Younger, Active TKA Patients May Not Need a Revision Procedure as They Age: Study
A 40-year study by researchers at Hospital for Special Surgery (HSS) has found that active young adults who underwent total knee arthroplasty (TKA) were unlikely to require a revision procedure in their lifetime.
The findings were presented at the 2025 Annual Meeting of the American Association of Orthopaedic Surgeons.
“As an increasing number of younger adults in their 40s and 50s consider total knee replacement, many wonder how long knee implants last before requiring a revision procedure,” says William J. Long, MD, FRCSC, an HSS hip and knee surgeon and the senior author of the study.
“The findings from our study – the largest and longest follow-up of patients under 55 undergoing total knee replacement – confirm that young patients can be confident their initial knee implants will allow them to pursue a high level of activity and more than likely last the rest of their lives.”
Study Data and Findings
Orthopaedic surgeons from HSS designed the longitudinal study to track outcomes for patients 55 years of age and younger who had undergone TKA between 1977 and 1992. During that period, surgeons at HSS had 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.
Previously, the investigators conducted patient follow-ups at 10, 25, and 30 years after surgery. For this final report, Dr. Long and colleagues analyzed outcomes after 40 years for 81 patients aged 33 to 55 years. The analysis included 107 knees in total.
Overall, 70% of patients in the study had not undergone a revision procedure in their lifetime. Patients were 3 to 4 times more likely to have passed away after 40 years than to have needed a revision. Remarkably, among the 49 patients who received the original Insall-Burstein I prostheses, 80% had not undergone a revision procedure.
“Considering that today’s knee replacements have addressed the pitfalls leading to the majority of revisions for mechanical issues in Insall-Burstein I and Insall-Burstein II implants, these are very reassuring findings,” Dr. Long said.
Dr. Long also examined 6 patients (8 knees) in person, and lead and presenting author Aaron Weinblatt, BA, contacted many more patients by phone. There were no signs of loosening, nor were there any changes in symmetry or alignment of the original components. In addition, patients reported an ongoing improved level of activity after surgery.
Patient-Reported Activity Data
This was supported by patient-reported activity data collected for 8 patients (10 knees) and measured using the Tegner Activity Scale (TAS). Before undergoing TKA, the average TAS score was only 1.5, indicating that patients could work in a sedentary job and walk on uneven ground but could not hike or backpack. At 40 years, their average TAS score was 2.7, indicating the ability to work in light labor occupations and participate in recreational activities such as swimming and walking in the woods.
“Patients requiring a total knee replacement should not delay having surgery,” Dr. Long said. “Our study results highlight that those who undergo knee replacement sooner are more likely to maintain a high level of activity that contributes to a healthy, longer-term lifespan.”
Dr. Long adds that a previous HSS study published in 2014 at the 30-year follow-up showed that for the small percentage of patients who required revisions, the vast majority were doing well, with an average TAS score of 3.0, a good range of motion and no signs of loosening. [1]
Reference
- Long WJ, Bryce CD, Hollenbeak CS, Benner RW, Scott WN. Total knee replacement in young, active patients: long-term follow-up and functional outcome: a concise follow-up of a previous report. J Bone Joint Surg Am. 2014 Sep 17;96(18):e159.
Source
Weinblatt AI, Bergstein VE, Taylor WL, Lyman S, Oettl FC, Scott WN, Long WJ. Total knee replacement in young, active patients: long-term follow-up and functional outcome: A final follow-up of previous report. Presented at the 2025 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 10-14, 2025, in San Diego, California.