Better Survival of Total Knee Replacement in Patients Older Than 70 Years: A Prospective Study with 8 To 12 Years Follow-Up

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

2 Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

Abstract

 Background:
Modern knee designs have popularized its use in younger patients due to its better performance. There remains uncertainty whether higher demands of these patients can affect implant survivorship.   
Purpose:
To assess whether modern knee designs have provided similar results in patients younger than 70 years versus older patients.
Methods:
We included 203 consecutive patients (236 knees) who underwent knee replacement for osteoarthritis with a mean follow-up of 11.4 years (range: 8.8 to 12). The mean age was 70 years (range: 31 to 85). Knee replacements were stratified into two groups: 109 were younger than 70 years and 127 were older than 70 years (70 years of age is the mandatory retirement age).
Results:
There were no significant pre-operative differences between groups with regards to knee alignment, alpha or beta angles, knee score or function score. Fourteen implants were radiographically loose at last follow up visit. Groups were matched in terms of demographic data. We found that patients older than 70 years had significantly better mean survivorship at 12 years. (97% vs. 88%; P=0.010). Patients under 70 years presented with a higher rate of polyethylene wear which was further associated with radiolucent lines in the femur and tibia as well as the presence of osteolysis. There was also an association between migration and presence of osteolysis.
Conclusions:
Patients over 70 years old undergoing cemented total knee replacement for osteoarthritis showed better implant survivorship versus patients under 70 years old.

Keywords


  1. Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty a long term follow-up. Clin Orthop Relat Res. 2001; 388:18-25.
  2. Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg (Am).  1991;73A:397-409.
  3. Ritter MA. The Anatomical Graduated Component total knee replacement. A long-term evaluation with 20-year survival analysis. J Bone Joint Surg (Br).  2009; 91:745-9.
  4. Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger. Clin Orthop Relat Res. 1998;356:22-7.
  5. Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin Orthop Relat Res. 1989;248:27-33.
  6. Stuart MJ, Rand JA. Total knee arthroplasty in young adults who have rheumatoid arthritis. J Bone Joint Surg (Am). 1988;70:84-7.
  7. Bertin KC, Komistek RD, Dennis DA, Hoff WA, Anderson DT, Langer T. In vivo determination of posterior femoral roll back for subjects having a NexGen posterior cruciate-retaining total knee arthroplasty. J Arthroplasty. 2002;17:1040-8.
  8. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. 
  9. Insall JN, Dorr LD, Scott RD, Scott WN. Rationales of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989; 248:13-4.
  10. Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9-12.
  11. Kilincoglu V, Unay K, Akan K, Esenkaya I, Poyanli O. Component alignment in simultaneous bilateral or unilateral total knee arthroplasty. Int Orthop. 2011; 35: 43-6.
  12. McCaskie AW, Deehan DJ, Green TP, Lock KR,Thompson JR, Harper WM, et al. Randomised, prospective study comparing cemented and cementless total knee replacement. Results of press-fit condylar knee replacement at five years. J Bone Joint Surg Br. 1998;80:971-5.
  13. Yoshioka Y, Siu D, Cooke TD. The anatomy and functional axes of the femur. J Bone Joint Surg Am. 1987; 69:873-80.
  14. Yoshioka Y, Siu DW, Scudamore RA, Cooke TD. Tibial anatomy and functional axes. J Orthop Res. 1989;7:132-7.
  15. Cooke TDV, Scudamore A. Healthy knee alignment and mechanics. In: Callaghan JJ, Rosenberg AG, Rubash HE, et al, editors. The adult knee. Philadelphia: Lippincott Williams & Wilkins; 2003:175-86.
  16. Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am. 1994;25:367-77.
  17. Claus AM, Engh CA Jr, Sychterz CJ, Xenos JS, Orishimo KF, Engh CA Sr. Radiographic definition of pelvis osteolysis following total hip arthroplasty. J Bone Joint Surg (Am). 2003;85:1519-26.
  18. Freeman MA. Radiolucent lines: A question of nomenclature. J Arthroplasty. 1999;14:1-2.
  19. Dalury DF, Barrett WP, Mason JB, Goldstein WM, Murphy JA, Roche MW. Midterm survival of a contemporary modular total knee replacement. A multicentre study of 1970 knees. J Bone Joint Surg (Br). 2008;90:1594-6.
  20. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone and Joint Surg (Am).  2003;85: 259-65.
  21. Bertin KC. Tibial component fixation in total knee arthroplasty: a comparison of pegged and stemmed designs. J Arthroplasty. 2001;16:670-8.
  22. Sundberg M, Lidgren L, Dahl AW, Robertsson O. Swedish Knee Arthroplasty Register. Annual Report 2013. Available at: www.myKnee.se/pdf/SKAR2013_Eng.pdf
  23. Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Early failures among 7174 primary total knee replacements a follow-up study from the Norwegian Arthroplasty Register 1994-2000. Acta Orthop Scan.  2002;73:117-29.
  24. Harryson LO, Robertsson O, Nayfeh JF. Higher cumulative revision rate of the knee arthroplasties in younger patients with osteoarthritis. Clin Orthop Relat Res. 2004;421:162-8.
  25. Robertson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41223 knees operated in 1988-1997. Acta Orthop Scand. 2001;72:503-13.
  26. Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N. Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg (Br). 2003;85:52-6.
  27. Roberts VI, Esler CN, Harper WM. A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg (Br). 2007;89:1452-6.
  28. Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop. 2010;81:413-9.
  29. Keenan AC, Wood AM, Arthur CA, Jenkins PJ, Brenkel IJ, Walmsley PJ. Ten-year survival of cemented total knee replacement in patients aged less than 55 years. J Bone Joint Surg Br. 2012;94(7):928-31.
  30. Collier  MB, Engh CA, McAuley JP, Ginn SD, Engh GA. Osteolysis after total knee arthroplasty: Influence of tibial baseplate surface finish and sterilization of polyethylene insert.  J Bone Joint Surg  (Am). 2005; 87:2702-8.
  31. Lombardi AV, Ellison BS, Berend KR. Polyethlylene wear is influenced by manufacturing technique in modular TKA. Clin Orthop Relat Res. 2008;466:2798-805.
  32. Reay E, Wu J, Holland J, Deehan D. Premature failure of the Kinemax plus total knee replacements. J Bone Joint Surg (Br). 2009;91:604-11.
  33. Griffin WL, Fehring TK, Pomeroy DL, Gruñe TA, Murphy JA. Sterilization and wear related failure in first and second generation press-fit condylar total knee arthroplasty. Clin Orthop Relat Res.  2007;464:16-20.
  34. Vyskocil P, Gerber C, Bamert P. Radiolucent lines and component stability in knee arthroplasty standard versus fluoroscopically-assisted radiographs. J Bone Joint Surg (Br). 1999;81:24-6.
  35. Henricson A, Linder L, Nilsson KG. A trabecular metal tibial component in total knee replacement in patients younger than 60 years. J Bone Joint Surg (Br). 2008;90:1585-93.
  36. Schai PA, Thornhill TS, Scott RD. Total knee arthroplasty with the PFC system: Results at a minimum of ten years and survivorship analysis. J Bone Joint Surg (Br). 1998;80:850-8.
  37. Lachiewicz PF, Soileau ES. Fifteen-year survival and osteolysis associated with a modular posterior stabilized knee replacement. A concise follow-up of a previous report. J Bone Joint Surg (Am). 2009; 91:1419-23.
  38. Huang CH, Ma HM, Liau JJ, Ho FY, Cheng CK. Osteolysis in failed total knee arthroplasty: A comparison of mobile-bearing and fixed-bearing knees. J Bone Joint Surg (Am). 2002;84:2224-9.
  39. Kim YH, Oh JH, Oh SH. Osteolysis around cementless porous coated anatomic knee prostheses. J Bone Joint Surg (Br). 1995;77:236-41.
  40. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthoplasties failing today? Clin Orthop Relat Res. 2002;404:7-13.