An 11-to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty PIVOT KNEE ARTHROPLASTY

Aims The Advance Medial-Pivot total knee arthroplasty ( TKA) was designed to reflect contemporary data regarding the kinematics of the knee. We wished to examine the longterm results obtained with this prosthesis by extending a previous evaluation. Patients and Methods We retrospectively evaluated prospectively 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 postoperative 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 degrees ( 85 degrees to 135 degrees) at final follow-up. Conclusion This study demonstrates satisfactory functional and radiographic long-term results for this implant.