Implications of patient selection and surgical technique for primary total knee arthroplasty

Between 1983 and 1992, one surgeon at Wheeling Hospital in Wheeling, W.Va., performed 121 primary cruciate-sparing total knee arthroplasties on patients with degenerative joint disease. Rigorous preoperative screening criteria and surgical protocol were developed to improve the clinical lifespan of the joint replacements. The average range of motion increased from 99.8 degrees to 107.1 degrees during a mean clinical follow-up period of 40.5 months (range 12-144 months). Among the 86 patients with a preoperative fixed flexion contracture, the average improvement in flexion was 12.0 degrees. Twelve of the patients developed postoperative medical complications, including two revisions of plastic tibial trays. The relatively low revision and complication rates are attributed to the experience of one surgeon utilizing similar guidelines for deliberate patient selection, preoperative educational programs, standardized operative protocol and surgical technique, and prosthesis familiarity.