A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis.
We report the long-term survival of a prospective randomised consecutive series of 501 primary knee replacements using the press-fit condylar posterior cruciate ligament-retaining prosthesis. Patients received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation. Altogether, 44 of 501 knees (8.8%) underwent revision surgery (24 cemented vs 20 cementless). For cemented knees the 15-year survival rate was 80.7% (95% confidence interval (CI) 71.5 to 87.4) and for cementless knees it was 75.3% (95% CI 63.5 to 84.3). There was no significant difference between the two groups (cemented vs cementless; hazard ratio (HR) 0.83, 95% CI 0.45 to 1.52, p = 0.55). When comparing the covariates there was no significant difference in the rates of survival between the side of operation (HR 0.58, p = 0.07), age (HR 0.97, p = 0.10) and diagnosis (HR 1.25 p = 0.72). However, there was a significant gender difference, with males having a higher failure rate with cemented fixation (HR 2.48, p = 0.004). Females had a similar failure rate in both groups. This single-surgeon series, with no loss to follow-up, provides reliable data of the revision rates of one of the most commonly-used total knee replacements. The survival of the press-fit condylar total knee replacement remained good at 15 years, irrespective of the method of fixation.
South Tees Hospitals NHS Trust, The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK. drpnbaker@hotmail.com
P N
PN
Baker
F M
FM
Khaw
L M G
LM
Kirk
C N A
CN
Esler
P J
PJ
Gregg
D001172:Arthritis, Rheumatoid / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001843:Bone Cements; D002484:Cementation / Q000379:methods*; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D015993:Life Tables; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D001843:Bone Cements