Background

Total knee arthroplasty (“TKA”) provides the foundation of surgical treatment for end-stage knee osteoarthritis. Notwithstanding the ubiquitous use of TKA, approximately 20% of patients report dissatisfaction following the procedure. These rates of dissatisfaction have directly led to the development of implant designs aimed at improving patient outcomes.

The Journey II BCS TKA (Smith and Nephew, Watford, UK) was designed to reproduce more natural knee kinematics. There is basic scientific evidence that this is achieved; however, there is currently insufficient evidence to conclude that the prosthesis actually improves clinical outcomes.

This study aims to assess patient-reported outcomes associated with the use of the Journey II BCS TKA implant.

Methods

We analysed a single-surgeon series of consecutive Journey II BCS TKAs. From a series of 284 patients (315 TKAs), 3 had died, 22 were lost to follow-up or declined participation and we excluded patients with a follow-up of under 6 months.

Primary outcomes were assessed by pre-operative and post-operative Oxford Knee Scores (“OKS”), post-operative Forgotten Joint Score (“FJS”) and a global satisfaction score using a five-point Likert scale. Secondary outcomes of re-operation rates were also recorded.

Results

Data from 238 patients (45% male), 258 TKAs, with a mean age of 66.4 years (37-87 years) was analysed. Mean time to follow-up was 25 months (6-57 months). There were no revision procedures performed, 1 patient underwent a debridement procedure (“DAIR”) for post-operative infection, and 2 patients required manipulation under anaesthesia (“MUA”) for stiffness.

Mean pre-operative OKS was 19 (2-46) rising to a mean average post-operative OKS of 39 (12-48) with the change ranging from -17 to 42. Average FJS at time of follow-up was 61.3 (0-100).

Only 6.3% of responders reported dissatisfaction with their TKA (95% confidence interval 3.3-9.3%) with 86.2% (95% confidence interval 81.9-90.4%) reporting that they were either satisfied (20.9%) or very satisfied (65.2%).

Conclusions

Our series of 258 Journey II BCS TKAs demonstrates favourable patient reported outcomes and a significantly lower rate of patient dissatisfaction compared to those reported in the literature. Given that the evidence suggests that early satisfaction following TKA is generally maintained longer term, our study supports the concept that improving the kinematics of TKA leads to improved patient reported outcomes. Further studies in this area are required.