Survivorship for modern total knee arthroplasties (TKA) is not precisely known from large series, other than registries. The present retrospective study therefore analyzed 846 TKAs at a minimum 10years’ follow-up.

Ten-year survivorship for TKAs in a multicenter study exceeds 90%, independently of design and level of prosthetic constraint.

Eight hundred and twenty-eight patients (846 TKAs) were assessed on the Knee Society score. Mean age was 71years (range, 41–93years); 274 males and 554 females (67%); 496 patients (60%) were active; diagnosis was principally osteoarthritis (n=752 [89%]). Most TKAs were cemented (n=704 [83%]), replacing the patella (n=668 [79%]) and sacrificed the posterior cruciate ligament (PCL) (n=707 [84%]), 65% being posterior-stabilized and 35% ultracongruent, with fixed (39%) or mobile bearing (61%).

At a minimum 10years’ follow-up, mean knee score rose from 35 (15–55) to 83 points (74–95), and functional score from 24 (5–45) to 74 points (60–90); mean flexion rose from 105° (25–125°) to 112° (25–125°). Mean hip-knee-ankle angle was 179.5° (169–189°). Sixty-three (7.5%) revision surgeries were required, mainly for loosening (n=18 [2%]) or infection (n=18 [1.8%]). Overall 10-year survivorship was 92% (95% CI: 0.90–0.94). There was no significant difference in survivorship according to implant design or PCL retention. Activity level correlated with revision rate; mechanical complications were more frequent in active and infectious complications in sedentary subjects. Revision was not more frequent in TKA aligned outside the 177–183° range.

Ten-year TKA survivorship was 92%, independently of design and level of mechanical stress. Revision was mainly for infection or loosening, and not for greater than 3° axis misalignment. Mechanical complications were more frequent in younger and more active subjects, for whom therefore other treatment options or technical improvements should be sought.

Level IV. Retrospective study.