Gurdev S. Gill

Total Condylar Knee Arthroplasty: 16− to 21-year Results

This study presents long term results of arthroplasty with posterior cruciate retention using the Total Condylar Knee implant. From 1976 to 1982, 139 patients had 159 knee arthroplasties using Total Condylar Knee prostheses. Sixty-three patients (72 knees) were available for followup at a minimum of 16 years (range, 16-21 years). The average age of the patients at the time of surgery was 61 years. There were 21 men and 42 women. Patients with 68 knees had osteoarthrosis, three had rheumatoid arthritis and one had posttraumatic arthritis. There were five delayed complications. One patient (one knee) underwent revision surgery and two patients (two knees) declined revision surgery because they were considered to be high surgical risks, as determined by their internists. The average preoperative score was 40.3 points and improved to 88.4 points at followup. Eighty-seven percent of the patients had a score equal to or more than 85 points at last evaluation. Prosthesis survivorship at 20 years was 98.6% for patients who had revision surgery. No femoral components were revised for aseptic loosening. Retention of the posterior cruciate in Total Condylar Knee prosthesis produces results comparable with the results of the original Total Condylar Knee prosthesis with cruciate sacrifice.

Mortality Following Primary Total Knee Arthroplasty

Background: Total joint arthroplasty is one of the most successful orthopaedic surgical procedures. However, it carries a risk of perioperative mortality. The purpose of this study was to determine the mortality rate for patients undergoing primary total knee arthroplasty in a private-practice setting involving one surgeon in a nonteaching institution. Methods: We analyzed 3048 consecutive primary total knee arthroplasties, performed between July 1976 and December 1996, with respect to mortality data (deaths that occurred intraoperatively, during hospitalization, and within ninety days after surgery) and comorbidities (major cardiovascular disease). Results: The mortality rate was 0.46% (fourteen patients; one death per 217 procedures) within ninety days after primary total knee arthroplasty. Conclusions: Increasing patient age and the presence of associated cardiovascular comorbidities were identified as risk factors for mortality. This information, we believe, is useful to patients, their families, physicians, and health-care planners in deciding when a total knee arthroplasty is appropriate. Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger

Seventy-two cemented total knee arthroplasties were performed on 52 patients who were 55 years old or younger. Results on 68 knees in 50 patients with an average follow-up period of 9.92 years are reported. The average age of the patients was 50.7 years (range, 30-55) at the time of surgery. The diagnosis was osteoarthritis in 37 knees, rheumatoid arthritis in 29 knees, and ankylosing spondylitis in 2 knees. The average preoperative Knee Society knee score was 23 and the average follow-up knee score was 97. All knees were rated as good or excellent for knee score. The average latest function score was 75 (preoperative, 36). Both knees in one patient required revision for loose components. This review demonstrates that cemented total knee arthroplasty in younger patients with osteoarthritis and rheumatoid arthritis can attain results comparable to the excellent results obtained in the older age groups.

Long-term results of Kinematic Condylar knee replacement: AN ANALYSIS OF 404 KNEES

We present the long-term results of the Kinematic Condylar Knee Arthroplasty followed in a prospective fashion. Between October 1982 and March 1988, 404 consecutive replacement arthroplasties were carried out on 335 patients. Of these, 354 knees had osteoarthritis, 45 rheumatoid arthritis and five other diagnoses. At the time of final follow-up 158 patients (188 knees) had died. No patient was lost to follow-up. The minimum follow-up for all living patients was ten years (10 to 17). The mean age at surgery was 68 years (30 to 92). There were seven complications (1.7%). Sixteen knees (3.9%) were revised, four because of infection. Survivorship was 99.4% (CI 97.9 to 99.8) at five years, 98.2% (CI 96.1 to 99.2) at ten years and 92.6% (CI 87.6 to 95.6) at 17 years.

Long-term follow-up evaluation of 1000 consecutive cemented total knee arthroplasties

This is a report of a retrospective study of 1000 consecutive, cemented total knee arthroplasties performed by one surgeon from January 1976 to August 1989. Eighty-five percent of the patients were available after a mean of 51 months. Using The Knee Society Clinical Rating System, a good to excellent result was found in 95% of the knees; function was good to excellent in 54% of the knees. By using an actuarial method, 94% of the knees can be expected to survive 13 years. A deep venous thrombosis or pulmonary embolus was found in 1.7% and was no less common in the 25% of the patients who received pharmacologic anticoagulation. The mortality rate was 0.4%. The infection rate was 0.7% and did not correlate with intraoperative cultures. There were 14 failures for a variety of reasons, and six unsuccessful knees were revised. Preoperative medical problems did not generally predict the postoperative complications. The average duration of hospitalization during the last five years of the study was 9.7 days. Careful and consistent preoperative, intraoperative, and postoperative care is responsible for the low complication rate. The cemented knee arthroplasty consistently continues to yield good results.

Long-term results of Kinematic Condylar knee replacement

We present the long-term results of the Kinematic Condylar Knee Arthroplasty followed in a prospective fashion. Between October 1982 and March 1988, 404 consecutive replacement arthroplasties were carried out on 335 patients. Of these, 354 knees had osteoarthritis, 45 rheumatoid arthritis and five other diagnoses. At the time of final follow-up 158 patients (188 knees) had died. No patient was lost to follow-up. The minimum follow-up for all living patients was ten years (10 to 17). The mean age at surgery was 68 years (30 to 92). There were seven complications (1.7%). Sixteen knees (3.9%) were revised, four because of infection. Survivorship was 99.4% (CI 97.9 to 99.8) at five years, 98.2% (CI 96.1 to 99.2) at ten years and 92.6% (CI 87.6 to 95.6) at 17 years.

Postoperative patellar tilt in total knee arthroplasty

The postoperative tilt of the patella was investigated in 80 consecutive bilateral total knee arthroplasties in 40 patients. We found that the greater the preoperative lateral tilt, the more likely the patella would tilt postoperatively. The obliquity of resection of the patella has a significant effect on the postoperative lateral tilt. Making the patella remnant thicker on the medial side can decrease the postoperative lateral tilt. A limited lateral peripatellar soft tissue release had no discernible effect on the postoperative lateral tilt of the resurfaced patella.

Long-term results of retention of the posterior cruciate ligament in total knee replacement in rheumatoid arthritis

We analysed the long-term results with a mean follow-up of 10.2 years, of 66 total knee replacements in 42 patients with rheumatoid arthritis. In all cases the posterior cruciate ligament was retained. There were only three complications (4.5%). Revision surgery was necessary in five knees (7.6%), including one (1.5%) with infection. At the final follow-up, 75.8% of knees were rated excellent clinically. Only 15% had an excellent function score. The survival rate of the implant was 90.7% at 19 years. The clinical, radiological and survivorship analysis shows that the posterior-cruciate-retaining knee arthroplasty performs well in rheumatoid arthritis.