Long-term Results of Total Knee Arthroplasty

Abstract

Early development of total knee replacement included hinged-type knee prostheses and interposition arthroplasty. These implants had high failure rates due to loosening, infection, or inadequate pain relief. The total condylar prosthesis was a tricompartmental, posterior cruciate sacrificing implant that was first used at the Hospital for Special Surgery in 1974. The results of the total condylar prosthesis have served as a standard by which newer designs have been compared. Numerous long-term studies have confirmed the excellent results of the total condylar knee. Scudari and Insall reported the 15-year survivorship of 224 total condylar prostheses and the cumulative rate of survival was 91%. The total condylar prosthesis led to the development of the Insall-Burstein (IB) posterior stabilized prosthesis. The IB design incorporated a femoral cam and tibial peg that increased rollback of the femoral component on the tibial component and improved flexion. The results of the Insall-Burstein posterior stabilized knee have proved to be even better than those of the total condylar prosthesis. Seven-year clinical survivorship was reported by Scudari and Insall to be 99%. Stern reported an overall 12-year survivorship rate of 94%. Total knee arthroplasty has proven to be a highly successful procedure for treating patients with advanced arthritis of the knee.