title: An 11- to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty: pivot knee arthroplasty.
abstract: OBJECTIVE
  The Advance Medial-Pivot total knee arthroplasty (TKA) was designed to reflect contemporary data regarding the kinematics of the knee. We wished to examine the long-term results obtained with this prosthesis by extending a previous evaluation.
  
  
  METHODS
  We retrospectively evaluated prospectively collected data from 225 consecutive patients (41 men and 184 women; mean age at surgery 71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both subjective and objective) and radiological outcome were assessed. Pre- and post-operative clinical and radiographic data were available at regular intervals for all patients. A total of ten patients (4.4%; ten TKAs) were lost to follow-up.
  
  
  RESULTS
  Survival analysis at 15 years showed a cumulative success rate of 97.3% (95% confidence interval (CI) 96.7 to 97.9) for revision for any reason, of 96.4% (95% CI 95.2 to 97.6) for all operations, and 98.8% (95% CI 98.2 to 99.4) for aseptic loosening as an end point. Three TKAs (1.06%) were revised due to aseptic loosening, two (0.7%) due to infection, one (0.35%) due to instability and one (0.35%) due to a traumatic dislocation. All patients showed a statistically significant improvement on the Knee Society Score (p = 0.001), Western Ontario and McMaster University Osteoarthritis Index (p = 0.001), Short Form-12 (p = 0.01), and Oxford Knee Score (p = 0.01). A total of 207 patients (92%) were able to perform age appropriate activities with a mean flexion of the knee of 117° (85° to 135°) at final follow-up.
  
  
  CONCLUSIONS
  This study demonstrates satisfactory functional and radiographic long-term results for this implant. Cite this article: Bone Joint J 2016;98-B:1050-5.
authors.affiliation: University of Thessalia, School of Health Sciences, Faculty of Medicine, University General Hospital, Biopolis, Larissa 41110, Greece.
authors.forename: Th
authors.initials: T
authors.lastname: Karachalios
authors.affiliation: University of Thessalia, School of Health Sciences, Faculty of Medicine, University General Hospital, Biopolis, Larissa 41110, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Varitimidis
authors.affiliation: University of Thessalia, School of Health Sciences, Faculty of Medicine, University General Hospital, Biopolis, Larissa 41110, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Bargiotas
authors.affiliation: University of Thessalia, School of Health Sciences, Faculty of Medicine, University General Hospital, Biopolis, Larissa 41110, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Hantes
authors.affiliation: KAT General Hospital, Athens 41110, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Roidis
authors.affiliation: University of Thessalia, School of Health Sciences, Faculty of Medicine, University General Hospital, Biopolis, Larissa 41110, Greece.
authors.forename: K N
authors.initials: KN
authors.lastname: Malizos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Advance medial-pivot design; Clinical outcome; Knee kinematics; Medial rotating total knee arthroplasty