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. 2020 Jan;35(1):139-144.
doi: 10.1016/j.arth.2019.08.011. Epub 2019 Aug 14.

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Taylor M Yong  1 , Emily C Young  2 , Ilda B Molloy  1 , Brian M Fisher  3 , Benjamin J Keeney  4 , Wayne E Moschetti  1
Affiliations

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Taylor M Yong et al. J Arthroplasty. 2020 Jan.

Abstract

Background: There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA).

Methods: We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA.

Results: Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n = 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision.

Conclusion: Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.

Keywords: TKA; bilateral; implant survivorship; long-term; total knee arthroplasty.

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Conflict of interest statement

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.08.011.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier plot depicting survival estimate for time to revision surgery per knee in 532 knees (266 patients). TKA, total knee arthroplasty; CI, confidence interval.
Fig. 2.
Fig. 2.
Kaplan-Meier plot for incident revision of either knee after bilateral TKA per patient (N = 266).
See this image and copyright information in PMC

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