The Bisurface Total Knee Replacement: A Unique Design for Flexion Four-to-Nine-Year Follow-up Study* Prospective multi-centre study on a composite ceramic femoral component in total knee arthroplasty: Five-year clinical and radiological outcomes. Ceramic-on-ceramic total hip arthroplasty: update. Clinical results of posterior cruciate ligament retaining TKA with alumina ceramic condylar prosthesis: comparison to Co–Cr alloy prosthesis Total knee arthroplasty with an oxidised zirconium femoral component: ten-year survivorship analysis. Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. A randomized trial of ceramic-on-ceramic bearing versus ceramic-on-crossfire-polyethylene bearing in total hip arthroplasty: five-year outcomes. Staged bilateral mobile-bearing and fixed-bearing total knee arthroplasty in the same patients: a prospective comparison of a posterior-stabilized prosthesis THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial Comparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty. A randomised prospective evaluation of ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearings in the same patients with primary cementless total hip arthroplasty Oxidized zirconium femoral component for TKA: a follow-up note of a previous report at a minimum of 10 years. Long-term comparison of mobile-bearing vs fixed-bearing total knee arthroplasty. Second-Generation Cementless Total Hip Arthroplasty: Eight to Eleven-Year Results Large-diameter Delta ceramic-on-ceramic versus common-sized ceramic-on-polyethylene bearings in THA. Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. Problems With Cementless Total Knee Arthroplasty at 11 Years Followup Conventional versus computer-navigated TKA: a prospective randomized study An 11- to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty: pivot knee arthroplasty. Kinematic total knee arthroplasty: a 10- to 14-year prospective follow-up review. Zirconia versus Co-Cr Femoral Heads in Total Hip Arthroplasty: Early Assessment of Wear Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study.
Background : The Bisurface knee prosthesis was design ed in 1989 to improve knee flexion without affecting the durability of the prosthesis . The prosthesis has a unique ball- and -socket joint in the midposterior portion of the femoral and tibial components , which functions as a posterior stabilizing cam mechanism and causes femoral rollback . The femoral component was made of alumina ceramic . The purpose of this study was to review the clinical results of the first 223 arthroplasties performed with this prosthesis in order to assess whether this new implant had achieved its design objectives . Methods : From December 1989 to May 1994 , all patients who were scheduled for primary total knee arthroplasty were enrolled in a prospect i ve study of the Bisurface knee . The patients were evaluated clinical ly according to The Hospital for Special Surgery knee-rating system and with a self-administered question naire , and they were evaluated radiographically according to the system of the Knee Society . Kaplan-Meier survivorship analysis was performed with revision of the knee or recommendation for revision as the end point . Results : One hundred and sixty-six patients treated with a total of 223 consecutive primary total knee arthroplasties were enrolled in the study , and 182 knees were followed for 3.9 to 9.0 years ( mean , 5.8 years ) . Preoperatively , the mean Hospital for Special Surgery knee score was 44.5 points . At the time of latest follow-up , the mean knee score was 86.3 points . The mean preoperative and postoperative ranges of flexion were 119 and 124 degrees , respectively . The patients , even those with a good preoperative range of motion , rarely lost deep flexion of the knee after the procedure . A revision operation was performed in eight knees ( because of infection in five , instability in two , and breakage of the peg of the patellar component in one ) . Two knees had recurrent medial-lateral subluxations of the femorotibial articulation , which were treated nonoperatively . No prosthesis had loosened aseptically and no alumina ceramic femoral component had broken by the time of latest follow-up . The rate of survival of the implant was 94 percent ( 95 percent confidence interval , 90 to 98 percent ) at six years . According to the patient question naires , 20 percent of the knees sometimes felt loose in daily living activities , which prompted us to improve the intrinsic stability of the prosthesis by improving the congruity of the ball- and -socket joint . Conclusions : Total knee arthroplasty with the Bisurface prosthesis result ed in an excellent range of motion and a high level of satisfaction with the operation ; the durability of the prosthesis is promising BACKGROUND Enhanced wear resistance of ceramics in general and improved mechanical characteristics of composite ceramics in terms of strength and resistance meet the dem and s for application in TKA . The aim of this prospect i ve international multi-centre study was to evaluate the 5-year clinical and radiological outcomes of an unconstrained TKA with a composite ceramic femoral component . METHODS A total of 107 patients ( 109 knees ) underwent TKA with the MULTIGEN-PLUS Ceramic Knee at seven centres in three European countries .  Clinical and radiological assessment s were performed preoperatively and postoperatively at 3 , 12 , 24 and 60 months , using HSS , WOMAC , SF-36 and st and ardised radiographs . RESULTS Mean HSS and WOMAC increased significantly from 55.1±11.5 ( 21 - 83 ) and 48.1±16.6 ( 3 - 90 ) preoperatively to 85.6±9.6 ( 49 - 98 ) and 73.3±20.4 ( 17 - 100 ) at 60 months . Mean SF-36 showed significant improvements in patients ' quality of life ( 49.1±17.6 ( 12 - 96 ) preoperatively versus 67.7±23.1 ( 12 - 100 ) at 60 months ) . Non-progressive radiolucent lines ( < 1 mm ) were observed around the femoral component in four cases . Neither implant migration nor loosening were registered . Kaplan-Meier survivorship was 96.0 % at 60 months ( 92.1 - 100 % , CI 95 % ) . CONCLUSIONS Five-year implant survival rate of the ceramic knee is comparable to other metallic and ceramic unconstrained TKA systems . Although the assessment of long-term implant survivorship is still pending , the ceramic implants represent a promising solution for patients with allergies against metallic components and furthermore for the general osteoarthritis population due to enhanced wear resistance This prospect i ve , r and omized , multicenter study of alumina ceramic-on-alumina ceramic bearing couples includes 452 patients ( 475 hips ) . Their average age was 53 years with approximately two thirds men and 82 % with osteoarthritis . At an average 8-year follow-up , clinical results were excellent and cortical erosions significantly less than in the conventional polyethylene-on-metal bearing group . Nine hips have undergone revision of one or both components for any reason . Of the 380 ceramic liners , 2 ( 0.5 % ) have fractured requiring reoperation , and 3 ( 0.8 % ) ceramic patients reported a transient squeaking sound , one of which had a head and liner change due to groin pain secondary to psoas tendinitis at 5 years . With no revisions for aseptic loosening and minimal cortical erosions , alumina-ceramic bearing couples are performing in a manner superior to the polyethylene-on-metal bearing in this young , active patient population In a prospect i ve study , 194 knees undergoing total knee arthroplasty ( 110 knees with alumina ceramic prostheses ; 84 knees with Co – Cr alloy prostheses )  were clinical ly and radiologically evaluated . Average follow-up period was 66 months ( 36–124 months ) . Average age at the time of surgery was 66 years . In the ceramic prostheses , two revision surgeries were performed because of breakage of the tibial tray and late infection , whereas two revisions of the Co – Cr alloy prostheses were carried out due to loosening and late infection . In the other patients , there were no significant differences in clinical parameters ( HSS knee score and range of motion ) between the two prostheses . In radiological evaluation , we could not find any radiolucent lines around the femoral ceramic component while radiolucency was present in three knees ( 3.6 % ) around the Co – Cr femoral component . Beneath the tibial tray , three knees ( 2.7 % ) showed a radiolucent line around the former prosthesis while eight knees ( 9.5 % ) demonstrated a radiolucent line around the latter prosthesis . Chi-square tests showed a significant difference in the occurrence of radiolucent line around both of the femoral and tibial prosthesis . This study demonstrated that clinical results of the alumina ceramic PCL retaining total knee prosthesis are comparable to the st and ard Co – Cr alloy PCL retaining total knee prosthesis . Although we could not draw any conclusions regarding the superiority of the ceramic prosthesis with respect to UHMWPE wear and long-term survivorship , this report encouraged a long-term follow-up study on ceramic prostheses AIMS Oxidised zirconium was introduced as a material for femoral components in total knee arthroplasty ( TKA ) as an attempt to reduce polyethylene wear . However , the long-term survival of this component is not known . METHODS We performed a retrospective review of a prospect ively collected data base to assess the ten year survival and clinical and radiological outcomes of an oxidised zirconium total knee arthroplasty with the Genesis II prosthesis . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and a patient satisfaction scale were used to assess outcome . RESULTS A total of 303 consecutive TKAs were performed in 278 patients with a mean age of 68 years ( 45 to 89 ) . The rate of survival ten years post-operatively as assessed using Kaplan-Meier analysis was 97 % ( 95 % confidence interval 94 to 99 ) with revision for any reason as the endpoint . There were no revisions for loosening , osteolysis or failure of the implant . There was a significant improvement in all components of the WOMAC score at final follow-up ( p < 0.001 ) . The mean individual components of the KOOS score for symptoms ( 82.4 points ; 36 to 100 ) , pain ( 87.5 points ; 6 to 100 ) , activities of daily life ( 84.9 points ; 15 to 100 ) and quality of life ( 71.4 points ; 6 to 100 ) were all at higher end of the scale . DISCUSSION This study provides further supportive evidence that the oxidised zirconium TKA gives comparable rates of survival with other implants and excellent functional outcomes ten years post-operatively . TAKE HOME MESSAGE Total knee arthroplasty with an oxidised zirconium femoral component gives comparable long-term rates of survival and functional outcomes with conventional implants Ceramic-on-ceramic coupling is thought to be a durable alternative to metal- or alumina-on-polyethylene pairing . No evidence exists suggesting superior clinical and radiological results for hydroxyapatite-coated stems versus uncoated stems . The aim of this study is to report the performance of an alumina-on-alumina bearing  cementless total hip arthroplasty and to compare stems with a tapered design with and without hydroxyapatite coating . We prospect ively analysed the results of  cementless tapered femoral stems ( 40 hydroxyapatite-coated versus 22 uncoated stems ) , a metal-backed fibre mesh hydroxyapatite-coated socket and alumina-on-alumina pairing .  Of 75 hips studied , 62 were available for follow-up ( mean of 10.5 years after surgery ) . The average Harris hip score was 90 . Only one hydroxyapatite-coated stem was revised for aseptic loosening . One instance of non-progressive osteolysis was detected around a screw of a cup . All other components showed radiographic signs of stable ingrowth .  Hydroxyapatite coating of the stem had no significant impact on the clinical or radiological results . Total hip arthroplasty with the presented implant and pairing provides a durable st and ard for all patients requiring hip joint replacement against which all newer generations of cementless implants should be judged BACKGROUND Early reports on modern  ceramic-on-ceramic total hip replacements  have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure , which , in the case of earlier design s , often had been caused by implant fracture . Several reports , however , have noted the presence of audible squeaking . The purpose of the present study was to determine the incidence of squeaking in association with the use of this bearing couple . METHODS During the period from March 2003 to May 2005 , three surgeons performed 159 total hip arthroplasties in 143 patients with use of a ceramic-on-ceramic bearing . One hundred and forty-nine hips ( 131 patients ) were available for review after at least one year of follow-up . These patients were followed prospect ively with use of the modified Hospital for Special Surgery hip score and a patient-administered question naire . Additionally , a control group of sixty hips ( forty-eight patients ) with a metal-on-polyethylene bearing  was matched to the ceramic group on the basis of age , sex , and body mass index to compare the incidence of squeaking and other noises . Radiographic evaluations were performed according to previously established criteria . RESULTS Fourteen ( 10.7 % ) of 131 patients described an audible squeak during normal activities . However , squeaking was reproducible clinical ly in only four patients , and only one patient complained of squeaking before being presented with the question naire . The average Hospital for Special Surgery score improved from 19.8 preoperatively to 38.4 at the time of the latest follow-up , indicating excellent clinical results . Ninety-five percent of the patients had a satisfaction score of > or = 8 of 10 . Three hips dislocated . One of those three hips squeaked and was revised because of recurrent dislocations . One patient was considering revision because of squeaking . In the matched metal-on-polyethylene cohort , there were no cases of squeaking . CONCLUSIONS The squeaking hip is a phenomenon that is unique to total hip replacements with hard-on-hard bearings . The incidence of squeaking in association with ceramic-on-ceramic bearings may be higher than previously reported as < 1 % of the patients in the present study reported this finding before being queried . The causes and implication s of squeaking are yet to be determined . The use of hard-on-hard bearings offers many advantages in terms of wear reduction , especially for young and active patients . Nonetheless , patients considering ceramic-on-ceramic bearings should be counseled with regard to this phenomenon This study determined how ceramic-on-ceramic bearing THA affected joint-specific pain , function and stiffness in the first five postoperative years compared with ceramic-on-highly-crosslinked-polyethylene bearing THA .  Subjects less than 61 years of age were r and omized  to ceramic-on-ceramic ( CERAMIC ) [ n = 48 ] or ceramic-on-highly-crosslinked-polyethylene ( POLYETHYLENE ) [ n = 44 ] bearing THA . Subjects were assessed using the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) and the R AND 12-Item Health Survey ( R AND -12 ) preoperatively , and at one and five years postoperatively . 92 subjects(50 ( 54 % ) males ; average age = 52 ( SD 6.6 ) years ) were enrolled . 78 ( 85 % ) subjects returned five years postoperatively . All subjects reported improvements at one and five years in all measured indices with no group differences detected . Seven ( 8 % ) subjects experienced postoperative THA complications , none related to bearing surfaces ; two subjects ( POLYETHYLENE ) required revision for instability . Both bearing surfaces provided excellent short-term results in younger subjects Mobile-bearing total knee arthroplasty ( TKA ) has several theoretical advantages over fixed-bearing TKA . We conducted a prospect i ve r and omized trial to compare the results of mobile-bearing and fixed-bearing posterior-stabilized TKA in the same patients using the same femoral component design of a mobile-bearing prosthesis in one knee and a fixed-bearing prosthesis in the other knee in 25 patients with osteoarthritis . The mean follow-up was 40 months . No significant differences were found in the mobile-bearing and fixed-bearing knees in terms of clinical and radiographic results . No osteolysis , loosening , or revision occurred . One knee with a mobile-bearing prosthesis had a dislocation of the rotating bearing ; however , spontaneous reduction occurred and the dislocation did not recur . Satisfactory early results can be achieved in both mobile-bearing and fixed-bearing knees . We could not demonstrate an advantage of a mobile-bearing TKA Although the published studies on the outcomes of  total hip arthroplasty (  THA ) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup , concern over ceramic fracture and squeaking persist . For these reasons , the use of ceramic is limited . Recently , a new alumina matrix composite material ( Delta ceramic ) with improved material properties was developed to address these concerns . We report the early outcomes and complications of a prospect i ve , r and omized , multicenter trial of 263 patients ( 264 hips ) at eight centers , comparing a Delta ceramic-on-ceramic ( COC ) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination ( COP ) . There were 177 COC hips and 87 COP hips . Complications  were reported for all patients , whereas  clinical and radiographic results were provided for the 233 patients with minimum 2-year followup ( average , 31.2 months ; range , 21–49 months ) . The Harris hip scores and clinical , radiographic , and survivorship outcomes were similar in both groups . There were four ( 2 % ) revisions in the COC group and two ( 2 % ) in the COP group . We encountered three intraoperative ceramic liner-related events . In addition , one patient receiving the COC underwent revision for chipping of the ceramic liner , and a second had ceramic fragmentation on followup radiographs but has not undergone revision . These liner related complications remain a concern . No patient reported squeaking in either group ; this leaves us hopeful the new material will lessen the frequency of squeaking . In the short term , the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene . Level of Evidence : Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The results of a prospect i ve multicenter trial comparing 357 hips r and omized to total hip arthroplasty with either ceramic-ceramic or ceramic-polyethylene couplings  are presented . No statistically significant difference in clinical outcomes scores between the ceramic-ceramic and ceramic-polyethylene groups was observed at any time interval . The mean linear rate was statistically lower ( P < .001 ) in the ceramic-ceramic group ( 30.5 μm/year ) when compared with the ceramic-polyethylene group ( 218.2 μm/year ) . The rates of ceramic implant fracture ( 2.6 % ) and audible component-related noise ( 3.1 % ) were statistically higher in the ceramic-ceramic group when compared with the ceramic-polyethylene group ( P < .05 ) . Lastly , there was no statistically significant difference in the dislocation or revision rate between the groups at the time of last clinical follow-up Purpose Very few studies have compared alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings in the same patient . The purpose of this prospect i ve r and omised study was to compare the clinical and radiographic results and the prevalence of osteolysis in cementless total hip arthroplasty using an alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings in young active patients . Methods We prospect ively compared the results of 100 patients ( 200 hips ) who had undergone a cementless total hip arthroplasty with an alumina-on-alumina ceramic bearing in one hip and an alumina-on-highly cross-linked polyethylene in the other . There were 66 men and 34 women with a mean age of 45.3 years ( range , 21–49 years ) at the time of surgery . The mean follow-up was 12.4 years ( range , 11–13 years ) . The patients were assessed clinical ly and radiographically at three months , one year , and annually thereafter . Results Harris hip , Western Ontario and McMaster Universities Osteoarthritis Index , and University of California , Los Angeles activity scores did not show statistically significant differences between the two groups of bearings preoperatively or at the time of final follow-up . Radiographic findings of the component were not significantly different between the two groups . The mean polyethylene linear penetration was 0.031 ± 0.004 mm per year . No hips in either group displayed osteolysis . The Kaplan-Meier survivorship with revision as the end point at 12.4 years was 100 % ( 95 % confidence interval [ CI ] , 94–100 % ) for the femoral component in both groups and 99 % ( 95 % CI , 93–100 % ) for the acetabular component . Conclusion The clinical and radiographic results of using an alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings were similar BACKGROUND New bearing surfaces for  total knee replacement  have been described in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants .  Oxidized zirconium is a new material that combines the strength of a metal with the wear properties of a ceramic . However , there are no reports as to who documents the long term results . We report a 10 year follow-up note of a selected series of TKAs with an oxidized zirconium femoral component . METHODS We prospect ively follow 98 TKAs performed in 94 patients with an oxidized zirconium femoral component . Five patients ( 5 knees ) had died and 6 ( 6 knees ) were lost to follow-up at a minimum of 2 years ( mean , 6.3 years ; range , 2 - 9 years ) after the operation . For the remaining 83 patients ( 87 knees ) , the minimum follow-up was 10 years ( mean , 11.3 years ; range , 10.0 - 12.6 years ) . In 51 cases ( 58.6 % ) , a cruciate-retaining implant with a deep-dished , more conforming PE was used , and in 36 cases ( 41.4 % ) , a posterior-stabilized design was used . The patellae were resurfaced in 32 cases ( 36.7 % ) and in 55 cases ( 63.3 % ) were left unresurfaced . RESULTS Survivorship was 97.8 % at 10 years postoperatively . Two knees were revised for aseptic loosening of the femoral component . No major complication was observed clinical ly or radiologically . Mean Knee Society score improved from 36 to 84 and functional score from 37 to 83 . CONCLUSIONS Oxidized zirconium femoral component in TKA performs well over the first 10 years following implantation , with excellent survival rates and good clinical and radiological outcomes . LEVEL OF EVIDENCE Level IV , therapeutic study Few published reports have been published regarding a comparison of the long-term outcomes between mobile- ( MB ) and fixed-bearing component design s for knee arthroplasty . The minimum 10-year clinical and radiologic follow-up of an unselected consecutive series of 89 patients ( 107 knees ) who were r and omized to have one of these different design s for primary arthroplasty was done . Twenty-six patients ( 30 knees ) who had a fixed-bearing design and 24 patients ( 33 knees ) who had an MB prosthesis were available for follow-up . Two MB knees were revised for aseptic loosening of a tibial component in one and femoral component fracture in the other . In patients who did not have revision surgery , there were no differences between the groups with respect to mean Knee Society scores , knee flexion , or pain scores Background : Second-generation cementless femoral components were design ed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces . We examined the eight to eleven-year results of total hip arthroplasty with a cementless , anatomically design ed femoral component and a cementless hemispheric acetabular component . Methods : Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating ( Anatomic Hip ) and a cementless hemispheric porous-coated acetabular component ( Harris-Galante II ) were performed in eighty-five patients . These patients were prospect ively followed clinical ly and radiographically . Six patients ( seven hips ) died and five patients ( seven hips ) were lost to follow-up , leaving seventy-four patients ( seventy-eight hips ) who had been followed for a mean of ten years ( range , eight to eleven years ) . The mean age at the time of the arthroplasty was fifty-two years . Results : The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up ; 86 % of the hips had a good or excellent result . Thigh pain was reported as mild to severe after seven hip arthroplasties . No femoral component was revised for any reason , and none were loose radiographically at the time of the last follow-up . Two hips underwent acetabular revision ( one because of dislocation and one because of loosening ) . Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point . The ten-year survival rate was 96.4 % ± 2.1 % for the total hip prosthesis , 100 % for the femoral component , and 96.4 % ± 2.1 % for the acetabular component . Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight ( 93 % ) of the -seventy-three hips with complete radiographic follow-up . Femoral osteolysis proximal to the lesser trochanter was noted in four hips ( 5 % ) . No osteolysis was identified distal to the lesser trochanter . Periacetabular osteolysis was identified in twelve hips ( 16 % ) . Five patients underwent exchange of the acetabular liner because of polyethylene wear . Conclusions : This second-generation cementless , anatomically design ed femoral component provided excellent clinical and radiographic results with a 100 % survival rate at ten years . The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty The higher failure rate of total hip arthroplasty ( THA ) in young , active patients remains a challenge for surgeons . Recently , larger-diameter femoral heads combined with an alumina matrix composite ceramic ( BIOLOX Delta ; CeramTec AG , Plochingen , Germany ) articulation was developed to improve implant longevity and meet patients ' activity dem and s while reducing the risk of component-related complications . The purpose of this study was to determine whether this new device may provide advantages for young , active patients . A prospect i ve , r and omized , controlled trial was conducted on 93 patients ( 113 THAs ) with more than 3 years of follow-up . Patients were r and omly divided into a study group ( 51 THAs ) with a 36-mm Delta ceramic-on-ceramic ( COC ) articulation and a control group ( 62 THAs ) with a common-sized alumina ceramic head on polyethylene liner ( COP ) articulation .  Clinical and radiographic results were collected to compare the outcomes and complications , including implant-related failures , osteolysis , and noises . The large-diameter Delta COC articulation provided greater range of motion improvement ( 6.1 ° more ) , similar Harris Hip Scores , and similar complication rates compared with the alumina COP articulation . This study suggests that in the short term , the large-diameter Delta COC articulation results in better range of motion with no higher complication rates ; however , mid-term ( 8 - 10 years ) or longer follow-up is necessary to determine its superiority in young , active patients Fifty-five total knee arthroplasties ( TKAs ) in thirty-nine adult ( mean age , 62 years ) patients with rheumatoid arthritis were studied prospect ively for a period of 1 - 7 years . All of the procedures were performed using cementless fixation of the tibial and femoral components . The Knee Society clinical rating system mean knee scores increased 56 points after operation ( mean , 88 points ) , and the mean functional scores increased 28 points ( mean , 64 points ) . Two revisions ( 4 % ) have been required , one for secondary late infection and one for failure of a cementless metal-backed patellar component . Good bone stock was retained in both , allowing for uneventful cementless revision . Forty-two arthroplasties ( 76 % ) were completely pain-free , twelve ( 22 % ) had mild , occasional discomfort with weight-bearing , and one ( 2 % ) had moderate pain at last examination . In this older rheumatoid population , cementless TKA offers good or excellent early clinical results and excellent preservation of bone stock should revision become necessary One hundred two patients with 131 consecutive cementless total knee arthroplasties that retained the posterior cruciate ligament were followed up prospect ively . The average age of the patients was 58 years ( range , 32–75 years ) . The mean followup on the surviving knee arthroplasties was 11 years ( range , 7–16 years ) . The patellar component was metal-backed in the first 112 ( 85 % ) knees , cementless all-polyethylene in the last 17 ( 13 % ) knees , and two knees had a prior patellectomy . Forty-four metal-backed patellar components ( 48 % ) were revised ; nine were loose , and 35 had polyethylene wear through . Thirteen femoral components ( 12 % ) were revised because of femoral abrasion from a failed metal-backed patellar component . No other femoral component was revised , loose , or had osteolysis develop . Nine ( 8 % ) tibial components had failure of ingrowth ; eight have been revised . Partial radiolucencies occurred in 53 % of the tibias . Thirteen ( 12 % ) small osteolytic lesions developed , all around screws or screw holes in the tibial components . At an average of 11 years followup , cementless fixation yielded mixed results : cementless femoral fixation was excellent and metal-backed patellar components had a 48 % patellar revision rate . Cementless tibial components had an 8 % aseptic loosening rate and a 12 % incidence of small osteolytic lesions . Based on these results , the authors have ab and oned cementless fixation in total knee arthroplasty Purpose The purpose of this study was to assess the midterm results of total knee arthroplasty ( TKA ) implanted with  a specific computer navigation system in a group of patients ( NAV ) and to assess the same prosthesis implanted with the conventional technique in another group ( CON ) ; we hypothesized that computer navigation surgery would improve implant alignment , functional scores and survival of the implant compared to the conventional technique . Methods From 2008 to 2009 , 225 patients were enrolled in the study and r and omly assigned in CON and NAV groups ; 240 consecutive mobile-bearing ultra-congruent score ( Amplitude , Valence , France ) TKAs were performed by a single surgeon , 117 using the conventional method and 123 using the computer-navigated approach .  Clinical outcome assessment was based on the Knee Society Score ( KSS ) , the Hospital for Special Surgery Knee Score and the Western Ontario Mac Master University Index score . Component survival was calculated by Kaplan – Meier analysis . Results Median follow-up was 6.4 years ( range 6–7 years ) . Two patients were lost to follow-up . No differences were seen between the two groups in age , sex , BMI and side of implantation . Three patients of CON group referred feelings of instability during walking , but clinical tests were all negative . NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis , lateral distal femoral angle , medial proximal tibial angle and tibial slope in post-operative radiographic assessment . There was one case of early post-operative superficial infection ( caused by Staph . Aureus ) successfully treated with antibiotics . No mechanical loosening , mobile-bearing dislocation or patellofemoral complication was seen . At 7 years of follow-up , component survival in relation to the risk of aseptic loosening or other complications was 100 % . There were no implant revisions . Conclusion This study demonstrates superior accuracy in implant positioning and statistical significant better functional outcomes of computer-navigated TKA . Computer navigation for TKAs should be used routinely in primary implants . Level of evidence II AIMS The Advance Medial-Pivot total knee arthroplasty ( TKA ) was design ed 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 . PATIENTS AND METHODS We retrospectively evaluated prospect ively 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 . CONCLUSION This study demonstrates satisfactory functional and radiographic long-term results for this implant . Cite this article : Bone Joint J 2016;98-B:1050 - 5 To underst and better the type and incidence of long-term complications in  total knee replacement , 306 primary Kinematic total knee arthroplasties performed between June 1978 and December 1982 were prospect ively review ed in detail . The Kinematic knee is a nonconstrained , posterior cruciate-retaining prosthesis that has right and left femoral components to afford anatomic tracking of the patella . The overall revision rate was 6.5 % . The most common cause for revision surgery was patellar complications . Ten revisions ( 3.06 % ) were for patellar component loosening . Two knees were revised for patella subluxation ( 0.65 % ) ; 1 was in a resurfaced rheumatoid patella , and 1 in an unsurfaced osteoarthritic patella . Stair climbing was better with an unsurfaced patella . Anterior knee pain was 21.8 % in the unsurfaced patella and 11.2 % in the replaced patella . These data suggest patella replacement is not appropriate with this design Polyethylene wear and associated osteolysis are major limitations to the long-term success of total hip arthroplasty . In vitro laboratory studies suggest polyethylene wear in THA may be substantially reduced with ceramic femoral heads . We evaluated the potential value of zirconia ceramic on conventional polyethylene as an “ alternative bearing ” for total hip arthroplasty in a prospect i ve , r and omized clinical trial in comparison with femoral heads made of Co-Cr-Mo . Patients were evaluated with st and ardized clinical outcome instruments , and measurement of head penetration was performed with computerized wear measurement software .  Study enrollment was halted because of a recall of the zirconia heads .  At that time , 30 total hip arthroplasties with Co-Cr-Mo heads and 30 total hip arthroplasties with zirconia heads had been performed . Mean followup was similar for both groups ( Co-Cr-Mo = 51.7 months ; zirconia = 51.2 months ) . The mean annual head penetration rate was low and similar for both groups ( Co-Cr-Mo = 0.060 mm/year ; and zirconia = 0.055 mm/year ) . In view of the recently reported potential for zirconia ceramics to undergo monoclinic phase transformation in vivo , with result ant increased fracture risk and degradation of wear properties , we do not recommend use of zirconia femoral heads as an “ alternative bearing ” for total hip arthroplasty . Level of Evidence : Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND High-flexion total knee arthroplasty was introduced to meet the dem and s of daily activity requiring increased knee flexion . However , concerns have been raised regarding the fixation of high-flexion total knee arthroplasty components and increased rates of loosening have been reported . To date , migration , and thus fixation , of high-flexion total knee arthroplasty components has not been analyzed and the preferential bearing type ( mobile or fixed ) is unknown . METHODS Of eighty-six consecutive eligible patients , seventy-four patients ( seventy-eight knees ) scheduled for total knee arthroplasty were r and omized to one of four  Legacy Posterior Stabilized ( LPS ) total knee prosthesis design s : ( 1 ) LPS-Flex mobile , ( 2 ) LPS-Flex fixed , ( 3 ) LPS mobile , and ( 4 ) LPS fixed . The primary outcome was component migration measured with use of Roentgen stereophotogrammetric analysis , and secondary outcomes were postoperative knee flexion and extension and Knee Society Score . Patients were evaluated postoperatively at six , twelve , twenty-six , and fifty-two weeks and annually thereafter . At the five-year follow-up , eight patients had died and two patients were lost to follow-up . Seventy-seven tibial and forty-two femoral components were suitable for migration measurements . RESULTS The overall five-year migration of the seventy-seven tibial components was not significantly different among the four total knee prosthesis design s ( compared with the LPS fixed design , the range of overall mean differences for the other three design s was 0.02 to 0.25 mm ) and migration was comparable at the two and five-year follow-up . Migration stabilized in all but three components ( two LPS-Flex mobile and one LPS fixed ) ; one of these components has already been revised and was aseptically loose . The overall five-year migration of the forty-two femoral components was comparable among the four design s ( compared with the LPS fixed design , the range of overall mean differences for the other three design s was 0.01 to 0.18 mm ) and was similar at two and five years postoperatively . One femoral component ( LPS-Flex mobile ) migrated excessively . In patients who had a mean postoperative flexion of ≥ 125 ° or a maximum flexion of ≥ 135 ° during the one to five-year follow-up period , migration of high-flexion components was comparable with that of conventional components and indicative of appropriate fixation . Postoperative flexion , extension , Knee Society Score , and Knee Society Score function were comparable during the five-year follow-up period and at the two and five-year follow-up . CONCLUSIONS The LPS-Flex total knee prosthesis with either a mobile or a fixed bearing had migration comparable that of with its conventional counterpart and is expected to have similar ( excellent ) long-term survival in these patients . LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
Overall , there was a notable enhancement of joint function after the procedure , with a satisfactory mid- and long-term survival of the ceramic components , which is comparable to that of the conventional alloy components reported previously .
However , revision due to aseptic loosening , wear , and component fracture appeared to be rare , demonstrating the safety of in vivo use of ceramic bearings in the TKA procedure .
Conclusions Ceramic TKA implants show similar post-operative clinical results and survival rate compared to their conventional metallic counterparts .
Our results confirmed the safety of in vivo use of ceramic bearings in TKA , with rare implant breakage and aseptic loosening .
Purpose Ceramic bearings have been widely used in total hip arthroplasty ( THA ) , which result ed in satisfactory clinical outcomes due to the excellent tribological characteristics of the implants .
However , ceramic components are not commonly used in total knee arthroplasty ( TKA ) because of brittleness .
This study aim ed to gather and analyze information regarding the clinical outcomes ( including survival without revision , causes of revision , functional outcome , and incidence of loosening ) and reach a definitive conclusion about the use of ceramic femoral components in total knee arthroplasty .