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

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Acknowledgments

The authors thank Steve S. Liu MD, Yubo Gao PhD, and Rhonda Chalus RN for their help in completion of this study.

Author information

Authors and Affiliations

  1. University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    John J. Callaghan MD & Mitchell W. Beckert BS

  2. VA Medical Center, Iowa City, IA, USA

    John J. Callaghan MD

  3. University of Wisconsin, Madison, WI, USA

    David W. Hennessy MD

  4. Des Moines Orthopaedic Surgeons, West Des Moines, IA, USA

    Devon D. Goetz MD

  5. North Carolina Orthopaedic Clinic, Durham, NC, USA

    Scott S. Kelley MD

Authors
  1. John J. Callaghan MD
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  2. Mitchell W. Beckert BS
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  3. David W. Hennessy MD
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  4. Devon D. Goetz MD
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  5. Scott S. Kelley MD
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Corresponding author

Correspondence to John J. Callaghan MD.

Additional information

One of the authors (JJC) has or may receive payments or benefits, in any 1 year, an amount in excess of $1,000,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA) and, in any 1 year, an amount in excess of $1000 from Lippincott Williams & Wilkins (Philadelphia, PA, USA).

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation was obtained.

This work was performed at the University of Iowa (Iowa City, IA, USA) and Des Moines Orthopaedic Surgeons (West Des Moines, IA, USA).

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Callaghan, J.J., Beckert, M.W., Hennessy, D.W. et al. Durability of a Cruciate-retaining TKA With Modular Tibial Trays at 20 Years. Clin Orthop Relat Res 471, 109–117 (2013). https://doi.org/10.1007/s11999-012-2401-9

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  • DOI: https://doi.org/10.1007/s11999-012-2401-9

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