Five to eight year results of the Johnson-Elloy (Accord) total knee arthroplasty

A study of tissue interface membranes from revision accord knee arthroplasty: the role of T lymphocytes

Despite four decades of advances in the design of orthopaedic devices aseptic loosening remains a major cause for the revision of total joint arthroplasty. This study used the techniques of immunohistochemistry and reverse transcription polymerase chain reaction to identify the inflammatory cell types, cytokines and chemokines within the interface tissue surrounding failed Accord Knee prostheses. Many T cells were identified within the tissue: however, the classical marker of activation, CD25 was expressed on very few cells. Molecular analysis failed to detect the synthesis of either Th1 or Th2 cytokines. These results suggest that the T cells are being actively recruited to the site of inflammation along the chemokine gradients but are not participating in a classical immune response.

Midterm clinical and radiographic results with the genesis I total knee prosthesis

The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation.

Long-term results of the Accord total knee replacement in the Countess of Chester Hospital

Between 1985 and 1996, 74 knees in 61 patients were replaced with a cemented Accord total knee arthroplasty at the Countess of Chester Hospital. This prosthesis is of an unconstrained meniscal-bearing design. At the time of study, 16 patients with 20 knees had died, six knees were lost to follow-up and one knee had become infected. Twenty-five knees had been revised or undergone further surgery (including four knees in deceased patients); these were classed as failures. Twenty-four patients with 26 knees still in situ were reviewed between July and September 1998. They were assessed clinically according to the Knee Society Scoring system and radiographically with weight-bearing antero-posterior and lateral films. The mean knee score was 60, and the mean function score was 42. Of the 25 knees that had failed, 19 had been revised for instability. Survivorship was 58% at 10 years with an average follow-up of 5 years 4 months. These results are poor compared with those reported on more conventional total knee replacements. The authors urge that new implants should be viewed critically because of the absence of long-term results, no matter how good their theoretical advantages appear to be.

Primary total knee arthroplasty using the Genesis Total Knee Arthroplasty System: 3- to 6-year follow-up study of 105 knees

This prospective study analyzed data from 105 primary total knee arthroplasties performed in 90 patients using the Genesis Total Knee Arthroplasty System. The 34 men and 56 women with a mean age of 68.7 years (range, 41-86 years) were evaluated at a mean follow-up period of 4.25 years (range, 3-6 years). Fifty-five procedures (52%) used cemented femoral and tibial components, 49 (47%) used cementless femoral and cemented tibial components, and 1 (1%) used cementless femoral and tibial components. The preoperative mean pain and function scores were 50 (range, 12-79) and 41 (range, 5-80), respectively. At the most recent follow-up evaluation, the mean pain score increased to 97 (range, 67-100), and the mean function score increased to 88 (range, 40-100). Mean preoperative range of motion was 104 degrees (range, 50 degrees-130 degrees) and increased to 116 degrees (range, 80 degrees-130 degrees) at most recent follow-up evaluation. Clinically, there were 100 excellent results (95%). 4 good results (4%), and 1 poor result (1%).

A tribological study of a series of retrieved accord knee explants

A tribological study of a series of 27 retrieved Accord meniscal bearing knee joints has been carried out. The roughness of the articulating surfaces of the meniscal and the femoral components was investigated, and the penetration into the polyethylene meniscal component was determined. There was generally little damage to the highly polished metallic femoral components. A general polishing and smoothing of the ultra high molecular weight polyethylene meniscal components was observed, although there was some subsequent deterioration of the polyethylene surfaces in certain cases. The penetration rate of the femoral components into the menisci was low, and was found to be similar to that reported for other meniscal knee joints.