title: The outcome of rotating-platform total knee arthroplasty with cement at a minimum of ten years of follow-up.
abstract: BACKGROUND
  Durable, long-term results have been reported for patients managed with first-generation mobile-bearing total knee arthroplasty. Second-generation mobile-bearing total knee arthroplasty has been introduced to enhance instrumentation, to increase flexion, and to improve functional outcome, but, to our knowledge, no long-term results are available.
  
  
  METHODS
  From May 1999 to June 2000, 116 consecutive rotating-platform total knee arthroplasties were performed by the two senior authors in 112 patients with use of the LPS-Flex Mobile cemented prosthesis, which was implanted with a measured resection technique. The patella was resurfaced in every knee. The average age of the patients at the time of surgery was sixty-nine years (range, thirty-seven to eighty-five years), and seventy-seven patients (eighty knees) were women. The predominant diagnosis was osteoarthritis. The clinical and radiographic evaluation was performed with use of the Knee Society rating system. The level of activity and patient-reported functional outcome were evaluated with use of the University of California at Los Angeles (UCLA) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), respectively.
  
  
  RESULTS
  The average duration of follow-up was 10.6 years (range, ten to 11.8 years). Three patients were lost to follow-up, and five patients died of causes unrelated to knee arthroplasty. Two knees were revised, one because of infection and one because of failure of the medial collateral ligament. Kaplan-Meier survivorship analysis showed an implant survival rate of 98.3% at ten years. For the 104 patients (108 knees) who were evaluated at a minimum of ten years, the average Knee Society knee and function scores improved from 34 to 94 points and from 55 to 88 points, respectively, at the time of the latest follow-up. There was no periprosthetic osteolysis and no evidence of implant loosening on follow-up radiographs. The average knee flexion was 117° preoperatively and 128° at the time of the latest follow-up evaluation. At the time of the latest follow-up, the KOOS quality-of-life score was significantly better for patients with >125° of flexion (p = 0.00034).
  
  
  CONCLUSIONS
  This study demonstrated durable clinical and radiographic results at a minimum of ten years after total knee replacement with a second-generation, cemented, rotating-platform, posterior-stabilized total knee prosthesis. According to the functional outcome results obtained in this study, we believe that this design is a valuable option for active patients undergoing total knee arthroplasty.
authors.affiliation: Service de Chirurgie Orthopédique, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France. jean-noel.argenson@ap-hm
authors.forename: Jean-Noel A
authors.initials: JN
authors.lastname: Argenson
authors.forename: Sebastien
authors.initials: S
authors.lastname: Parratte
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ashour
authors.forename: Bertrand
authors.initials: B
authors.lastname: Saintmard
authors.forename: Jean-Manuel
authors.initials: JM
authors.lastname: Aubaniac
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D001843:Bone Cements / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000502:physiology; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000601:surgery; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements