Durability of a cruciate-retaining TKA with modular tibial trays at 20 years

Abstract

Background: Modular tibial trays have been utilized in TKA for more than 20 years. However, concerns have been raised about modular implants and it is unclear whether these devices are durable in the long term.

Questions/purposes: We determined (1) survival, (2) relationship of age and polyethylene thickness with revision, (3) function, and (4) radiographic lucencies and osteolysis in patients having a single TKA implant at 20-year followup.

Methods: We prospectively followed 75 patients implanted with 101 Press-Fit Condylar(®) (Johnson and Johnson Professional, Inc, Raynham, MA, USA) posterior cruciate-retaining TKAs (with modular tibial trays) between 1988 and 1991. At 20 years, 59 patients were deceased. We clinically evaluated the living 16 patients (22 knees) and contacted the relatives of all deceased patients to confirm implant status. We clinically assessed 14 of the 16 patients with the Knee Society score, WOMAC, and UCLA and Tegner activity level scores. Radiographically, we determined lucencies, component migration, and osteolysis. We performed survival analysis including all original patients. Minimum followup was 20 years (mean, 20.6 years; range, 20-21.8 years).

Results: Six reoperations were performed in five patients (6% rate of revision) over the 20-year followup. All revisions were related to polyethylene wear and occurred at least 10 years after the primary procedure. Survivorship with revision for any reason as the end point was 91% (95% CI, 0.83-0.97) at 20 years. Average Knee Society clinical and functional scores were 90 (range, 60-100) and 59 (range, 30-87), respectively.

Conclusions: Our data demonstrate the durability of this posterior cruciate-retaining TKA design. The data provide a standard for newer designs and newer bearing surface materials at comparable followup.

Fig. 1A–F

Graphs demonstrate the Kaplan-Meier survivorship curves with accompanying 95% CIs with (A) any revision, (B) liner revision, (C) tibial component revision, (D) femoral component revision, (E) patellar component revision, and (F) revision for component loosening as end points.

Fig. 2A–C

Lateral, AP, and Merchant view radiographs were taken (A) preoperatively, (B) postoperatively, and (C) at the 20-year final followup. This patient was 53 years old at the time of the index surgery and 74 years old at the time of 20-year final followup. Preoperatively, she had 10° valgus deformity with functionally limiting pain. At the time of 20-year followup, she had a Knee Society pain score of 100 of 100 (no pain with activity) and function score of 86 of 100. Her Tegner and UCLA activity level scores were both 5 of 10, which corresponded to moderately heavy labor.

Fig. 3

A graph demonstrates the Kaplan-Meier survivorship curves with the end point of patient survival based on age at the time of surgery of the index procedure.