Olson Nicholas R, Strait Alexander V, Ho P Henry, Fricka Kevin B, Hamilton William G, Sershon Robert A
Anderson Orthopaedic Research Institute, Alexandria, Virginia.
Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia.
J Arthroplasty. 2025 Sep;40(9):2235-2242. doi: 10.1016/j.arth.2025.04.046. Epub 2025 Apr 23.
Modern total knee arthroplasty (TKA) implants are designed with the goal of improving patient outcomes and reducing revisions. The purpose of this study was to determine if material and technical advancements in TKA design over three decades have translated to improvements in implant-related revisions, survivorship, and patient-reported outcome measures (PROMs) at a high-volume institution.
Prospectively collected data were queried for all primary, cemented TKAs performed by eight surgeons from February 1995 to February 2024. A total of 11,767 TKAs were included from three different manufacturers. The primary outcome was the implant-related mechanism of failure. Secondary outcomes included revision indications, survivorship using any revision as an endpoint, survivorship using aseptic revision as an endpoint, and PROMs. Patients who received older-generation implants had significantly longer mean follow-up (mean 6.6, 0 to 25.3, versus mean 2.9, 0 to 11.2 years; P < 0.01).
Among the 312 revisions, earlier-generation implant-related failures were most commonly due to implant loosening (1.0%), polyethylene wear (0.3%), and instability (0.3%). The most common causes for revision extrinsically were infection (1.2%), loosening (1.0%), and polyethylene wear (0.3%). The current-generation implant-related failures were most commonly due to implant loosening (0.3%), instability (0.2%), and fracture (0.1%). Reasons for all-cause revision due to extrinsic causes were most commonly due to infection (0.7%) and loosening (0.3%). Survivorship using all-cause revisions as an endpoint (P > 0.05) and using aseptic revisions as an endpoint (P > 0.05) were similar between the two generations. No clinically important differences in postoperative Oxford, Knee Society, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores were identified between generational TKA designs.
At our institution, the adoption of newer TKA designs has not led to clinically important changes in the 10-year survivorship or PROMs over older generations of high-performing implants from the same manufacturers. The focus should continue to remain on improving implant design and surgical technique.
现代全膝关节置换术（TKA）植入物的设计目标是改善患者预后并减少翻修手术。本研究的目的是确定三十年来TKA设计在材料和技术方面的进步是否转化为一家大型机构中与植入物相关的翻修手术、生存率以及患者报告结局指标（PROMs）的改善。
查询了1995年2月至2024年2月期间八位外科医生进行的所有初次、骨水泥固定TKA的前瞻性收集数据。总共纳入了来自三个不同制造商的11,767例TKA。主要结局是与植入物相关的失败机制。次要结局包括翻修指征、以任何翻修手术为终点的生存率、以无菌性翻修手术为终点的生存率以及PROMs。接受较老一代植入物的患者平均随访时间明显更长（平均6.6年，0至25.3年，而平均2.9年，0至11.2年；P < 0.01）。
在312例翻修手术中，较早一代与植入物相关的失败最常见原因是植入物松动（1.0%）、聚乙烯磨损（0.3%）和不稳定（0.3%）。外部翻修的最常见原因是感染（1.2%）、松动（1.0%）和聚乙烯磨损（0.3%）。当前一代与植入物相关的失败最常见原因是植入物松动（0.3%）、不稳定（0.2%）和骨折（0.1%）。因外部原因进行全因翻修的原因最常见的是感染（0.7%）和松动（0.3%）。以全因翻修手术为终点（P >
