eMedicine Specialties > Orthopedic Surgery > Knee

Total Knee Arthroplasty: Follow-up

Author: Simon H Palmer, MD, Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex
Coauthor(s): Mervyn J Cross, MBBS, FRACS, Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia
Contributor Information and Disclosures

Updated: Apr 14, 2009

Outcome and Prognosis

Most patients seem satisfied with their knee replacements, and if pain relief is the main indication for surgery, this indeed should be the case. Satisfactory knee function is usually restored following total knee arthroplasty, and the majority of patients are able to return to low-impact sporting activity.15,16 Long-term studies confirm satisfactory functional scores and show a 91-96% prosthesis survival rate at 14-15 years of follow-up. No difference appears to exist between PCL-retaining and PCL-substituting designs. Cementless designs do not have the same length of follow-up, but studies at 10-12 years report a 95% prosthesis survival rate.3,7,8,17,18

Future and Controversies

Cemented total knee replacements will remain the criterion standard for total knee arthroplasty, but use of uncemented designs with bioactive surfaces (eg, hydroxyapatite) are showing promising midterm results (see Image 17).19

Total knee arthroplasty. Electro-micrograph showi...

Total knee arthroplasty. Electro-micrograph showing incorporation of bone (red) onto the surface of the hydroxyapatite.

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Total knee arthroplasty. Electro-micrograph showi...

Total knee arthroplasty. Electro-micrograph showing incorporation of bone (red) onto the surface of the hydroxyapatite.


Research into mobile bearing knee replacements continues. Such prostheses appear to demonstrate an attractive way of overcoming the constraint-versus-conformity conflict inherent in any artificial knee replacement.

 


More on Total Knee Arthroplasty

Overview: Total Knee Arthroplasty
Workup: Total Knee Arthroplasty
Treatment: Total Knee Arthroplasty
Follow-up: Total Knee Arthroplasty
Multimedia: Total Knee Arthroplasty
References
Further Reading
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References

  1. Deirmengian CA, Lonner JH. What's new in adult reconstructive knee surgery. J Bone Joint Surg Am. Nov 2008;90(11):2556-65. [Medline].

  2. Lee K, Goodman SB. Current state and future of joint replacements in the hip and knee. Expert Rev Med Devices. May 2008;5(3):383-93. [Medline].

  3. Ranawat CS, Flynn WF Jr, Saddler S. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop. Jan 1993;(286):94-102. [Medline].

  4. Chitnavis J, Sinsheimer JS, Clipsham K. Genetic influences in end-stage osteoarthritis. Sibling risks of hip and knee replacement for idiopathic osteoarthritis. J Bone Joint Surg Br. Jul 1997;79(4):660-4. [Medline].

  5. Insall JN, Dorr LD, Scott RD. Rationale of the Knee Society clinical rating system. Clin Orthop. Nov 1989;(248):13-4. [Medline].

  6. Soderman P, Malchau H. Validity and reliability of Swedish WOMAC osteoarthritis index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP). Acta Orthop Scand. Feb 2000;71(1):39-46. [Medline].

  7. Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg [Am]. Mar 1991;73(3):397-409. [Medline].

  8. Ritter MA, Herbst SA, Keating EM. Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop. Dec 1994;(309):136-45. [Medline].

  9. Greene KA, Schurman JR 2nd. Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty. Oct 2008;23(7 Suppl):15-9. [Medline].

  10. [Best Evidence] Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br. Jan 2009;91(1):52-7. [Medline].

  11. [Best Evidence] Andersen LØ, Husted H, Otte KS, Kristensen BB, Kehlet H. A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop. Dec 2008;79(6):806-11. [Medline].

  12. [Best Evidence] Shum CF, Lo NN, Yeo SJ, Yang KY, Chong HC, Yeo SN. Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes. J Arthroplasty. Feb 2009;24(2):204-9. [Medline].

  13. [Best Evidence] Mockford BJ, Thompson NW, Humphreys P, Beverland DE. Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?. J Arthroplasty. Dec 2008;23(8):1110-4. [Medline].

  14. [Best Evidence] Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum. Feb 15 2009;61(2):184-91. [Medline].

  15. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. Oct 2008;90(10):2245-52. [Medline].

  16. Bradbury N, Borton D, Spoo G. Participation in sports after total knee replacement. Am J Sports Med. Jul-Aug 1998;26(4):530-5. [Medline].

  17. Buechel FF. Cementless meniscal bearing knee arthroplasty: 7- to 12-year outcome analysis. Orthopedics. Sep 1994;17(9):833-6. [Medline].

  18. March LM, Cross M, Tribe KL, Lapsley HM, Courtenay BG, Cross MJ, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage. May 2004;12(5):400-8. [Medline].

  19. Meneghini RM, Hanssen AD. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. Oct 2008;21(4):307-14. [Medline].

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Keywords

total knee arthroplasty, TKA, total knee replacement, knee replacement, knee replacement surgery, knee surgery, knee pain, osteoarthritis of the knee, total joint arthroplasty, artificial knee

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Contributor Information and Disclosures

Author

Simon H Palmer, MD, Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex
Disclosure: Nothing to disclose.

Coauthor(s)

Mervyn J Cross, MBBS, FRACS, Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia
Mervyn J Cross, MBBS, FRACS is a member of the following medical societies: American Orthopaedic Society for Sports Medicine, Australasian College of Sports Physicians, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Hughston Society, and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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