Elsevier

The Journal of Arthroplasty

Volume 26, Issue 8, December 2011, Pages 1145-1148
The Journal of Arthroplasty

The Natural History of Anterior Knee Pain in 2 Posterior-Stabilized, Modular Total Knee Arthroplasty Designs

https://doi.org/10.1016/j.arth.2010.12.013Get rights and content

Abstract

Anterior knee pain (AKP) has been a persistent complaint after total knee arthroplasty; however, the natural course of this complaint has not been fully investigated. This is a 10-year follow-up report of a prospective, randomized study between the Insall-Burstein II (Zimmer, Warsaw, IN) and the Press Fit Condylar Modular (Johnson & Johnson, Raynham, MA) knees. Up to one third of total knee arthroplasties will experience mild to moderate AKP at 1-year follow-up, which will persist in approximately 30% of these previously symptomatic knees at 10-year follow-up. New-onset AKP will develop in approximately 10% of previously asymptomatic knees.

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Material and Methods

Two hundred fifteen patients (320 knees) were initially enrolled by 3 surgeons (CSR, TPS, REW) between November 1990 and June 1993 after approval of the institutional review board. The patients were randomized to receive either the IB II or the PFC Modular implant. The surgical procedure included the standard medial parapatellar approach with patellar resurfacing. All components were cemented. All patient-derived outcomes were assessed using a patient administered questionnaire (PAQ) and a

Results

At the final follow-up (mean, 10 ± 0.5 years), 45 patients were deceased and 111 patients were lost to follow-up or refused to participate, leaving 59 patients (80 knees) for final analysis (Table 1). The IB II group (27 patients, 36 knees) included 20 females and 7 males all with diagnosis of osteoarthritis. The mean average age was 72 ± 8.3 years (range, 58-81 years). The mean postoperative KSS and KSFS were 94 and 78, respectively. The mean ROM at 10-year follow-up was 113°. The PFC Modular

Discussion

Limited data exist regarding the incidence and natural history of AKP after TKA. The current study is a prospective, randomized trial that was initiated to investigate the incidence of AKP between 2 implants, IB II and PFC Modular. Both implants are posterior-stabilized and have evolved from the total condylar prosthesis 4, 7, 8, 9. However, the IB II has a shallow, less congruent trochlear groove and a more boxy lateral profile (Fig. 2, Fig. 3). It was thought these features were at least

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    Citation Excerpt :

    The patellar score was previously defined by Feller et al [24], which has a maximum of 30 points, allocating for maximum 15 points for AKP, and 5 points for each of quadriceps strength, ability to rise from a chair, and stair-climbing. The intensity of self-reported AKP was defined using the VAS with a continuous score from 0 to 100 to determine the level of pain [25,26]. Score of 0-10 was defined as no pain, 20-40 as mild pain, 50-70 as moderate pain, and greater than 70 as severe pain [25].

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The Conflict of Interest statements associated with this article can be found at doi:10.1016/j.arth.2010.12.013.

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