Long-term results of the treatment of severe osteoarthritis and rheumatoid arthritis with 193 total knee replacements.

We undertook a clinical and surgical study with evaluation of the long-term results (average 5 years, range 1-9 years) of 193 stabilized posterior cemented total knee replacements (TKRs) type Insall-Burstein in patients with severe osteoarthritis (OA) and rheumatoid arthritis (RA), carried out consecutively by the same surgeon from January 1986 to January 1995, at our COT Unit at the Central Military Hospital "Gomez Ulla" in Madrid, in collaboration with the Departments of Traumatology and Morphological Sciences of the University of Alcala de Henares (Madrid). The principal purpose was to examine the success rate of this type of prothesis implanted during primary surgery, according to severity of the case. Six methodology protocols were produced in this study (exploratory, surgical technique in primary surgery, revision surgery, rehabilitation, evaluation and clinical revisions), and satisfactory statistical results (SPSS/PC+) were obtained with the three scales of evaluation: Harris Galante, The Hospital for Special Surgery and Knee Society. These were: 90.5% +/- 0.8% excellent and good results for the OA series, and 83.9% +/- 5% for the RA series. The analysis of survival after long-term monitoring was also statistically significant, with a 96.95% survival rate. Complications arose in 3.10% of cases (6 revisions: 4 aseptic loosenings and 2 loosenings due to infection), which were treated with a constrained prosthesis, and in cases of infection with an arthrodesis. After undertaking a comparative study with other series, we conclude that the Insall-Burnstein stabilized posterior total knee prosthesis, is an excellent Primary replacement associated with long-term survival in patients with a severe degree of articular destruction and functional incapacity, and we give some specific recommendations to reduce complications.