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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1996 Nov;78(6):515–520.

Current techniques in total knee replacement: results of a national survey.

A M Phillips 1, N J Goddard 1, J E Tomlinson 1
PMCID: PMC2502847  PMID: 8943636

Abstract

A postal questionnaire was sent to all Fellows of the British Orthopaedic Association to obtain a census of total knee replacement (TKR) preferences in the United Kingdom; 1162 questionnaires were sent and 721 replies received. There were 92 Fellows who had retired or filled in the forms incorrectly, and 32 no longer perform TKR. Thus, 597 responded correctly, giving a 62% response rate. This gives an extrapolated total of 34,677 TKRs being implanted per year in the UK, with an average of 34.3 being performed by each surgeon per year. Only 9% perform more than 90 per year. There were 41 different prostheses in current use among the respondents to our questionnaire, of which five prostheses constituted 61% of the total. Cemented prostheses were used by 95.2%. Resurfacing of the patella was always carried out by 32%, while 19% never resurface it; the most common reason for doing so being patellofemoral arthropathy at operation. Intramedullary alignment was used for the femoral component in 86%, 76% preferred extramedullary alignment for the tibial component. Regarding cementing technique, 43% use pulsatile lavage, 9% used a cement gun, 88% dry the bone and 56% seal the hole made by the femoral alignment device in the femur before cementing. All components were cemented simultaneously by 65% and one at a time by 31%. Metal-backed tibial prostheses are now used by 98% of surgeons, modular tibial components being preferred by 80%. Metal-backed patellar components were used by 13%. An onlay type of patella was preferred by 51%. This survey highlights the great diversity of surgical practice in the UK, which may reflect uncertainty regarding best practice in total knee replacement.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albrektsson B. E., Carlsson L. V., Freeman M. A., Herberts P., Ryd L. Proximally cemented versus uncemented Freeman-Samuelson knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1992 Mar;74(2):233–238. doi: 10.1302/0301-620X.74B2.1544959. [DOI] [PubMed] [Google Scholar]
  2. Dennis D. A. Removal of well-fixed cementless metal-backed patellar components. J Arthroplasty. 1992 Jun;7(2):217–220. doi: 10.1016/0883-5403(92)90021-h. [DOI] [PubMed] [Google Scholar]
  3. Freeman M. A., Samuelson K. M., Bertin K. C. Freeman-Samuelson total arthroplasty of the knee. Clin Orthop Relat Res. 1985 Jan-Feb;(192):46–58. [PubMed] [Google Scholar]
  4. Freeman M. A., Tennant R. The scientific basis of cement versus cementless fixation. Clin Orthop Relat Res. 1992 Mar;(276):19–25. [PubMed] [Google Scholar]
  5. Grace J. N., Rand J. A. Patellar instability after total knee arthroplasty. Clin Orthop Relat Res. 1988 Dec;(237):184–189. [PubMed] [Google Scholar]
  6. Grewal R., Rimmer M. G., Freeman M. A. Early migration of prostheses related to long-term survivorship. Comparison of tibial components in knee replacement. J Bone Joint Surg Br. 1992 Mar;74(2):239–242. doi: 10.1302/0301-620X.74B2.1544960. [DOI] [PubMed] [Google Scholar]
  7. Hashemi-Nejad A., Birch N. C., Goddard N. J. Current attitudes to cementing techniques in British hip surgery. Ann R Coll Surg Engl. 1994 Nov;76(6):396–400. [PMC free article] [PubMed] [Google Scholar]
  8. Keblish P. A., Varma A. K., Greenwald A. S. Patellar resurfacing or retention in total knee arthroplasty. A prospective study of patients with bilateral replacements. J Bone Joint Surg Br. 1994 Nov;76(6):930–937. [PubMed] [Google Scholar]
  9. Knutson K., Lewold S., Robertsson O., Lidgren L. The Swedish knee arthroplasty register. A nation-wide study of 30,003 knees 1976-1992. Acta Orthop Scand. 1994 Aug;65(4):375–386. doi: 10.3109/17453679408995475. [DOI] [PubMed] [Google Scholar]
  10. Laskin R. S., Bucknell A. The use of metal-backed patellar prostheses in total knee arthroplasty. Clin Orthop Relat Res. 1990 Nov;(260):52–55. [PubMed] [Google Scholar]
  11. Lewold S., Knutson K., Lidgren L. Reduced failure rate in knee prosthetic surgery with improved implantation technique. Clin Orthop Relat Res. 1993 Feb;(287):94–97. [PubMed] [Google Scholar]
  12. Lynch A. F., Rorabeck C. H., Bourne R. B. Extensor mechanism complications following total knee arthroplasty. J Arthroplasty. 1987;2(2):135–140. doi: 10.1016/s0883-5403(87)80020-7. [DOI] [PubMed] [Google Scholar]
  13. Marmor L. Technique for patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res. 1988 May;(230):166–167. [PubMed] [Google Scholar]
  14. Parmet J. L., Berman A. T., Horrow J. C., Harding S., Rosenberg H. Thromboembolism coincident with tourniquet deflation during total knee arthroplasty. Lancet. 1993 Apr 24;341(8852):1057–1058. doi: 10.1016/0140-6736(93)92414-o. [DOI] [PubMed] [Google Scholar]
  15. Rand J. A. Patellar resurfacing in total knee arthroplasty. Clin Orthop Relat Res. 1990 Nov;(260):110–117. [PubMed] [Google Scholar]
  16. Ritter M. A., Herbst S. A., Keating E. M., Faris P. M. Radiolucency at the bone-cement interface in total knee replacement. The effects of bone-surface preparation and cement technique. J Bone Joint Surg Am. 1994 Jan;76(1):60–65. doi: 10.2106/00004623-199401000-00008. [DOI] [PubMed] [Google Scholar]
  17. Scuderi G. R., Insall J. N. Total knee arthroplasty. Current clinical perspectives. Clin Orthop Relat Res. 1992 Mar;(276):26–32. [PubMed] [Google Scholar]
  18. Stuchin S. A., Ruoff M., Matarese W. Cementless total knee arthroplasty in patients with inflammatory arthritis and compromised bone. Clin Orthop Relat Res. 1991 Dec;(273):42–51. [PubMed] [Google Scholar]
  19. Stulberg S. D., Stulberg B. N., Hamati Y., Tsao A. Failure mechanisms of metal-backed patellar components. Clin Orthop Relat Res. 1988 Nov;(236):88–105. [PubMed] [Google Scholar]
  20. Tria A. J., Jr, Harwood D. A., Alicea J. A., Cody R. P. Patellar fractures in posterior stabilized knee arthroplasties. Clin Orthop Relat Res. 1994 Feb;(299):131–138. [PubMed] [Google Scholar]
  21. Vince K. G., Insall J. N. Long-term results of cemented total knee arthroplasty. Orthop Clin North Am. 1988 Jul;19(3):575–580. [PubMed] [Google Scholar]
  22. Vince K. G., McPherson E. J. The patella in total knee arthroplasty. Orthop Clin North Am. 1992 Oct;23(4):675–686. [PubMed] [Google Scholar]
  23. Whiteside L. A. Cementless revision total knee arthroplasty. Clin Orthop Relat Res. 1993 Jan;(286):160–167. [PubMed] [Google Scholar]
  24. Windsor R. E., Scuderi G. R., Moran M. C., Insall J. N. Mechanisms of failure of the femoral and tibial components in total knee arthroplasty. Clin Orthop Relat Res. 1989 Nov;(248):15–20. doi: 10.1097/00003086-198911000-00005. [DOI] [PubMed] [Google Scholar]

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