Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.118
Peer-review started: October 13, 2023
First decision: December 7, 2023
Revised: December 15, 2023
Accepted: January 9, 2024
Article in press: January 9, 2024
Published online: February 18, 2024
Processing time: 116 Days and 12.3 Hours
Advances in implant material and design have allowed for improvements in total knee arthroplasty (TKA) outcomes. A cruciate retaining (CR) TKA provides the least constraint of TKA designs by preserving the native posterior cruciate liga
To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.
A retrospective, multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System (JOURNEY™ II CR; Smith and Nephew, Inc., Memphis, TN) at an urban, academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon. Patient demographics, surgical information, clinical outcomes, and PROMs data were collected via query of electronic medical records. The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and Patient-Reported Outcomes Measurement Information System (PROMIS®) scores. The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.
Of the 255 patients, 65.5% were female, 43.8% were White, and patients had an average age of 60.6 years. Primary osteoarthritis (96.9%) was the most common primary diagnosis. The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home (92.5%). There were 18 emergency department (ED) visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%, including a 2.4% orthopedic-related ED visit rate and a 4.7% non-orthopedic-related ED visit rate. There were three (1.2%) hospital readmissions within 90 d postoperatively. With a mean time to latest follow-up of 3.3 years, four patients (1.6%) required revision, two for arthrofibrosis, one for aseptic femoral loosening, and one for peri-prosthetic joint infection. There were significant improvements in KOOS JR, PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Mobility, and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.
The evaluated implant is an effective, novel design offering excellent outcomes and low complication rates. At a mean follow up of 3.3 years, four patients required revisions, three aseptic and one septic, resulting in an overall implant survival rate of 98.4% and an aseptic survival rate of 98.8%. The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
Core Tip: This study aimed to assess mid-term clinical and patient-reported outcomes of 255 total knee arthroplasties (TKAs) using a novel, kinematically-designed cruciate retaining total knee arthroplasty implant. With a mean time to follow-up of 3.3 years, there was a high implant survival rate of 98.4%. Four patients (1.6%) required a revision TKA surgery, including three (1.2%) revised for aseptic indications. Patients who received the kinematically-designed cruciate retaining TKA showed significant improvements in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Intensity, PROMIS Pain Interference, PROMIS Mobility, and PROMIS Physical Health.