Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Continuation of an Earlier Study At 5-Year Minimum Follow-Up
BACKGROUND: Studying and reporting the continuous, prospective outcomes of a post-surgical orthopaedic population without loss to follow-up at various standard landmarks over time is rarely achieved in total knee arthroplasty (TKA) literature. Small case series populations reported at an early follow-up time is common, and usually not beyond any initial publication for further reporting. The purpose of this study was to advance the knowledge base of the performance of Freedom Knee system through the continuous monitoring of a previously reported early series TKA patient population.
METHODS: A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of five-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender.
RESULTS: There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. One patient required tibial component and polyethylene insert revision following a motor vehicle accident resulting in a proximal tibial fracture and component loosening. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 6.9 years). In addition, there was an average significant increase in change of HSS score (p<0.001) and ROM (P<0.001) when compared to pre-operative baseline but no significant difference in HSS or ROM between the two and five-year outcome results.CONCLUSIONS: The design characteristic for component sizing and functional expectations were re-confirmed in the reported Western population cohort series, and observed optimum safety, performance and efficacy through five-years. Further continued study efforts of this primary TKA system is warranted across multiple surgeons and all ethnic cultures.
Rodriguez, J.A., H. Bhende, and C.S. Ranawat, Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res, 2001(388): p. 10-7.
Rasquinha, V.J., et al., The press-fit condylar modular total knee system with a posterior cruciate-substituting design. A concise follow-up of a previous report. J Bone Joint Surg Am, 2006. 88(5): p. 1006-10.
Lonner, J.H., et al., Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res, 2000(380): p. 85-90.
Chon, J.G., A.V. Lombardi, Jr., and K.R. Berend, Hybrid stem fixation in revision total knee arthroplasty (TKA). Surg Technol Int, 2004. 12: p. 214-20.
Levitsky, K.A., et al., Total knee arthroplasty without patellar resurfacing. Clinical outcomes and long-term follow-up evaluation. Clin Orthop Relat Res, 1993(286): p. 116-21.
Insall, J., et al., Total condylar knee replacment: preliminary report. Clin Orthop Relat Res, 1976(120): p. 149-54.
Ranawat, C.S. and O. Boachie-Adjei, Survivorship analysis and results of total condylar knee arthroplasty. Eight- to 11-year follow-up period. Clin Orthop Relat Res, 1988(226): p. 6-13.
Ranawat, C.S., et al., Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop Relat Res, 1993(286): p. 94-102.
Patil, S., et al., How do knee implants perform past the second decade? Nineteen- to 25-year followup of the Press-fit Condylar design TKA. Clin Orthop Relat Res, 2015. 473(1): p. 135-40.
Walker, P.S., C. Ranawat, and J. Insall, Fixation of the tibial components of condylar replacement knee prostheses. J Biomech, 1976. 9(4): p. 269-75.
Ranawat, C.S., H.A. Rose, and W.J. Bryan, Replacement of the patello-femoral joint with the total condylar knee arthroplasty. Int Orthop, 1984. 8(1): p. 61-5.
Ranawat, C.S., H.A. Rose, and D.S. Rich, Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. Instr Course Lect, 1984. 33: p. 412-6.
Ranawat, C.S., The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res, 1986(205): p. 93-9.
Ranawat, C.S., W.F. Flynn, Jr., and R.G. Deshmukh, Impact of modern technique on long-term results of total condylar knee arthroplasty. Clin Orthop Relat Res, 1994(309): p. 131-5.
Durbhakula, S.R., L., Restoration of femoral condylar anatomy for achieving optimum functional expectations: Component design and early results. Reconstructive Review, 2016. 6(September): p. 5.
Ayers, D.C., et al., Using joint registry data from FORCE-TJR to improve the accuracy of risk-adjustment prediction models for thirty-day readmission after total hip replacement and total knee replacement. J Bone Joint Surg Am, 2015. 97(8): p. 668-71.
Etkin, C.D. and B.D. Springer, The American Joint Replacement Registry-the first 5 years. Arthroplast Today, 2017. 3(2): p. 67-69.
Heckmann, N., et al., Early Results From the American Joint Replacement Registry: A Comparison With Other National Registries. J Arthroplasty, 2019.
Vaidya, S.V., et al., Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty, 2000. 15(1): p. 79-85.
Uehara, K., et al., Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty, 2002. 17(8): p. 1028-32.
Rosenstein, A.D., et al., Gender differences in the distal femur dimensions and variation patterns in relation to TKA component sizing. Orthopedics, 2008. 31(7): p. 652.
Matsumoto, T., et al., Differing prosthetic alignment and femoral component sizing between 2 computer-assisted CT-free navigation systems in TKA. Orthopedics, 2011. 34(12): p. e860-5.
Copyright (c) 2019 Sridhar Durbhakula, Vinay S. Durbhakula, Navin S. Durbhakula
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