Long-term Durability of Ceramic Tri-condylar Knee Implants: A Minimum 15-year Follow-up

Abstract Background Ceramic bearings are not commonly used in total knee arthroplasty. So far, little information is available about whether long-term survivorship and good clinical outcomes can be ensured with ceramic knee implants. The purposes of the current study were to evaluate the clinical and radiological outcomes, and to assess the long-term durability of a ceramic tri-condylar implant. Methods A total of 507 consecutive total knee arthroplasties were carried out using a ceramic tri-condylar femoral implant. The posterior cruciate ligament was sacrificed, and all components were fixed with bone cement. Clinical outcomes were assessed retrospectively with the Knee Society scoring system. Kaplan-Meier survivorship was calculated to determine the cumulative survival rate. Results One hundred and sixty-seven knees (114 patients) were available for clinical outcomes. The average range of flexion improved from 118.1° preoperatively to 123.7° at a minimum 15-year follow-up ( P < 0.001). The average Knee Society knee score improved from 39.1 to 92.8 ( P < 0.001). The functional score also improved from 36.0 to 47.0 ( P < 0.001). With revision for any surgery or radiographic failure as the end-point, Kaplan-Meier survivorship at 15 years was 94.0%. With revision of any component as the end-point, the corresponding survivorship was 96.2%. Conclusion Clinically, the postoperative knee flexion range and Knee Society scores were good after long-term follow-up. The survivorship of the ceramic knee implant was excellent over the 15-year follow-up, and long-term durability was achieved, making ceramic a promising alternative material for the femoral component in total knee arthroplasty.