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The Journal of Bone and Joint Surgery 82:1626 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

The Bisurface Total Knee Replacement: A Unique Design for Flexion

Four-to-Nine-Year Follow-up Study*

Masao Akagi, M.D.{dagger}, Takashi Nakamura, M.D.{ddagger}, Yoshitaka Matsusue, M.D.{ddagger}, Toyoji Ueo, M.D.§, Kohichi Nishijyo, M.D.§ and Eijiro Ohnishi, M.D.§

Investigation performed at the Department of Orthopaedic Surgery, Kyoto University, Kyoto City, Japan
*No benefits have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Peterson Tribology Laboratory, Department of Orthopaedics, Loma Linda University, 250 Caroline, Suite H, San Bernadino, California 92408. E-mail address: massa{at}kuhp.kyoto-u.ac.jp
{ddagger}Department of Orthopaedic Surgery, School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City 606-8507, Japan.
§Department of Orthopaedic Surgery, Tamatsukuri-Kohseinenkin Hospital, 1-2 Tamatsukuri, Tamayu-cho, Yatsuka County, Shimane Prefecture 699-0294, Japan.

Background: The Bisurface knee prosthesis was designed in 1989 to improve knee flexion without affecting the durability of the prosthesis. The prosthesis has a unique ball-and-socket joint in the midposterior portion of the femoral and tibial components, which functions as a posterior stabilizing cam mechanism and causes femoral rollback. The femoral component was made of alumina ceramic. The purpose of this study was to review the clinical results of the first 223 arthroplasties performed with this prosthesis in order to assess whether this new implant had achieved its design objectives.

Methods: From December 1989 to May 1994, all patients who were scheduled for primary total knee arthroplasty were enrolled in a prospective study of the Bisurface knee. The patients were evaluated clinically according to The Hospital for Special Surgery knee-rating system and with a self-administered questionnaire, and they were evaluated radiographically according to the system of the Knee Society. Kaplan-Meier survivorship analysis was performed with revision of the knee or recommendation for revision as the end point.

Results: One hundred and sixty-six patients treated with a total of 223 consecutive primary total knee arthroplasties were enrolled in the study, and 182 knees were followed for 3.9 to 9.0 years (mean, 5.8 years). Preoperatively, the mean Hospital for Special Surgery knee score was 44.5 points. At the time of latest follow-up, the mean knee score was 86.3 points. The mean preoperative and postoperative ranges of flexion were 119 and 124 degrees, respectively. The patients, even those with a good preoperative range of motion, rarely lost deep flexion of the knee after the procedure. A revision operation was performed in eight knees (because of infection in five, instability in two, and breakage of the peg of the patellar component in one). Two knees had recurrent medial-lateral subluxations of the femorotibial articulation, which were treated nonoperatively. No prosthesis had loosened aseptically and no alumina ceramic femoral component had broken by the time of latest follow-up. The rate of survival of the implant was 94 percent (95 percent confidence interval, 90 to 98 percent) at six years. According to the patient questionnaires, 20 percent of the knees sometimes felt loose in daily living activities, which prompted us to improve the intrinsic stability of the prosthesis by improving the congruity of the ball-and-socket joint.

Conclusions: Total knee arthroplasty with the Bisurface prosthesis resulted in an excellent range of motion and a high level of satisfaction with the operation; the durability of the prosthesis is promising.


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