Original article
Five- to 8-Year Results of the Uncemented Duracon Total Knee Arthroplasty System

https://doi.org/10.1016/j.arth.2007.06.002Get rights and content

Abstract

We report prospective clinical and radiographic outcomes of a series of 219 hydroxyapatite-coated Duracon (Stryker Howmedica Osteonics Corporation, Kalamazoo, Mich) total knee arthroplasties with a follow-up of 5 to 8 years. Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and SF-12 Health Status Questionnaire were used. Analysis of fluoroscopic radiographs was performed with the American Knee Society Score. All living patients (186 knees) were followed up. Twenty-eight patients (30 knees) had died. The preoperative Knee Society Score of 43.8 increased to 77.1 and the preoperative Function score of 20.3 increased to 63.4. WOMAC scores showed marked improvement (pain, 250 preoperatively to 157; stiffness, 115 preoperatively to 56; and function, 910 preoperatively to 588). There was no radiographic evidence of loosening or migration. Gaps visible at the bone-implant interface healed over the first year. Three prostheses were revised, 2 for deep infection and 1 for tibial tray subsidence. A survivorship of 98.6% has been achieved at 8 years. This intermediate-term study with 100% follow-up at 8 years demonstrates excellent clinical and radiographic outcomes. It is our opinion that these are comparable to the gold standard cemented total knee arthroplasties and may have advantages over other uncoated cementless designs.

Section snippets

Patients and Methods

Between August 1997 and March 1999, a prospective study was undertaken recruiting a cohort of 219 consecutive primary TKAs in 180 patients using the HA-coated Duracon prosthesis (Stryker Howmedica Osteonics). There were 108 women and 72 men. The indications for surgery were primary osteoarthritis (130 knees), rheumatoid arthritis (27 knees), avascular necrosis (17 knees), and posttraumatic osteoarthritis (16 knees). The mean age of the patients was 71 years (range, 42-91 years). Bilateral

Results

The mean preoperative knee score was 43.8 points (range, 0-95) at 5 years; this increased to 77.1 (range, 26-99). The mean preoperative functional score was 20.3 (range, 0-95); this increased to 63.4 (range, 0-100). Fig. 1 illustrates the scores over the 5-year assessment period.

The WOMAC scores all showed improvement, particularly in function. At 5 years minimum, the preoperative function score of 919 was reduced to 588, pain improved from 266 to 157, and stiffness was reduced from 124 to 56

Discussion

This study documents the results of the HA-coated Duracon Total Knee Replacement System at 5- to 8-year follow-up. Our survivorship of 98.6% is comparable not only with that of other HA-coated TKA studies, but also with those of the gold standard cemented designs 10, 11, 12, 13. Having achieved a 100% follow-up rate, we can be confident of our results in the intermediate follow-up period. To stand the test of time, longer term follow-up will be required.

The clinical and radiographic analysis

Acknowledgments

We thank Mr K. Ravikumar (Consultant Orthopedic Surgeon, Maidstone Hospital) and Mr A. Shetty (Consultant Orthopedic Surgeon, Medway Maritime Hospital) for their research into gap healing. We also thank Mrs A. P. Nicholl, orthopedic research associate at our hospital, for her help during the preparation of this article.

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    Partial funding for the post of the research associate was provided by Stryker UK Corporation.

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