2017 ISAKOS Biennial Congress ePoster #1210

 

Total Knee Arthroplasty in Patients Aged 55 Years and Younger with Osteoarthritis: A Systematic Review and Meta-Analysis

Ciaran McGarvey, MA, MSc, FRCS(Tr&Orth), London UNITED KINGDOM
Ziad Harb, FRCS (Tr&Orth), London UNITED KINGDOM
Fabian Wong, MRCS, MBBS, BSc, London UNITED KINGDOM
Peter Earnshaw, London UNITED KINGDOM
Diane L. Back, FRCS Ed, Chesham, Bucks UNITED KINGDOM
Andrew Davies, FRCS, London UNITED KINGDOM
Adil Ajuied, MBBS, BSc(Hons), MSc, FRCS(Tr&Orth), London UNITED KINGDOM

Guy's and St Thomas' NHS Foundation Trust, Kings Health Partners, London, UNITED KINGDOM

FDA Status Not Applicable

Summary

Excluding implants with design flaws which are now well recognised, TKA in patients under 55 demonstrated excellent survival and functional benefit up to the end of the second decade.

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Abstract

Introduction

TKA in younger patients has been associated with higher rates of failure. Previous reviews have included only Level 4 evidence from cohorts with a variety of pre-operative diagnoses. We aimed to perform a systematic review of outcomes following TKA in patients under 55 with exclusively osteoarthritis (OA) or post-traumatic arthritis (PTOA).

Method

Systematic review of the Cochrane, and PubMed databases according to PRISMA guidelines. Included studies provided demographic, clinical, functional and survival data for patients exclusively under 55 with OA or PTOA. Methodology and quality of reporting were assessed using CONSORT and STROBE guidelines. Studies reporting both pre and post-operative range-of-motion (ROM) and Knee Society Scores (KSS) and were included for meta-analysis.

Results

Thirteen studies (1368 patients) were included in the review. Six cohorts were from individual limbs of PRCTs. Seven cohorts were included in the meta-analysis. Average follow-up was 6.2-25.1 years. Male/female ratio ranged from 4.8/1 (more males) to 1/3.7 (more females), and mean BMI ranged from 25.6 – 33.6. Cumulative survival (end point any revision) was 97%, 96% and 92.1% at 9, 10 and 12 years, 85-97% at 15-18 years and 70.1% at 30 years. Meta-analysis showed mean improvement of 60.5(CI 56.2-64.9) and 45.7(CI 41.0-50.4) in the clinical and functional KSS respectively. The improvement in both clinical and functional KSS was statistically significant. Mean improvement in ROM was 2.4o(CI 0.23-5.0, p=0.07). There were no significant differences between cemented and cementless implants.

Conclusion

Excluding implants with design flaws which are now well recognised, TKA in this patient group demonstrated excellent survival and functional benefit up to the end of the second decade, including in prospective randomized controlled trials. Among modern implants, no design or fixation method offered any advantage. While functional status appears to decline in the third decade, this may be related to other joints or medical co-morbidities and these should be stated as longer follow-up data is reported.