title: Survival analysis of total knee arthroplasty at a minimum 10 years' follow-up: a multicenter French nationwide study including 846 cases.
abstract: BACKGROUND
  Survivorship for modern total knee arthroplasties (TKA) is not precisely known from large series, other than registries. The present retrospective study therefore analyzed 846 TKAs at a minimum 10 years' follow-up.
  
  
  OBJECTIVE
  Ten-year survivorship for TKAs in a multicenter study exceeds 90%, independently of design and level of prosthetic constraint.
  
  
  METHODS
  Eight hundred and twenty-eight patients (846 TKAs) were assessed on the Knee Society score. Mean age was 71 years (range, 41-93 years); 274 males and 554 females (67%); 496 patients (60%) were active; diagnosis was principally osteoarthritis (n=752 [89%]). Most TKAs were cemented (n=704 [83%]), replacing the patella (n=668 [79%]) and sacrificed the posterior cruciate ligament (PCL) (n=707 [84%]), 65% being posterior-stabilized and 35% ultracongruent, with fixed (39%) or mobile bearing (61%).
  
  
  RESULTS
  At a minimum 10 years' follow-up, mean knee score rose from 35 (15-55) to 83 points (74-95), and functional score from 24 (5-45) to 74 points (60-90); mean flexion rose from 105° (25-125°) to 112° (25-125°). Mean hip-knee-ankle angle was 179.5° (169-189°). Sixty-three (7.5%) revision surgeries were required, mainly for loosening (n=18 [2%]) or infection (n=18 [1.8%]). Overall 10-year survivorship was 92% (95% CI: 0.90-0.94). There was no significant difference in survivorship according to implant design or PCL retention. Activity level correlated with revision rate; mechanical complications were more frequent in active and infectious complications in sedentary subjects. Revision was not more frequent in TKA aligned outside the 177-183° range.
  
  
  CONCLUSIONS
  Ten-year TKA survivorship was 92%, independently of design and level of mechanical stress. Revision was mainly for infection or loosening, and not for greater than 3° axis misalignment. Mechanical complications were more frequent in younger and more active subjects, for whom therefore other treatment options or technical improvements should be sought.
  
  
  METHODS
  Level IV. Retrospective study.
authors: Orthopedic Surgery Department, Sainte-Marguerite Hospital, Marseille University Hospitals, 270, boulevard Sainte-Marguerite, 13009 Marseille, France. jean-noel.argenson@ap-hm.fr
authors: J-N
authors: JN
authors: Argenson
authors: S
authors: S
authors: Boisgard
authors: S
authors: S
authors: Parratte
authors: S
authors: S
authors: Descamps
authors: M
authors: M
authors: Bercovy
authors: P
authors: P
authors: Bonnevialle
authors: J-L
authors: JL
authors: Briard
authors: J
authors: J
authors: Brilhault
authors: J
authors: J
authors: Chouteau
authors: R
authors: R
authors: Nizard
authors: D
authors: D
authors: Saragaglia
authors: E
authors: E
authors: Servien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome