Knee osteoarthritis (KOA) is prevalent among middle-aged and elderly populations, can cause disability and significantly impairs quality of life. Total knee arthroplasty (TKA) is an effective treatment for end-stage KOA; however, long-term outcome and prosthesis survivorship were limited reported, particularly in Chinese cohorts.
Led by Professor Weng Xi-sheng and Professor Feng Bin, the orthopedic team at Peking Union Medical College Hospital conducted a landmark follow-up study spanning over two decades. The research analyzed KOA patients who underwent primary TKA between 1993 and 2002, aiming to evaluate long-term prosthesis survivorship and clinical outcomes, thereby addressing the lack of data in extended TKA follow-up for Chinese populations.
Among 226 patients (246 knees) with minimum follow-up of 10 years, 104 patients (131 knees) were included in the final analysis. Results demonstrated prosthesis survival rates of 93.6%, 92.4%, 89.8%, and 71.8% at 10, 15, 20, and 25 years post-TKA, respectively. For the 29 patients (35 knees) with minimum ≥20-year follow-up, 12 patients (16 knees) underwent final functional assessments. There is a decline in Hospital for Special Surgery (HSS) knee scores at Post-OP 20 years compared to Post-OP 10-year outcomes. However, the knee scores remained markedly improved than the preoperative baselines, with 100% patient satisfaction scale (Table 1).
Table 1. Evaluation results of knee joint function in 12 patients with follow up time ≥ 20 years (x±s)
Program |
Pre-operation |
10 year follow-up |
Last follow up |
HSS score |
58.75±7.19 |
95.25±13.32 |
84.69±11.03*# |
Pain score |
12.50±2.50 |
35.94±8.14 |
35.31±8.74* |
Function score |
11.19±2.16 |
17.88±3.90 |
9.69±6.87# |
ROM score |
11.75±2.11 |
12.88±1.76 |
11.56±2.00# |
ROM extension-flexion |
93.44±17.30 |
101.88±13.33 |
91.56±15.98 |
ROM: Range of motion; HSS: Hospital for Special Surgery
Comparison with preoperative，*P＜0.05；
Comparison with 10 years of follow-up，# P＜0.05
This study provides the first insight of ≥20-year follow-up data in a Chinese TKA cohort, preliminarily validating the long-term effectiveness of TKA for knee disorders, characterized by high long-term prosthesis survivorship, sustained functional improvement, and high patient satisfaction rate. Future efforts will expand cohort diversity to generate robust clinical evidence for optimizing surgical techniques and modern prosthesis design.
Source:
Medical Journal of Peking Union Medical College Hospital, 2025, 16(1) :35-41.
Funds:
National High Level Hospital Clinical Research Funding 2022-PUMCH-C-036
Beijing Municipal Natural Science Foundation L232006
About the author:
Dr. Bin Feng is an Attending Orthopedic Surgeon/ Professor/ doctoral supervisor in the orthopaedic department, peking union medical college hospital, China. His specialty interests focus on joint reconstruction surgery, artificial hip and knee joint replacement, robotic assisted joint replacement, complex joint reconstruction surgery, and treatment of femoral head necrosis. His research interests focus on artificial intelligence on orthopaedic surgery, robotic assisted surgery and mechanism of avascular necrosis. His one of the earliest doctors in China to carry out robotic assisted joint replacement. Until now, he has published more than 80 papers as the first author or corresponding author, presided more than 6 national/regional scientific research projects, owns 10 invention patents. He is an active member of Chinese Medical Association and Beijing Medical Association. He also is deputy director of the Joint specialty of orthopaedic department of Peking Union Medical College Hospital.
About Medical Journal of Peking Union Medical College Hospital
Medical Journal of Peking Union Medical College Hospital (Med J PUMCH, ISSN 1674-9081), hosted by Chinese Academy of Medical Science(CAMS) and Peking Union Medical College Hospital(PUMCH), was originally launched in July 2010. It is a peer-reviewed open access journal and publishes bimonthly in Chinese. Our vision and mission are to promote transparency in the publication process, build a robust academic communication platforms for medical professionals in China, and ultimately improve the clinical practices of medicine. Xiehe Yixue Zazhi is now indexed in the major scientific databases, including Scopus, DOAJ, A Guide to the Core Journals of China (2023 Edition), Chinese Science Citation Database (CSCD), Chinese S&T Journal Citation Reports (Natural Science, Core Edition), etc.
