2010;92:1466–1470.
    1. Stiehl JB. In: LCS Mobile Bearing Knee Arthroplasty: A 25 Years Worldwide Review. 1. Hamelynck KJ, Stiehl JB, editor. New York: Springer; 2001. Introduction on future trends with the LCS; p. 311.
    1. O'Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am. 2002;84-A:1362–1371.
    1. Fitzgerald SJ, Trousdale RT. Why knees fail in 2011: patient, surgeon, or device? Orthopedics. 2011;34:e513–e515.
    1. Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ. Knee replacement. Lancet. 2012;379:1331–1340. doi: 10.1016/S0140-6736(11)60752-6.
    1. Nelissen RG, Pijls BG, Karrholm J, Malchau H, Nieuwenhuijse MJ, Valstar ER. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am. 2011;93(Suppl 3):62–65.
    1. Schemitsch EH, Bhandari M, Boden SD, Bourne RB, Bozic KJ, Jacobs JJ, Zdero R. The evidence-based approach in bringing new orthopaedic devices to market. J Bone Joint Surg Am. 2010;92:1030–1037. doi: 10.2106/JBJS.H.01532.
    1. Anand R, Graves SE, de Steiger RN, Davidson DC, Ryan P, Miller LN, Cashman K. What is the benefit of introducing new hip and knee prostheses. J Bone Joint Surg Am. 2011;93(Suppl 3):51–54.

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