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.
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Acknowledgments
We thank Staci R. Johnson MEd, for her contributions to data collection and manuscript preparation for this study.
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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.
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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
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DOI: https://doi.org/10.1007/s11999-014-3713-8