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Promising short-to-midterm outcomes seen with total stabilizer knee system for revision TKA
Results from this study indicated that at 7-year follow-up, patients who underwent surgery with a new revision total knee arthroplasty system had “excellent” survivorship and good functional results.
“In our results, this implant demonstrated 96% aseptic and 94% all-cause survivorships and patients had excellent reported outcomes (mean postoperative Knee Society score of 86 points and mean flexion range of motion of 106),” Michael A. Mont, MD, told Healio.com/Orthopedics. “The surviving group had no progressive radiolucencies or osteolysis on radiographic evaluation. In conclusion, this revision system may be considered as an excellent option for patients undergoing revision TKA.”
Mont and colleagues identified 93 patients who underwent revision TKA with the Triathlon TS Knee System (Stryker Orthopaedics) for component instability or aseptic loosening. The mean follow-up was 4 years. Kaplan-Meier analysis was used to assess survivorship. The Knee Society Roentgenographic Evaluation and Scoring System was used for radiographic analysis. The Knee Society score (KSS) was used to evaluate clinical outcomes. In addition, range of motion and complications were determined.
Results showed aseptic survivorship and all-cause survivorship were 96% and 94%, respectively. Investigators noted mean KSS was 86 points at final follow-up. The mean functional KSS was 52 points at final follow-up. The mean postoperative extension was 2° and flexion was 106°.
According to researchers, there were three medical complications and 11 surgical complications. There were no progressive radiolucencies or osteolysis seen at the final follow-up. – by Monica Jaramillo
Disclosure: Mont reports he is a board or committee member of the American Academy of Orthopaedic Surgeons; is a paid consultant for Abbott, Cynmedica, Parica, Mallinckrodt Pharmaceuticals, Performance Dynamics Inc., and Sage; is a paid consultant for and receives research support from DJ Orthopaedics, Johnson & Johnson, Ongoing Care Solutions and TissueGene; is on the editorial or governing board for Journal of Arthroplasty, Journal of Knee Surgery, Orthopedics and Surgical Techniques International; receives research support from NIH (NIAMS & NICHD); receives intellectual property royalties from Microport; has stock of stock options for Peerwell; is a paid consultant for and receives research support from Orthosensor; and receives intellectual property royalties, is a paid consultant for and receives research support from Stryker.
Perspective
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The authors are commended for analyzing and reporting the results of their surgeries. Design surgeons are often the first source of information on new implant systems. It has been debated, however, if the results of design surgeons translate to a broader range of users.
The authors identified several limitations of the study including small sample size, retrospective design and length of follow-up. Absent a control group, the reader is left to wonder what the results would be of another revision system used for similar cases by these same experienced surgeons. The inclusion criteria were revision for instability or aseptic loosening. For assessing this new total stabilizer knee, I would have preferred separate analysis and reporting of cases revised instability vs. those revised for aseptic loosening. Although the re-revision rate was low, I would have appreciated a more detailed analysis and reporting of the failures and the retrieved implants. Specifically, did component rotation or rotational constraint contribute to component loosening?