A 13- to 16-year clinical and radiological outcome study of the genesis II cruciate retaining total knee arthroplasty with an oxidised zirconium femoral component

Purpose: The Genesis II Total Knee Arthroplasty with an oxidized zirconium (OxiniumTM) femoral component (Smith & Nephew, Memphis, TN, USA) was introduced in an attempt to reduce polyethylene wear and osteolysis. Methods: We retrospectively evaluated prospectively collected data from 245 consecutive patients (40 men and 205 women; mean age at surgery 70.1 years, range 44 to 85 years) who underwent 261 TKAs with a mean follow-up of 15.1 years (range 13 to 16 years). Implant failure rate, complication rate, clinical (both subjective and objective) and radiological outcomes were assessed. Results: At final follow-up, 24 (9.8 %) patients (24 TKAs) were lost to follow-up and 35 (14.3%) patients (35 TKAs) had died for reasons unrelated to surgery. Four TKAs, in four patients, were revised because of aseptic loosening. In five TKAs (five patients) secondary patella resurfacing was performed because of patellofemoral pain. Survivorship analysis showed a cumulative success rate of 98.4% (95% CI, 94.3% - 100%) at 15 years with revision for aseptic loosening as an end point, and 95.6% (95% CI, 92.7% - 98.7%) at 15 years with revision for any reason as an end point. All patients showed a statistically significant improvement (p = 0.01) in the Knee Society clinical rating system, WOMAC Score, KOOS Score, Oxford Knee Score and EuroQol 5D Score. Surgery fulfilled patient expectations for 90.1% of patients; in 5.4% it did not, and 4.5% declined to answer. Conclusion: This study demonstrates satisfactory long-term clinical results for this knee design. © 2019 Elsevier B.V

Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head A CASE SERIES INVOLVING 26 HIPS

The introduction of a trabecular tantalum rod has been proposed for the management of early-stage osteonecrosis of the femoral head but serves as a single-point of support of the necrotic lesion. We describe a technique using two or three 4.2 mm (or later 4.7 mm) tantalum pegs for the prevention of collapse of the necrotic lesion. We prospectively studied 21 patients (26 hips) with non-traumatic osteonecrosis of the femoral head treated in this manner. Of these, 21 patients (24 hips) were available for radiological and clinical evaluation at a mean follow-up of 46 months (18 to 67). Radiological assessment showed that only eight hips deteriorated according to the Association Research Circulation Osseous classification, and four hips according to the Classification of the Japanese Investigation Committee of Health and Welfare. Functional improvement was obtained with an improvement in the mean Harris hip score from 65.2 (33.67 to 95) to 88.1 (51.72 to 100), the mean Merle D'Aubigne-Postel score from 13 (6 to 18) to 16 (11 to 18), a mean visual analogue score for pain from 5.2 (0 to 9.5) to 2.6 (0 to 7), and the mean Short-Form 36 score from 80.4 (56.8 to 107.1) to 92.4 (67.5 to 115.7). Of these 24 hips followed for a minimum of 18 months, three were considered as failures at the final follow-up, having required total hip replacement. One of the hips without full follow-up was also considered to be a failure. In more than two-thirds of the surviving hips a satisfactory clinical outcome was achieved with promising radiological findings. The estimated mean implant survival was 60 months (95% confidence interval 53.7 to 66.3)