Zirconium total knee replacements theoretically have a low incidence of failure as they are low friction, hard wearing and hypo allergenic; we present the five year survival data.

Data was collected prospectively from 212 patients who underwent Profix zirconium total knee replacements with an all-polyethylene tibial component. Revision surgery or a Knee Society Roentgenographic Evaluation System (KSRES) score of 10 or more was considered failure. SF 12 and WOMAC scores were recorded preoperatively, at three months, at one year, at three years and at five years. KSRES scores were recorded at all postoperative intervals.

There were 92 male and 120 female patients with a median age of 63 years, range 25 to 87. 188 implants were for osteoarthritis and 24 were for rheumatoid arthritis. Eight patients died and six were lost to follow up, the remaining 198 patients reached a minimum of five year follow-up.

At five years, the mean WOMAC score improved from 56 to 35 and the mean SF12 physical component score improved from 28 to 34. The mean SF12 mental component score remained unchanged at 51.

The five year survival with failure due to implant related reasons was 99.5% (95% CI 97.3 - 100). This was due to one tibial component becoming aseptically loose in the first year.

Reoperations excluded from this analysis were downsizing of the tibial component for stiffness and patella resurfacing. When these were included the five year survival was 98.1% (95% CI 95.1 - 99.3).

Our results demonstrate that the Profix zirconium total knee replacement has a low medium term failure rate comparable to the best implants. Further research is needed to establish if the beneficial properties of zirconium improve long term implant survival.

This study reports on the follow-up of Total Knee Arthroplasty patients in secondary care, by a physiotherapist working in an extended scope practitioner role, as a member of the orthopaedic team, and who had undertaken a negotiated work based learning module (NWBL) to develop practice skills in image interpretation at the School of Health Sciences, University of Liverpool.

Following successful completion of the NWBL by the physiotherapist an audit was undertaken of the patients seen in a total knee arthroplasty review clinic during a twelve month period. The patients were reviewed at one, three, five or seven years post-operatively on the behalf of two orthopaedic consultants specialising in total knee joint replacement (TKR). A total of 508 TKR’s were reviewed in 438 patients. Of these 37 (7%) were booked for further review by the consultants; 24 (4.7%) regarding management of their TKR, 7 (1.5%) regarding management of their contra-lateral knee and 9 (2%) regarding management of another joint. Radiographs of a further 34(6.7%) patients were discussed with the consultants (usually within a week) but did not require a review appointment by them.

The number of cases who had radiographs discussed with the consultants, but who did not require a further review appointment, suggests that the practitioner erred on the side of caution in image interpretation.

The results suggest a physiotherapist working in an extended scope practitioner role can carry out yearly follow-up of TKR patients, provided the appropriate practice skills have been developed, thereby reducing the congestion in busy follow-up clinics and allowing the surgeons to concentrate on more complex cases.

Practitioners working in such roles should be members of the orthopaedic team with regular communication with the orthopaedic surgeons.