No component loosening of a cementless deep dish rotating platform knee at a 5-year follow-up.

PURPOSE: Cemented fixation remains the gold standard in total knee arthroplasty. With an increasing number of younger patients undergoing total knee arthroplasty and a growing patient population demanding higher physical activity, a rising interest in discussion of cementless fixation is notable. The current scientific literature does not give a clear recommendation for or against uncemented total knee arthroplasty. The purpose of this study was the investigation of the 5-year clinical and radiographic outcomes of a cementless deep-dish rotating platform implant. METHODS: A total of 91 primary cementless total knee arthroplasties were included in this single-centre prospective observational study. The primary outcome was revision rate due to aseptic component loosening. Further outcome measures were assessment of the of the radiographic outcome as well as the clinical outcome based on Range of Motion and scores such as American Knee Society Score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and European Quality of Life 5 Dimension 3 Level at a follow-up of 5 years. RESULTS: Mean age of the study population was 67.3 ± 6.6 years with 49.5% of the participants being female. Aseptic component loosening occurred in none of the patients. Implant survival with revision for any reason as endpoint was 97.8% (95% CI 100-96%) and 95.6% (95% CI 100-94%) with reoperation of any cause as endpoint. Radiolucent lines were detected in a total of eight cases (8.8%) and disappeared within the first year after surgery in five cases. Total Range of Motion improved significantly from 106° ± 15° preoperatively to 118° ± 10° at final FU (p < 0.001). All investigated scores improved significantly after total knee arthroplasty. CONCLUSION: The results of this study reveal excellent mid-term performance of a cementless deep dish rotating platform total knee implant, with no component loosening, very low overall revision rate, only temporarily present radiolucent lines in a minority of patients and excellent clinical results. Therefore, cementless total knee arthroplasty is an appropriate treatment option for patients with severe osteoarthritis of the knee. LEVEL OF EVIDENCE: Level II (prospective cohort study).

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis.

INTRODUCTION: Osteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity. The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France). MATERIAL AND METHODS: In this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. RESULTS: At a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint. CONCLUSION: This study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.