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The Journal of Bone and Joint Surgery, Vol 65, Issue 5 619-628, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements
JN Insall, RW Hood, LB Flawn and DJ Sullivan
We studied the first 100 consecutive patients (125 knees) to undergo knee
arthroplasty with the original total condylar-I prosthesis for either
osteoarthritis or osteonecrosis on the Knee Service at The Hospital for
Special Surgery. They were followed for an average of 6.6 years (range,
five to nine years), which is the longest follow-up of a total knee
prosthesis that is still widely used in its original and unmodified form.
At five to nine years of follow-up, eleven patients (fourteen knees) were
dead and ten patients (eleven knees) could not be traced, leaving 100 knees
(seventy-nine patients) for clinical evaluation. This included one knee
from which the prosthesis was removed for sepsis at six months, four that
were revised for pain, and two that were revised because of subluxation.
Two patients had a loose tibial component. Sixty-four knees were rated as
excellent and twenty-seven were rated as good. There were two fair and
seven poor results. Detailed radiographic evaluation of the 100 knees
showed that only minimum changes in the varus or valgus alignment or the
fixation of the prosthetic components had occurred with time. At follow-up,
41 per cent of the tibial components showed some evidence of radiolucency,
although with the exception of the two loose components just mentioned
there were no complete or circumferential radiolucent lines. Most
radiolucencies were present by the end of the first postoperative year, and
in 81 per cent of the knees there was no further change. Although a special
attempt was made to determine any evidence of wear of the polyethylene
tibial component, we were unable to demonstrate unequivocal wear in any
knee. Our experience had led us to conclude that the long-term success of
current total knee designs will probably not be significantly affected by
polyethylene wear or loss of component fixation. The majority of failures
in our series were attributed to errors in surgical technique.
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