Knee prostheses under scrutiny: safety questioned
KNEE implants are the latest prosthetic device to come under scrutiny, with claims there is little or no evidence of safety and cost-effectiveness for many on the market.
In the wake of controversy over faulty breast and hip implants, The Lancet has published a review of knee replacement surgery, co-authored by Australian orthopaedic surgeon Professor Stephen Graves, director of the National Joint Replacement Registry.
While orthopaedic manufacturers are continually introducing new designs and clinicians expect this will improve outcomes, “there is evidence to suggest that this belief is incorrect”, the experts said.
Looking at the reasons for revision surgery, they noted that implant wear was most common and that data from joint replacement registries showed revision was 2.5 times higher in patients with osteoarthritis younger than 65 years compared to older patients.
The 10 year risk of revision after primary total knee replacement for patients with osteoarthritis was 4% in Sweden and 6% in Australia, but the increasingly young age at which prostheses were being implanted suggested a growing future burden.
“Major emphasis needs to be placed on management of young patients with early arthritis to develop treatment strategies that reverse or slow down progression of disease,” they said.
They also advocated more trials of new implant designs.
Lancet 2012, online 6 March