Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2013

01-01-2013 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

Durability of a Cruciate-retaining TKA With Modular Tibial Trays at 20 Years

Authors: John J. Callaghan, MD, Mitchell W. Beckert, BS, David W. Hennessy, MD, Devon D. Goetz, MD, Scott S. Kelley, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2013

Login to get access

Abstract

Background

Modular tibial trays have been utilized in TKA for more than 20 years. However, concerns have been raised about modular implants and it is unclear whether these devices are durable in the long term.

Questions/purposes

We determined (1) survival, (2) relationship of age and polyethylene thickness with revision, (3) function, and (4) radiographic lucencies and osteolysis in patients having a single TKA implant at 20-year followup.

Methods

We prospectively followed 75 patients implanted with 101 Press-Fit Condylar® (Johnson and Johnson Professional, Inc, Raynham, MA, USA) posterior cruciate-retaining TKAs (with modular tibial trays) between 1988 and 1991. At 20 years, 59 patients were deceased. We clinically evaluated the living 16 patients (22 knees) and contacted the relatives of all deceased patients to confirm implant status. We clinically assessed 14 of the 16 patients with the Knee Society score, WOMAC, and UCLA and Tegner activity level scores. Radiographically, we determined lucencies, component migration, and osteolysis. We performed survival analysis including all original patients. Minimum followup was 20 years (mean, 20.6 years; range, 20–21.8 years).

Results

Six reoperations were performed in five patients (6% rate of revision) over the 20-year followup. All revisions were related to polyethylene wear and occurred at least 10 years after the primary procedure. Survivorship with revision for any reason as the end point was 91% (95% CI, 0.83–0.97) at 20 years. Average Knee Society clinical and functional scores were 90 (range, 60–100) and 59 (range, 30–87), respectively.

Conclusions

Our data demonstrate the durability of this posterior cruciate-retaining TKA design. The data provide a standard for newer designs and newer bearing surface materials at comparable followup.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Literature
1.
Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.PubMed
2.
Babis GC, Trousdale RT, Morrey BF. The effectiveness of tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am. 2002;84:64–68.PubMed
3.
Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components of total joint replacement. J Bone Joint Surg Am. 1986;68:1041–1051.PubMed
4.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed
5.
Benjamin J, Szivek J, Dersam G, Perselin S, Johnson R. Linear and volumetric wear of tibial inserts in posterior cruciate-retaining knee arthroplasties. Clin Orthop Relat Res. 2001;392:131–138.PubMedCrossRef
6.
Buechel FF Sr. Long-term followup after mobile-bearing total knee replacement. Clin Orthop Relat Res. 2002;404:40–50.PubMedCrossRef
7.
Callaghan JJ, Reynolds ER, Ting NT, Goetz DD, Clohisy JC, Maloney WJ. Liner exchange and bone grafting: rare option to treat wear & lysis of stable TKAs. Clin Orthop Relat Res. 2011;469:154–159.PubMedCrossRef
8.
Callaghan JJ, Wells CW, Liu SS, Goetz DD, Johnston RC. Cemented rotating-platform total knee replacement: a concise followup, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am. 2010;82:705–711.
9.
Collier JP, Mayor MB, McNamara JL, Surprenant VA, Jensen FE. Analysis of the failure of 122 polyethylene inserts from uncemented tibial knee components. Clin Orthop Relat Res. 1991;273:232–242.PubMed
10.
Collier JP, Sperling DK, Currier JH, Sutula LC, Saum KA, Mayor MB. Impact of gamma sterilization on clinical performance of polyethylene in the knee. J Arthroplasty.1996;11:377–389.PubMedCrossRef
11.
Collier MB, Engh CA Jr, Engh GA. Shelf age of the polyethylene tibial component and outcome of unicondylar knee arthroplasty. J Bone Joint Surg Am. 2004;86:763–769.PubMed
12.
Collier MB, Engh CA Jr, McAuley JP, Engh GA, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after total knee arthroplasty. J Bone Joint Surgery Am. 2007;89:1306–1314.CrossRef
13.
Conditt MA, Stein JA, Noble PC. Factors affecting the severity of backside wear of modular tibial inserts. J Bone Joint Surgery Am. 2004;86:305–311.
14.
Engh GA, Dwyer KA, Hanes CK. Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prostheses. J Bone Joint Surgery Br. 1992;74:9–17.
15.
Engh GA, Koralewicz LM, Pereles TR. Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg Am. 2000;82:516–523.PubMed
16.
Engh GA, Lounicia S, Rao AR, Collier MB. In vivo deterioration of tibial baseplate locking mechanisms in contemporary modular total knee components. J Bone Joint Surg Am. 2001;83:1660–1665.PubMed
17.
Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.PubMed
18.
Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL. Factors influencing wear and osteolysis in press-fit condylar modular total knee replacements. Clin Orthop Relat Res. 2004;428:40–50.PubMedCrossRef
19.
Feng EL, Stulberg SD, Wixson RL. Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. Clin Orthop Relat Res 1994;299:60–71.PubMed
20.
Fetzer GB, Callaghan JJ, Templeton JE, Goetz DD, Sullivan PM, Kelley SS. Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year followup investigation. J Arthroplasty. 2002;17:961–966.PubMedCrossRef
21.
Gill GS, Joshi AB. Long-term results of kinematic condylar knee replacement: an analysis of 404 knees. J Bone Joint Surg Br. 2001;83:355–358.PubMedCrossRef
22.
Gill GS, Joshi AB, Mills DM. Total condylar knee arthroplasty: 16- to 21-year results. Clin Orthop Relat Res. 1999;367:210–215.PubMedCrossRef
23.
Griffin WL, Scott RD, Dalury DF, Mahoney OM, Chiavetta JB, Odum SM. Modular insert exchange in knee arthroplasty for treatment of wear and osteolysis. Clin Orthop Relat Res. 2007;464:132–137.PubMed
24.
Hirakawa K, Bauer TW, Stulberg BN, Wilde AH, Borden JS. Characterization of debris adjacent to failed knee implants of 3 different designs. Clin Orthop Relat Res. 1996;331:151–158.PubMedCrossRef
25.
Hooper G, Rothwell A, Frampton C. The low contact stress mobile-bearing total knee replacement: a prospective study with a minimum followup of ten years. J Bone Joint Surg Br. 2009;91:58–63.PubMed
26.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMed
27.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRef
28.
Ma HM, Lu YC, Ho FY, Huan CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty. 2005;20:580–584.PubMedCrossRef
29.
Malin AS, Callaghan JJ, Bozic KJ, Liu SS, Goetz DD, Sullivan N, Kelley SS. Routine surveillance of modular PFC TKA shows increasing failures after 10 years. Clin Orthop Relat Res. 2010;468:2469–2476.PubMedCrossRef
30.
Parks NL, Engh GA, Topoleski LD, Emperado J. The Coventry Award. Modular tibial insert micromotion: a concern with contemporary knee implants. Clin Orthop Relat Res. 1998;356:10–15.PubMedCrossRef
31.
Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term followup. Clin Orthop Relat Res. 2001;388:18–25.PubMedCrossRef
32.
Rodricks DJ, Patil S, Pulido P, Colwell CW. Press-fit condylar design total knee arthroplasty: fourteen to seventeen-year followup. J Bone Joint Surg Am. 2007;89:89–95.PubMedCrossRef
33.
Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res. 2001;388:10–17.PubMedCrossRef
34.
Sextro GS, Berry DJ, Rand JA. Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis. Clin Orthop Relat Res. 2001;388:33–40.PubMedCrossRef
35.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed
36.
Weir DJ, Moran CG, Pinder IM. Kinematic condylar total knee arthroplasty: 14-year survivorship analysis of 208 consecutive cases. J Bone Joint Surg Br. 1996;78:907–911.PubMedCrossRef
37.
White SE, Paxson RD, Tanner MG, Whiteside LA. Effects of sterilization on wear in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:164–171.PubMedCrossRef
38.
Williams IR, Mayor MB, Collier JP. The impact of sterilization method on wear in knee arthroplasty. Clin Orthop Relat Res. 1998;356:170–180.PubMedCrossRef
Metadata
Title
Durability of a Cruciate-retaining TKA With Modular Tibial Trays at 20 Years
Authors
John J. Callaghan, MD
Mitchell W. Beckert, BS
David W. Hennessy, MD
Devon D. Goetz, MD
Scott S. Kelley, MD
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2401-9

Other articles of this Issue 1/2013

Clinical Orthopaedics and Related Research® 1/2013 Go to the issue

Symposium: Papers Presented at the Annual Meetings of the Knee Society

The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Long-term Survivorship and Failure Modes of Unicompartmental Knee Arthroplasty

Letter to the Editor

Letter to the Editor: Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Symposium: Papers Presented at the Annual Meetings of The Knee Society

Papers Presented at the Annual Meetings of The Knee Society: Editorial Comment

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Total Knee Arthroplasty With a Computer-navigated Saw: A Pilot Study