Skip to main content
SpringerLink
Log in

New Total Knee Arthroplasty Designs: Do Young Patients Notice?

  • Symposium: 2014 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 15 July 2014

Abstract

Background

Although the volume of total knee arthroplasties (TKAs) performed in the United States continues to increase, recent reports have shown the percentage of patients who remain “unsatisfied” is as high as 15% to 30%. Recently, several newer implant designs have been developed to potentially improve patient outcomes.

Questions/purposes

The purpose of this study was to determine the impact of high-flex, gender-specific, and rotating-platform TKA designs on patient satisfaction and functional outcomes.

Methods

A four-center study was designed to quantify the degree of residual symptoms and functional deficits in patients undergoing TKA with newer implant designs compared with a 10-year-old, cruciate-retaining (CR) TKA system introduced in 2003. Each contributing surgeon was fellowship-trained and specialized in joint replacement surgery. Only patients younger than 60 years old were included. Data were collected by an independent, third-party survey center blinded to the implant type, who administered questionnaires about patient satisfaction, residual symptoms, function, and pre- and postoperative activity levels using previously published survey instruments. Two hundred thirty-seven CR, 137 rotating-platform, 88 gender-specific, and 65 high-flex TKAs were included in the analysis. Differences in baseline demographic variables were accounted for using multiple logistic regression statistical analyses.

Results

Patients who received certain newer designs reported more residual symptoms (grinding, popping, and clicking) in the 30 days before survey administration than the group receiving a 10-year-old CR design (CR, 24% [57 of 237 patients] versus gender-specific, 36% [32 of 88 patients]; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.1–3.8; p = 0.03; and rotating-platform, 43% [59 of 137 patients]; OR, 2.2; 95% CI, 1.3–3.7; p < 0.001). They also reported more functional problems, including getting in and out of a chair (CR, 19% [46 of 237 patients] versus gender-specific, 37% [32 of 88 patients]; OR, 1.0; 95% CI, 1.1–3.5; p = 0.001). Patients with newer TKA designs did not demonstrate any improvements in function or patient satisfaction versus those who received the 10-year-old CR design.

Conclusions

When interviewed by an independent, blinded third party, the use of newer implant designs did not improve patient satisfaction and the presence of residual symptoms when compared with patients who received the 10-year-old CR design. Future studies should prospectively determine whether the purported benefits of newer implant designs improve patient-perceived outcomes.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop Relat Res. 1996;331:87–92.

    Article  PubMed  Google Scholar 

  2. Argenson JN, O’Connor JJ. Polyethylene wear in meniscal knee replacement. A one to nine-year retrieval analysis of the Oxford knee. J Bone Joint Surg Br. 1992;2:228–232.

    Google Scholar 

  3. Argenson JN, Scuderi GR, Komistek RD, Scott WN, Kelly MA, Aubaniac JM. In vivo kinematic evaluation and design considerations related to high flexion in total knee arthroplasty. J Biomech. 2005;2:277–284.

    Article  Google Scholar 

  4. Australian Orthopaedic Association National Joint Replacement Registry annual report. 2010. Available at: https://aoanjrr.dmac.adelaide.edu.au/en. Accessed November 14, 2013.

  5. Barrack RL, Ruh EL, Chen J, Lombardi AV Jr, Berend KR, Parvizi J, Della Valle CJ, Hamilton WG, Nunley RM. Impact of socioeconomic factors on outcome of total knee arthroplasty. Clin Orthop Relat Res. 2014;472:86–97.

    Article  PubMed  Google Scholar 

  6. Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement. J Bone Joint Surg Am. 1986;7:1041–1051.

    Google Scholar 

  7. Bistolfi A, Massazza G, Lee GC, Deledda D, Berchialla P, Crova M. Comparison of fixed and mobile-bearing total knee arthroplasty at a mean follow-up of 116 months. J Bone Joint Surg Am. 2013;12:e83.

    Google Scholar 

  8. Booth RE Jr. The gender-specific (female) knee. Orthopedics. 2006;9:768–769.

    Google Scholar 

  9. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Centers for Disease Control and Prevention (CDC). Prevalence of cholesterol screening and high blood cholesterol among adults—United States, 2005, 2007, and 2009. MMWR Morb Mort Wkly Rep. 2012;61:697–702.

  11. Chatman AB, Hyams SP, Neel JM, Binkley JM, Stratford PW, Schomberg A, Stabler M. The patient-specific functional scale: measurement properties in patients with knee dysfunction. Phys Ther. 1997;8:820–829.

    Google Scholar 

  12. Chin KR, Dalury DF, Zurakowski D, Scott RD. Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg. 2002;4:213–217.

    Google Scholar 

  13. Colizza WA, Insall JN, Scuderi GR. The posterior stabilized total knee prosthesis. Assessment of polyethylene damage and osteolysis after a ten-year-minimum follow-up. J Bone Joint Surg Am. 1995;11:1713–1720.

    Google Scholar 

  14. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty. 2007;2:160–165.

    Article  Google Scholar 

  15. Greene KA. Gender-specific design in total knee arthroplasty. J Arthroplasty. 2007;7(Suppl 3):27–31.

    Article  Google Scholar 

  16. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br. 2007;11:1457–1461.

    Article  Google Scholar 

  17. Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003:115–122.

  18. Horn KK, Jennings S, Richardson G, Vliet DV, Hefford C, Abbott JH. The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012;1:30–42.

    Article  Google Scholar 

  19. Kelly NH, Fu RH, Wright TM, Padgett DE. Wear damage in mobile-bearing TKA is as severe as that in fixed-bearing TKA. Clin Orthop Relat Res. 2011;469:123–130.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kim YH, Choi Y, Kim JS. Comparison of standard and gender-specific posterior-cruciate-retaining high-flexion total knee replacements: a prospective, randomised study. J Bone Joint Surg Br. 2010;5:639–645.

    Article  Google Scholar 

  21. Kim YH, Park JW, Kim JS. High-flexion total knee arthroplasty: survivorship and prevalence of osteolysis: results after a minimum of ten years of follow-up. J Bone Joint Surg Am. 2012;15:1378–1384.

    Article  Google Scholar 

  22. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the united states from 2005 to 2030. J Bone Joint Surg Am. 2007;4:780–785.

    Article  Google Scholar 

  23. Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467:2606–2612.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Lee SM, Seong SC, Lee S, Choi WC, Lee MC. Outcomes of the different types of total knee arthroplasty with the identical femoral geometry. Knee Surg Relat Res. 2012;4:214–220.

    Article  Google Scholar 

  25. Lombardi AV Jr, Nunley RM, Berend KR, Ruh EL, Clohisy JC, Hamilton WG, Della Valle CJ, Parvizi J, Barrack RL. Do patients return to work after total knee arthroplasty? Clin Orthop Relat Res. 2014;472:138–146.

    Article  PubMed  Google Scholar 

  26. Lutzner J, Hubel U, Kirschner S, Gunther KP, Krummenauer F. Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome. Chirurg. 2011;7:618–624.

    Article  Google Scholar 

  27. MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award: Gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612–2616.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Meding JB, Meding LK, Ritter MA, Keating EM. Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res. 2012;470:144–149.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Murphy M, Journeaux S, Russell T. High-flexion total knee arthroplasty: a systematic review. Int Orthop. 2009;4:887–893.

    Article  Google Scholar 

  30. Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–965.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Nakamura E, Banks SA, Tanaka A, Sei A, Mizuta H. Three-dimensional tibiofemoral kinematics during deep flexion kneeling in a mobile-bearing total knee arthroplasty. J Arthroplasty. 2009;7:1120–1124.

    Article  Google Scholar 

  32. New Zealand National Joint Registry 10 year report. 2010. Available at: http://www.nzoa.org.nz/nz-joint-registry. Accessed November 13, 2013.

  33. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.

    Article  PubMed  Google Scholar 

  34. Parvizi J, Nunley RM, Berend KR, Lombardi AV, Ruh EL, Clohisy JC, Hamilton WG, DellaValle CJ, Barrack RL. High level of residual symptoms in young patients with total knee arthroplasty. Clin Orthop Relat Res. 2014;472:133–137.

    Article  PubMed  Google Scholar 

  35. 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;3:196–199.

    Article  Google Scholar 

  36. Radler BT, Ryff CD. Who participates? Accounting for longitudinal retention in the MIDUS national study of health and well-being. J Aging Health. 2010;3:307–331.

    Article  Google Scholar 

  37. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am. 2003;7:1278–1285.

    Google Scholar 

  38. Schurman DJ, Rojer DE. Total knee arthroplasty: range of motion across five systems. Clin Orthop Relat Res. 2005;430:132–137.

    Article  PubMed  Google Scholar 

  39. Singh JA, O’Byrne MM, Harmsen WS, Lewallen DG. Predictors of moderate-severe functional limitation 2 and 5 years after revision total knee arthroplasty. J Arthroplasty. 2010;7:1091–5, 1095.e1–4.

  40. Song EK, Jung WB, Yoon TR, Park KS, Seo HY, Seon JK. Comparison of outcomes after bilateral simultaneous total knee arthroplasty using gender-specific and unisex knees. J Arthroplasty. 2012;2:226–231.

    Article  Google Scholar 

  41. Sultan PG, Most E, Schule S, Li G, Rubash HE. Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop Relat Res. 2003;416:167–173.

    Article  PubMed  Google Scholar 

  42. Thomsen MG, Husted H, Otte KS, Holm G, Troelsen A. Do patients care about higher flexion in total knee arthroplasty? A randomized, controlled, double-blinded trial. BMC Musculoskelet Disord. 2013;14:127.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Wainwright C, Theis JC, Garneti N, Melloh M. Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J Bone Joint Surg Br. 2011;10:1411–1415.

    Article  Google Scholar 

  44. Wegener JT, van Ooij B, van Dijk CN, Karayeva SA, Hollmann MW, Preckel B, Stevens MF. Long-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial. Reg Anesth Pain Med. 2013;1:58–63.

    Article  Google Scholar 

  45. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;8:890–895.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Staci R. Johnson MEd, for her contributions to data collection and manuscript preparation for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO, 63110, USA

    Ryan M. Nunley MD, Denis Nam MD & Robert L. Barrack MD

  2. Joint Implant Surgeons, Inc, Mount Carmel Health System, New Albany, OH, USA

    Keith R. Berend MD & Adolph V. Lombardi MD

  3. Colorado Joint Replacement Center, Denver, CO, USA

    Douglas A. Dennis MD

  4. Rush University Medical Center, Chicago, IL, USA

    Craig J. Della Valle MD

Authors
  1. Ryan M. Nunley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Denis Nam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith R. Berend MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adolph V. Lombardi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas A. Dennis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Craig J. Della Valle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert L. Barrack MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Denis Nam MD.

Additional information

Funding for this study was provided by Stryker Inc (Mahwah, NJ, USA) (RMN). One of the authors certifies that he (RMN) has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Smith & Nephew, Inc (Memphis, TN, USA), an amount of less than USD 10,000 from Wright Medical Technology, Inc (Memphis, TN, USA), an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of less than USD 10,000 from CardioMEMS (Atlanta, GA, USA), and an amount of less than USD 10,000 from Integra LifeSciences (Plainsboro, NJ, USA). One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc (Warsaw, IN, USA). One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc, an amount of USD 10,000 to 100,000 from Innomed Inc (Savannah, GA, USA), and an amount from USD 10,000 to 100,000 from Pacira Pharmaceuticals Inc (Parsippany, NJ, USA). One of the authors certifies that he (DAD) has or may receive payments or benefits, during the study period, an amount of more the USD 1,000,001 from DePuy Synthes, Inc (Warsaw, IN, USA). One of the authors certifies that he (CJDV) has or may receive payments or benefits, during the study period, of greater than USD 10,000 but less than USD 100,000 from Biomet, Inc, an amount of less than USD 10,000 from CD Diagnostics (Claymont, DE, USA), an amount of greater than USD 10,000 but less than USD 100,000 from DePuy Synthes, Inc, an amount of greater than USD 100,001 but less than USD 1,000,000 from Smith & Nephew, Inc, and an amount of less than USD 10,000 from Convatec (Skillman, NJ, USA). One of the authors certifies that he (RLB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Smith & Nephew, Inc, and an amount of more than USD 1,000,001 from Stryker Orthopaedics.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

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 prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Washington University School of Medicine, St Louis, MO, USA, in cooperation with the University of Wisconsin Survey Center, Madison, WI, USA; Joint Implant Surgeons, Inc, New Albany, OH, USA; Colorado Joint Replacement Center, Denver, CO, USA; and Rush University Medical Center, Chicago, IL, USA.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nunley, R.M., Nam, D., Berend, K.R. et al. New Total Knee Arthroplasty Designs: Do Young Patients Notice?. Clin Orthop Relat Res 473, 101–108 (2015). https://doi.org/10.1007/s11999-014-3713-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3713-8

Keywords

Search

Navigation