TKA in young, active more successful than thought

By Susan A. Nowicki, APR

The results of early and intermediate studies on total knee arthroplasty (TKA) done in younger, more active patients have not shown significant failure rates from aseptic loosening or component wear, said the authors of Paper 51 on Wednesday. Although potential component loosening and wear, bone loss, and the technical challenges presented by the perceived need for multiple revision surgeries have discouraged the widespread use of TKA in younger patients, actual clinical experience has been encouraging.

Researchers said that with the increasing number of patients undergoing TKA, the number of revisions has also been increasing and they particularly wanted to examine the results in more active patients to see how they compared to those in older, less active patients. The authors reported on the 10- to 17-year results of primary TKA using the press fit condylar (PFC) knee system in 54 active patients with osteoarthritis who were 55 years of age or younger at the time of surgery. They noted that there has been concern that tibial modularity has led to increased osteolysis by introducing backside wear. “We chose to study this modular design to evaluate the wear-related issue in these young patients,” they said.

The median length of follow-up was 12 years. The group included 21 men and 23 women. The mean age was 51.2 years (range: 29 to 55 years). The preoperative diagnosis was osteoarthritis in all 54 knees. Clinical and radiographic evaluations were performed prior to surgery and at 1 year, 5 years, 10 years and at latest follow-up (clinical examination, phone interview and detail mail questionnaire). Fifty knee arthroplasties had follow-up radiographs available for review at a median of 8 years (range: 5 to 15 years) from surgery.

The investigators concluded that, “The concern that long-term follow-up would reveal revision rates similar to total hip arthroplasty in young patients with osteoarthritis has not been the case with patients in our study group. Cemented TKA in the younger patient with osteoarthritis using the PFC knee system is a durable, reliable procedure with excellent survivorship, estimated to be 96 percent at 10 years and 86 percent at 15 years of follow-up…it has demonstrated reliable durable pain relief, deformity correction and functional improvement for patients with knee arthritis of varied etiologies.”

The researchers did note that concern remains about an increase in failure associated with polyethylene wear and osteolysis during the second decade following TKA and suggested that longer term follow-up was needed to evaluate the 20-year result in these patients.

The research team included Gavan P. Duffy, MD, and Amy R. Crowder, MD, both of Jacksonville, Fla.

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