A yet-to-be published study from Hospital for Special Surgery (HSS) has found that active young adults who elect to have total knee replacement (TKA) are “unlikely” to require a revision…ever. This is the largest and longest follow-up of patients under 55 undergoing total knee replacement in existence.
Senior author William Long, M.D., a hip and knee surgeon at HSS, told OTW, “We looked at the 40-year outcomes of a cohort of 88 young patients who underwent total knee replacement for osteo and post-traumatic arthritis between 1977 and 1992.”
“The most important results are as follows,” noted Dr. Long to OTW. “There was a very low rate of complications in these young patients. Patients all experienced an increased level of function following total knee replacement that was sustained over the 40-year timeframe of this study.”
“The average patient, whose health was not otherwise compromised, had a Tegner activity score consistent with hiking, swimming and recreational sports, e.g., golf. There was excellent durability, with a revision-free survivorship in the oldest of the two prosthesis design at 40-years.”
“The fact that the implant survivorship far exceeded the patient survival curve (only 19.1.4% were still alive at 40 years) suggests the vast majority of patients did not need revision knee surgery in their lifetime.”
During that period, surgeons used knee prostheses known as the Insall-Burstein I and Insall-Burstein II—predecessors of implants used today that provide posterior stability. Both designs were conceived and developed at HSS. The investigators previously conducted patient follow-ups at 10 and 30 years following surgery.
Since these implant designs were from the 1980s, OTW asked Dr. Long about how transferable are these study results to today’s knee prostheses. “These prostheses (in the study) were the foundational, or predicate designs, upon which all of our modern implants are based,” said Dr. Long. “Though we see excellent results in this study, we have since made a number of changes in an effort to improve design and function.”
“It is incumbent on us to continue to carefully follow our results. I am the Knee Society representative on the American Joint Registry Steering Committee. As the largest joint registry in the world, it will serve as an important tool in following results at a much broader population level.”
“This paper is the longest study in the world of young patients undergoing total knee replacement. As the number of young patients undergoing knee replacement continues to rise, this foundational study supports the expectation that the vast majority of them will achieve a high level of durable function and longevity from the implant, more than likely exceeding their lifespan.”

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