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.
Baker
P N
PN
South Tees Hospitals NHS Trust, The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK. drpnbaker@hotmail.com
Khaw
F M
FM
Kirk
L M G
LM
Esler
C N A
CN
Gregg
P J
PJ
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