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Posterior Stabilized Prosthesis. Results after Follow-Up of Nine to Twelve Years.

Stern, Insall·J Bone Joint Surg Am·1992·405 citations·Hip & Knee
DOI·PubMed
SummaryAbstract on PubMed →

Stern and Insall report 9–12 year outcomes of 289 posterior stabilized (PS) total knee arthroplasties with all-polyethylene tibial components performed at HSS, asking whether the PCL-substituting cam-spine design caused accelerated bone-cement interface failure or inferior survivorship compared with the total condylar prosthesis.

Study Snapshot

Design
Retrospective cohort
Setting: Single center, Hospital for Special Surgery, NYC
Funding: Industry (undisclosed)
Objective
Determine whether posterior stabilized knee prosthesis yields durable long-term outcomes
Outcome(s)
Implant survival and HSS knee score at 9–12 years
Subjects
289 arthroplasties (218 patients); 194 available at 9–12 years
  • Posterior stabilized cemented TKA, all-polyethylene tibial component
Inclusion
  • Posterior stabilized TKA with all-polyethylene tibial component
  • Implanted 1978–1981 at HSS
Exclusion
  • Died <9 years postoperatively (n=66 knees)
  • Lost to follow-up <9 years (n=29 knees)
Follow-up
9–12 years
Statistics
Armitage survivorship analysis

Key Findings

  • 94% cumulative survival at 13 years with a 0.4% average annual failure rate; 14 of 289 knees required revision
  • HSS scoring of all 194 evaluable knees:
    –61% excellent
    –26% good
    –6% fair
    –7% poor (all revised knees classified poor by convention)
  • Knee Society knee score averaged 92 points; functional score averaged 66 points across 180 intact knees — Category A patients averaged 85 functional points vs. 47 for Category C
  • Mean ROM at 9–12 years was 110 degrees, versus 91 degrees reported for the total condylar prosthesis — a 19-degree advantage for the PS design
  • Radiolucent lines ≥1 mm found around 49% of tibial and 39% of patellar components, yet no unrevised component met radiographic criteria for loosening

Clinical Relevance

When counseling patients on PS versus PCL-retaining TKA, this study supports that PCL sacrifice with a cam-spine mechanism does not compromise long-term fixation and yields superior range of motion; the Knee Society functional score stratification also reminds you that a great knee score in a medically infirm patient (Category C) will still translate to a modest functional score — set expectations accordingly.

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|

Posterior Stabilized Prosthesis. Results after Follow-Up of Nine to Twelve Years.

Stern, Insall·J Bone Joint Surg Am·1992·405 citations·Hip & Knee
DOI·PubMed
SummaryAbstract on PubMed →

Stern and Insall report 9–12 year outcomes of 289 posterior stabilized (PS) total knee arthroplasties with all-polyethylene tibial components performed at HSS, asking whether the PCL-substituting cam-spine design caused accelerated bone-cement interface failure or inferior survivorship compared with the total condylar prosthesis.

Study Snapshot

Design
Retrospective cohort
Setting: Single center, Hospital for Special Surgery, NYC
Funding: Industry (undisclosed)
Objective
Determine whether posterior stabilized knee prosthesis yields durable long-term outcomes
Outcome(s)
Implant survival and HSS knee score at 9–12 years
Subjects
289 arthroplasties (218 patients); 194 available at 9–12 years
  • Posterior stabilized cemented TKA, all-polyethylene tibial component
Inclusion
  • Posterior stabilized TKA with all-polyethylene tibial component
  • Implanted 1978–1981 at HSS
Exclusion
  • Died <9 years postoperatively (n=66 knees)
  • Lost to follow-up <9 years (n=29 knees)
Follow-up
9–12 years
Statistics
Armitage survivorship analysis

Key Findings

  • 94% cumulative survival at 13 years with a 0.4% average annual failure rate; 14 of 289 knees required revision
  • HSS scoring of all 194 evaluable knees:
    –61% excellent
    –26% good
    –6% fair
    –7% poor (all revised knees classified poor by convention)
  • Knee Society knee score averaged 92 points; functional score averaged 66 points across 180 intact knees — Category A patients averaged 85 functional points vs. 47 for Category C
  • Mean ROM at 9–12 years was 110 degrees, versus 91 degrees reported for the total condylar prosthesis — a 19-degree advantage for the PS design
  • Radiolucent lines ≥1 mm found around 49% of tibial and 39% of patellar components, yet no unrevised component met radiographic criteria for loosening

Clinical Relevance

When counseling patients on PS versus PCL-retaining TKA, this study supports that PCL sacrifice with a cam-spine mechanism does not compromise long-term fixation and yields superior range of motion; the Knee Society functional score stratification also reminds you that a great knee score in a medically infirm patient (Category C) will still translate to a modest functional score — set expectations accordingly.

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