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Acceptable Survival Rate of Cemented Knee Arthroplasty in Patients Under 50

What was once thought to be a procedure only for older people, knee arthroplasties (replacements) are becoming more necessary for younger, active patients. Currently there are other surgical options for patients under 55 years old who have arthritic disease, causing pain and immobility to the joints, particularly the knee and hip.

Although other options for treatment exist, many don't provide long-term relief and may affect the function of the knee. However, many surgeons are still reluctant to opt for arthroplasty with the younger patients, citing higher failure rates than with older patients and the need for surgery revisions later on. The authors of this study investigated whether a total knee arthroplasty (TKA) would be better and stronger for this population if it was a cemented arthroplasty.

Researchers used a registry for joint replacements to find patients, over a 14-year period, who had had knee arthroplasty. The patients had to have been under 55 years old at the time of surgery. The researchers identified 1047 knee arthroplasties with follow up of between 0 to 171 months. Endpoint for the study was revision surgery of the replacement, which could be removal, exchange, or the addition of a component.

Interestingly, the researchers noted that, through the course of the study, the total percentage of the registry's population became younger: those under 55 years represented 4.6 percent in 1991; this rose to 17.1 percent by 2005.

The arthroplasties performed were cemented, cementless, a hybrid, or unicompartmental (UKA). The results showed that 73 patients required revisions over the study period. Over the 14 years, there was a 74.5 percent survival for the arthroplasties. The cemented group had the highest survival rate, followed by the UKA and cementless groups, which had similar rates.

The patients with cementless implants were 2.7 times as likely to need revisions compared with cemented implants, while those with the UKA were 2.9 times as likely. Loosening of the implant occurred in 31.5 percent of the cases needing revisions, wear and tear on the bone (osteolysis) in 19.2 percent, and progression of arthritis in 13.7 percent.

One the information was analyzed, the researchers concluded that because delaying TKA in younger patients can result in increased pain and limited ability to function, use of TKA in this age group is warranted. They write that that they found "acceptable survival in our registry of cemented TKA implants of various designs at 14 years."

Terence J. Gioe, MD, et al. Knee Arthroplasty in the Young Patient. In Clinical Orthopaedics and Related Research. November 2007. Vol. 464. Pp. 83-87.


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