J Orthopaed Traumatol (2011) 12:131–136 DOI 10.1007/s10195-011-0142-2 O R I G I N A L A R T I C L E Cemented ﬁxed-bearing PFC total knee arthroplasty: survival and failure analysis at 12–17 years A. Bistolﬁ • G. Massazza • F. Rosso • D. Deledda • V. Gaito • F. Lagalla • C. Olivero • M. Crova Received: 7 March 2011 / Accepted: 25 May 2011 / Published online: 23 June 2011 The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Background Total knee arthroplasty (TKA) is the appropriate treatment for degenerative pathology of the knee. Implant surveillance is mandatory to improve clinical results. We present the long-term results of a series of consecutive TKA Press Fit Condylar (J&J), cemented ﬁxed bearing with selective patellar resurfacing in nonselected patients. Materials and methods In this prospective case series, 223 TKA were clinically and radiographically evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society Roentgenographic Evaluation and Scoring System. Results There were 197 patients, with an average age of 68.4 years [95% conﬁdence interval (CI) 52.7–84.1 years]; 49 arthroplasties were implanted in men (21.1%) and 184 (78.9%) in women. The average follow-up was approxi- mately 13.5 years (162.1 months; 95% CI 132.3–191.9), and it was possible to evaluate 179 implants (76.8% of the implanted prosthesis) in 176 patients. The average HSS score increased from 61.5 (95% CI 60.4–62.7) to 89.4 (95% CI 87.7–.93.5) points. The cumulative average sur- vival rate at 15 years (the endpoint being failure with A. Bistolﬁ G. Massazza F. Lagalla C. Olivero M. Crova Department of Orthopedics and Traumatology, CTO/M. Adelaide Hospital, Turin, Italy A. Bistolﬁ G. Massazza F. Rosso D. Deledda V. Gaito M. Crova Department of Orthopedics and Traumatology, University of the Studies of Turin, Turin, Italy A. Bistolﬁ (&) c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Turin, Italy e-mail: alessandro.bistolﬁ@cto.to.it revision) was 90.6% ± 2% standard deviation. Resurfac- ing the patella did not make a difference in terms of implant survival. Progressive radiolucent lines were observed around 20 implants (14.3%); all were revised. Conclusions The PFC system is an excellent prosthetic solution. Early clinical complications, mechanical axis and patellar resurfacing do not correlate with implant failure, whereas progressive radiolucent lines do. Keywords Total knee arthroplasty Failure analysis Long-term survival Introduction Total knee arthroplasty (TKA) is the appropriate treatment for degenerative pathology of the knee. Among many existing implants, the Press Fit Condylar (PFC) total knee prosthesis (Johnson & Johnson, Raynham, MA, USA) was introduced in the 1980s to obtain a long-term, strong interface between prosthesis and bone. Despite the sub- sequent introduction of rotating and uncemented implants [1–3], the cemented models with a ﬁxed bearing still rep- resent the gold standard, with good results and survival reported beyond 10 years [4, 5]. Nevertheless, the primary reason for TKA failure is still not clear, and several problems such as malalignment, wear, loosening, infec- tions, unexplainable persistent pain, etc. have been observed. In addition, it is still a subject of debate whether or not patella resurfacing should be performed. Therefore, long-term prospective surveillance of the implants and analysis of the causes of failure are still of interest to knee surgeons. In this study, we analysed a series of cemented TKA, with a ﬁxed bearing and selective patellar resurfac- ing, in nonselected patients operated randomly by different 123