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[Knee endoprosthesis: clinical aspects].

C Stukenborg-Colsman1, C J Wirth

  • 1Klinik Orthopädie, Medizinische Hochschule Hannover.

Der Orthopade
|October 3, 2000
PubMed
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Total knee arthroplasty (TKA) has a notable revision rate. This study found aseptic loosening and polyethylene wear were primary drivers for revision TKA, highlighting areas for future implant improvement.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Medical Device Engineering

Background:

  • Total knee arthroplasty (TKA) complications and failure rates remain significant despite advancements.
  • Revision TKA constitutes approximately 10% of all TKA procedures.

Purpose of the Study:

  • To evaluate the outcomes and identify reasons for revision in a cohort of total knee arthroplasties.
  • To assess the long-term efficacy of different fixation methods (cemented, uncemented, hybrid) and patellar resurfacing.

Main Methods:

  • A retrospective review of 209 TKAs (182 patients) performed between June 1991 and June 1994.
  • Analysis of fixation methods (73% uncemented, 11.2% cemented, 15.8% hybrid) and patellar component types (96% resurfaced).
  • Follow-up assessment of clinical outcomes, functional scores, and reasons for revision surgery over a 7-year period.

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Main Results:

  • Significant improvements in knee and function scores were observed at 1 and 5-7 years postoperatively.
  • Low rates of general (77%) and local (80%) postoperative complications were reported.
  • A 7-year revision rate of 20.1% (42 revisions) was recorded, with aseptic loosening (8.1%) and polyethylene wear (4.8%) as leading causes.

Conclusions:

  • While TKA offers significant functional improvement, revision surgery remains necessary for a substantial number of patients.
  • Polyethylene wear and aseptic loosening are critical areas for future implant design and material development.
  • Uncemented fixation requires specific considerations, such as hydroxyapatite coating, for optimal long-term performance.