Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry

Objective Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. Design In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. Results A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. Conclusion The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

[1]  L. Ryd,et al.  Patient-Specific Implants for Focal Cartilage Lesions in The Knee: Implant Survivorship Analysis up to Seven Years Post-Implantation. , 2020, Surgical technology international.

[2]  M. Brittberg,et al.  Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years , 2020, Knee Surgery, Sports Traumatology, Arthroscopy.

[3]  H. Skjøt-Arkil,et al.  HemiCAP Knee Implants: Mid- to Long-Term Results , 2019, Cartilage.

[4]  Ç. Işık,et al.  Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants , 2019, Archives of Orthopaedic and Trauma Surgery.

[5]  Sigrun Alba Johannesdottir Schmidt,et al.  The Danish health care system and epidemiological research: from health care contacts to database records , 2019, Clinical epidemiology.

[6]  H. Skjøt-Arkil,et al.  UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years , 2019, Knee Surgery, Sports Traumatology, Arthroscopy.

[7]  E. Solheim,et al.  Long-Term Survival after Microfracture and Mosaicplasty for Knee Articular Cartilage Repair: A Comparative Study Between Two Treatments Cohorts , 2018, Cartilage.

[8]  Sion Glyn-Jones,et al.  The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study , 2017, The Lancet.

[9]  Lars Engebretsen,et al.  A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years. , 2016, The Journal of bone and joint surgery. American volume.

[10]  Patrick J. Reardon,et al.  Long-term Outcomes After Osteochondral Autograft Transfer: A Systematic Review at Mean Follow-up of 10.2 Years. , 2016, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[11]  T. Strand,et al.  Results at 10–14 years after microfracture treatment of articular cartilage defects in the knee , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[12]  B. B. Christensen.  Autologous tissue transplantations for osteochondral repair. , 2016, Danish medical journal.

[13]  C. Cooper,et al.  Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. , 2015, Osteoarthritis and cartilage.

[14]  Douglas G Altman,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. , 2014, International journal of surgery.

[15]  Anup Kumar,et al.  Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[16]  Tim Bryant,et al.  The John Insall Award: A Minimum 10-year Outcome Study of Autologous Chondrocyte Implantation , 2014, Clinical orthopaedics and related research.

[17]  Deepak Goyal,et al.  Evidence-based status of microfracture technique: a systematic review of level I and II studies. , 2013, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  J. Bellemans,et al.  Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[19]  A. V. von Keudell,et al.  Radiological evaluation of cartilage after microfracture treatment: a long-term follow-up study. , 2012, European journal of radiology.

[20]  A. Odgaard,et al.  Existing data sources for clinical epidemiology: The Danish Knee Arthroplasty Register , 2012, Clinical epidemiology.

[21]  R. Fitzpatrick,et al.  Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set , 2012, BMJ Open.

[22]  H. Thermann,et al.  Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee , 2011, Archives of Orthopaedic and Trauma Surgery.

[23]  L. Miller,et al.  Clinical and economic consequences of the treatment gap in knee osteoarthritis management. , 2011, Medical hypotheses.

[24]  Constantine Frangakis,et al.  Multiple imputation by chained equations: what is it and how does it work? , 2011, International journal of methods in psychiatric research.

[25]  K. Saleh,et al.  Evaluating comorbidities in total hip and knee arthroplasty: available instruments , 2010, Journal of Orthopaedics and Traumatology.

[26]  L. Engebretsen,et al.  Focal Cartilage Defects in the Knee Impair Quality of Life as Much as Severe Osteoarthritis , 2010, The American journal of sports medicine.

[27]  D. Saris,et al.  Patient Profiling in Cartilage Regeneration: Prognostic Factors Determining Success of Treatment for Cartilage Defects , 2009, The American journal of sports medicine.

[28]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[29]  G. Bentley,et al.  Who is the ideal candidate for autologous chondrocyte implantation? , 2006, The Journal of bone and joint surgery. British volume.

[30]  Konrad Malinowski,et al.  Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[31]  Lars Engebretsen,et al.  Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies , 2004, The American journal of sports medicine.

[32]  J. Steadman,et al.  Microfracture: surgical technique and rehabilitation to treat chondral defects. , 2001, Clinical orthopaedics and related research.

[33]  B. P. Smith,et al.  Cartilage injuries: a review of 31,516 knee arthroscopies. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[34]  L. Dorr,et al.  Rationale of the Knee Society clinical rating system. , 1989, Clinical orthopaedics and related research.

[35]  M. Brittberg,et al.  Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Five-Year Follow-up of a Prospective Randomized Trial , 2018, The American journal of sports medicine.