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Minoda Y, Nakagawa S, Ueyama H, Warashina H, Kato M, Matsumoto T, Nozaki M, Kobayashi M, Horikoshi Y, Yasuda J. Clinical outcomes and radiolucent line analysis in cementless mobile-bearing total knee arthroplasty: a prospective multicentre study in Japan. Sci Rep 2024; 14:20902. [PMID: 39245768 DOI: 10.1038/s41598-024-71806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 08/30/2024] [Indexed: 09/10/2024] Open
Abstract
The objective of this study was to assess radiolucent lines (RLLs) and to determine their effect on clinical outcomes of the newly introduced cementless mobile-bearing total knee arthroplasty (TKA) system. This was prospective, multicentre study. Seventy-eight patients with knee osteoarthritis who underwent primary TKA were enrolled. Patient-reported outcome measures (PROMs) and radiographic assessments were evaluated at preoperative baseline and at 6 weeks, 1 year, and 2 years after surgery. KOOS, PKIP, 2011KSS, EQ-5D-3L and SKO improved from preoperative baseline to all postoperative timepoints, with no loosening of components. No RLLs were detected at 6 weeks after surgery. However, RLLs ≥ 1 mm developed in 2.8% of the patients for the femur and 9.7% for the tibia at 1 year after surgery, and values were 5.7% and 10.9%, respectively, at 2 years after surgery. RLL incidence was not correlated with PROMs. Age, sex, body mass index, range of motion knee flexion, posterior cruciate ligament treatment and β angle did not impact the occurrence of RLLs. There were no intraoperative complications, revisions or reoperations. This TKA system improved PROMs and showed less incidence of RLLs compared to the previous reported TKA without implant-related complications.
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | | | | | | | | | | | | | | | | | - Junko Yasuda
- Johnson & Johnson K.K. Medical Company, Tokyo, Japan
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Mosher ZA, Bolognesi MP, Malkani AL, Meneghini RM, Oni JK, Fricka KB. Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How? J Arthroplasty 2024; 39:S45-S53. [PMID: 38458333 DOI: 10.1016/j.arth.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients. METHODS This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed. RESULTS Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients. CONCLUSIONS Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation.
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Affiliation(s)
- Zachary A Mosher
- Anderson Orthopaedic Research Institute (AORI), Alexandria, Virginia; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University, Indianapolis, Indiana
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute (AORI), Alexandria, Virginia; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia
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Hall AJ, Cullinan R, Alozie G, Chopra S, Greig L, Clarke J, Riches PE, Walmsley P, Ohly NE, Holloway N. Total knee arthroplasty using a cemented single-radius, condylar-stabilized design performed without posterior cruciate ligament sacrifice. Bone Joint J 2024; 106-B:808-816. [PMID: 39084655 DOI: 10.1302/0301-620x.106b8.bjj-2023-1371.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without posterior cruciate ligament sacrifice. Methods This retrospective cohort study included consecutive patients undergoing TKA at a specialist centre in the UK between November 2010 and December 2012. Data were collected using a bespoke electronic database and cross-referenced with national arthroplasty audit data, with variables including: preoperative characteristics, intraoperative factors, complications, and mortality status. Patient-reported outcome measures (PROMs) were collected by a specialist research team at ten years post-surgery. There were 536 TKAs, of which 308/536 (57.5%) were in female patients. The mean age was 69.0 years (95% CI 45.0 to 88.0), the mean BMI was 32.2 kg/m2 (95% CI 18.9 to 50.2), and 387/536 (72.2%) survived to ten years. There were four revisions (0.7%): two deep infections (requiring debridement and implant retention), one aseptic loosening, and one haemosiderosis. Results Kaplan-Meier analysis demonstrated no difference in implant survival according to sex, age, or obesity status. Ten-year PROMs were available for 196/387 (50.6%) surviving patients and were excellent: mean Oxford Knee Score 34.4 (95% CI 32.7 to 36.1); mean Forgotten Joint Score (FJS) 51.2 (95% CI 16.1 to 86.3); mean EuroQol five-dimension five-level questionnaire score 69.9 (95% CI 46.8 to 93.0); 141/196 (71.9%) achieved the 22-point FJS patient-acceptable symptom state (PASS); and 156/196 (79.6%) were "very satisfied or satisfied". Conclusion This is the only large study reporting ten-year implant survival and functional outcomes of TKA using a cemented single-radius design and with a CS tibial bearing construct. The findings of excellent implant survival, safety, and functional outcomes indicate that this combination is a safe and effective option in routine TKA. Further investigation of this single-radius design TKA with CS tibial bearings with well-matched patient study groups will allow further insight into the performance of these implants.
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Affiliation(s)
- Andrew J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Fife Orthopaedics, National Treatment Centre, Kirkcaldy, UK
| | - Rachael Cullinan
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Glory Alozie
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Swati Chopra
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Leanne Greig
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Jon Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Scottish Arthroplasty Project, Public Health Scotland, Edinburgh, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Phil Walmsley
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Fife Orthopaedics, National Treatment Centre, Kirkcaldy, UK
- Scottish Arthroplasty Project, Public Health Scotland, Edinburgh, UK
| | - Nicholas E Ohly
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
| | - Nicholas Holloway
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
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Le GT, van Duren BH, Ilo K, Berber R, Matar HE, Bloch BV. Cementless TKA use as an alternative to cemented TKA in high BMI patients: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12067. [PMID: 39011084 PMCID: PMC11247335 DOI: 10.1002/jeo2.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/03/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient. To address the growing concerns around the longevity of implant fixation, some have advocated cementless over cemented fixation. However, there is no clear consensus on whether a cementless fixation has more favourable outcomes. The aim of this paper was to present a systematic review and meta-analysis of the existing evidence to establish if cementless TKA has a lower rate of aseptic loosening in high BMI patients when compared to cemented TKA procedures. Methods A systematic review was performed, and the following databases Medical Literature Analysis and Retrieval System Online (1946 to date), PubMed (1966 to date) and Excerpta Medica Database (1974 to date) were searched. All studies comparing cementless to cemented TKA in patients with BMI > 30 were considered. Meta-analysis compared aseptic loosening and all-cause revision between cemented and uncemented implant use in BMI > 30 patients. Results The search returned 91 articles in total; after duplicates were removed, the yield was 44 studies. Of the remaining studies that were assessed, three studies met the inclusion criteria for meta-analysis. The pooled odds ratio for all-cause revisions was 0.17 (95%, 0.08-0.36) in favour of uncemented implants (p < 0.01). The pooled odds ratio for aseptic loosening was 0.15 (95% confidence interval, 0.02-0.90) in favour of uncemented implants (p = 0.04). Conclusions Meta-analysis demonstrated a significant decrease in all-cause revisions and revisions for aseptic loosening when using uncemented fixation in high BMI patients when compared to the use of cemented implants. Level of Evidence The level of evidence is 1 for our systematic review.
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Affiliation(s)
- Giang Truong Le
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
| | - Bernard Hendrick van Duren
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK
| | - Kevin Ilo
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK
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Abdioğlu AA, Peker G. Comparison of bilateral cementless total knee arthroplasty results between patients in different BMI groups. Arch Orthop Trauma Surg 2024; 144:2317-2326. [PMID: 38642162 DOI: 10.1007/s00402-024-05335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION The aim of this study was to compare the results of cementless bilateral total knee arthroplasty (TKA) between individuals in different obesity groups. MATERIALS AND METHODS This was a retrospective cohort study. Patients with a body mass index (BMI) greater than 25 who underwent bilateral TKA for gonarthrosis between 2014 and 2020 and completed a minimum follow-up of 24 months were included. Age, sex, height, weight, BMI, operation time, length of stay, patient satisfaction, knee scores and complications were compared. Patients with missing data, who were followed for less than 24 months or had postoperative fractures around the knee were excluded. RESULTS There was a significant difference between the groups in terms of operation time (Class III > overweight > Class II > Class I p < 0.001). There was a significant difference in complications between the groups (Class III > Class I > Class II > overweight p = 0.010). According to our pairwise comparison, complications were more common in the class III group than in the overweight group. Knee score (KS) and function score (FS) increased significantly after surgery in all groups (p < 0.001), with no difference in FS (p = 0.448). Knee score changes were greater in the overweight and class I groups (p < 0.001). There was a significant interaction between both KS and FS and person satisfaction (p < 0.001). CONCLUSION Cementless TKA improved KS and FS in all obesity groups, yielded high patient satisfaction. Although the incidence of complications was higher in the morbidly obese patients than in the overweight patients, the difference was not significant. Patients with morbid obesity should be informed about related risks before planning cementless TKA.
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Affiliation(s)
- Ahmet Atilla Abdioğlu
- Department of Orthopedics and Traumatology, Fatih State Hospital, Trabzon, 61100, Turkey.
| | - Gökhan Peker
- Department Of Orthopedics and Traumatology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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Remily EA, Wilkie WA, Mohamed NS, Smith LS, Malkani AL, Jaggard CE, Kolisek FR, Monesmith EA, Nace J, Delanois RE. Sequentially Irradiated and Annealed Highly Cross-Linked Polyethylene: Clinical and Radiographic Outcomes in Total Knee Arthroplasty at 10-Year Follow-up. Orthopedics 2023; 46:e111-e117. [PMID: 36476288 DOI: 10.3928/01477447-20221129-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Highly cross-linked polyethylene (HXLPE) has become the preferred bearing surface in total hip arthroplasty. However, its acceptance in total knee arthroplasty (TKA) has not been as robust because of concerns pertaining to wear and its impact on implant failure. Therefore, this multicenter study was purposed to evaluate the 10-year (1) radiographic outcomes; (2) complications; and (3) implant survivorship in patients with TKA receiving a sequentially irradiated and annealed HXLPE. A retrospective, multi-center study was performed on 139 patients (171 TKAs) who underwent primary TKA with HXLPE and possessed a minimum of 10-year follow-up. Radiographs were analyzed for radiolucencies along the implant-fixation interface using the Modern Knee Society Radiographic Evaluation System. Kaplan-Meier analysis determined implant survivorship when the end points were revision for polyethylene wear and polyethylene revision for any reason. Sixteen TKAs (9.9%) demonstrated periprosthetic linear radio-lucencies. Seventeen TKAs (9.9%) required additional surgeries, 9 (5.3%) of which were revisions, with 1 (0.6%) TKA requiring revision because of polyethylene wear. Other causes of revision included instability (1.8%), infection (1.6%), and arthrofibrosis (1.6%). The mean time to revision was 5.9 years (range, 0.1-11.1 years). Survivorship pertaining to polyethylene revision for wear was 99.4%, whereas all-cause polyethylene revision was 94.7%. This study in patients undergoing primary TKA using a second-generation HXLPE demonstrated excellent results with respect to polyethylene wear characteristics and strength with a 99.4% survivorship at 10 years. [Orthopedics. 2023;46(2):e111-e117.].
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Schwabe MT, Hannon CP. The Evolution, Current Indications and Outcomes of Cementless Total Knee Arthroplasty. J Clin Med 2022; 11:jcm11226608. [PMID: 36431091 PMCID: PMC9693456 DOI: 10.3390/jcm11226608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Total knee arthroplasty (TKA) has been performed by orthopedic surgeons for decades, but the cementless TKA has only recently gained much interest in the world of arthroplasty. Initially, early designs had multiple complications, particularly with aseptic loosening due to osteolysis and micromotion. However, modifications have shown good outcomes and excellent survivorship. Over the last several decades, changes in implant designs as well as implant materials/coatings have helped with bone in growth and stability. Furthermore, surgeons have been performing TKA in younger and more obese patients as these populations have been increasing. Good results from the cementless TKA compared to cemented TKA may be a better option in these more challenging populations, as several studies have shown greater survivorship in patients that are younger and have a greater BMI. Additionally, a cementless TKA may be more cost effective, which remains a concern in today's healthcare environment. Overall, cemented and cementless TKA have great results in modern times and there is still a debate as to which implant is superior.
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Goh GS, Wells Z, Ong CB, Small I, Ciesielka KA, Fillingham YA. Does Body Mass Index Influence the Outcomes and Survivorship of Modern Cementless Total Knee Arthroplasty? J Arthroplasty 2022; 37:2171-2177. [PMID: 35644461 DOI: 10.1016/j.arth.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Higher body mass index (BMI) has been associated with higher rates of aseptic loosening following cemented total knee arthroplasty (TKA). However, there is a paucity of evidence on the effect of BMI on the durability of modern cementless TKA. We aimed to assess the association between BMI and clinical outcomes following cementless TKA and to determine if there was a BMI threshold beyond which the risk of revision significantly increased. METHODS We identified 1,408 cementless TKAs of a modern design from an institutional registry. Patients were classified into BMI categories: normal (n = 136), overweight (n = 476), obese class I (n = 423), II (n = 258), and III (n = 115). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and 12-item Short Form Health Survey scores were collected preoperatively and 2 years postoperatively. Survivorship was recorded at minimum 2 years (range, 24 to 88 months). BMI was analyzed as a continuous and categorical variable. RESULTS The improvement in patient-reported outcomes was similar across the groups. Thirty four knees (2.4%) were revised and 14 (1.0%) were for aseptic failure. Mean time-to-revision was 1.2 ± 1.3 years and did not differ across BMI categories (P = .455). Survivorship free from all-cause and aseptic revision was 97.1% and 99.0% at mean 4 years, respectively. Using Cox regression to control for demographics and bilateral procedures, BMI had no association with all-cause revision (P = .612) or aseptic revision (P = .186). Receiver operating characteristic curve analysis found no relationship between BMI and revision risk (c-statistic = 0.51). CONCLUSION BMI did not influence functional outcomes and survivorship of modern cementless TKA, possibly due to improved biological fixation at the bone-implant interface. Longer follow-up is necessary to confirm these findings.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zachary Wells
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian B Ong
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ilan Small
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kerri-Anne Ciesielka
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mercurio M, Gasparini G, Sanzo V, Familiari F, Castioni D, Galasso O. Cemented Total Knee Arthroplasty Shows Less Blood Loss but a Higher Rate of Aseptic Loosening Compared With Cementless Fixation: An Updated Meta-Analysis of Comparative Studies. J Arthroplasty 2022; 37:1879-1887.e4. [PMID: 35452802 DOI: 10.1016/j.arth.2022.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aim of this study was to update the current evidence on functional outcomes, complications, and reoperation rates between cemented and cementless total knee arthroplasty (TKA) by evaluating comparative studies published over the past 15 years. METHODS The PubMed, MEDLINE, Scopus, and the Cochrane Central databases were used to search keywords and a total of 18 studies were included. Random and fixed effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs). RESULTS A total of 5,222 patients were identified with a mean age of 64.4 ± 9.4 and 63 ± 8.6 years for the cemented and cementless TKA groups, respectively. The mean follow-up was 107.9 ± 30 and 104.3 ± 10 months for the cemented and cementless TKA groups, respectively. Cemented TKA showed a significantly greater postoperative Knee Society Score (MD = -0.95, 95% CI [-1.57, 0.33], P = .003) and range of motion (MD = -1.09, 95% CI [-1.88, -0.29], P = .0007), but no differences in other outcome scores were found. The incidence of periprosthetic joint infection, radiolucent lines, instability, and polyethylene wear was also comparable. Cemented TKA showed less perioperative blood loss (SMD = -438.41, 95% CI [-541.69, -35.14], P < .0001) but a higher rate of manipulation under anesthesia (OR = 3.39, 95% CI [1.64, 6.99], P = .001) and aseptic loosening (OR = 1.62, 95% CI [1.09, 2.41], P = .02) than cementless TKA. No differences were found in terms of the reoperation rate. CONCLUSION When cemented and cementless fixations are compared in primary TKA, comparable functional outcomes and reoperation rates can be achieved. Cemented TKA showed less blood loss but a higher rate of manipulation under anesthesia and aseptic loosening.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Valentina Sanzo
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Davide Castioni
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Olimpio Galasso
- Department of Orthopedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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Carlson BJ, Gerry AS, Hassebrock JD, Christopher ZK, Spangehl MJ, Bingham JS. Clinical outcomes and survivorship of cementless triathlon total knee arthroplasties: a systematic review. ARTHROPLASTY 2022; 4:25. [PMID: 35655250 PMCID: PMC9164316 DOI: 10.1186/s42836-022-00124-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Over the last decade, cementless total knee arthroplasty has demonstrated improved outcomes and survivorship due to advances in technologies of implant design, manufacturing capabilities, and biomaterials. Due to increasing interest in cementless implant design for TKA, our aim was to perform a systematic review of the literature to evaluate the clinical outcomes and revision rates of the Triathlon Total Knee system over the past decade. Methods A systematic review of the literature was conducted following PRISMA guidelines for patients who underwent total knee arthroplasty with cementless Triathalon Total Knee System implants. Patients had a minimum of two-year follow-up and data included clinical outcome scores and survivorship data. Results Twenty studies were included in the final analysis. The survivability of the Stryker Triathlon TKA due to all causes was 98.7%, with an aseptic survivability of 99.2%. The overall revision incidence per 1,000 person-years was 3.4. Re-revision incidence per 1,000 person-years was 2.2 for infection, and 1.3 for aseptic loosening. The average KSS for pain was 92.2 and the average KSS for function was 82.7. Conclusions This systematic review demonstrated excellent clinical outcomes and survivorship at a mean time of 3.8 years. Additional research is necessary to examine the long-term success of the Stryker Triathlon TKA and the use of cementless TKAs in obese and younger populations. Level of evidence III.
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Affiliation(s)
- Brian J Carlson
- Department of Orthopedics, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Maricopa, Phoenix, AZ, 85260, USA
| | - Adam S Gerry
- Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, Whitman, WA, 99202, USA
| | - Jeffrey D Hassebrock
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
| | - Zachary K Christopher
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA.
| | - Mark J Spangehl
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
| | - Joshua S Bingham
- Midwestern University, Arizona College of Osteopathic Medicine, 19555 N 59th Ave. Glendale, Los Angeles, AZ, 85308, USA
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11
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Desmarais J, Dalury D, Bernasek TL, Fisher DA, Nunley RM, Fickenscher MC, Gorab RS. A Short-Term Multicenter Analysis of Radiolucent Lines in a Single Uncemented Rotating Platform Implant for Total Knee Arthroplasty. Arthroplast Today 2022; 15:34-39. [PMID: 35392363 PMCID: PMC8980437 DOI: 10.1016/j.artd.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/18/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Uncemented total knee arthroplasty is increasing as a potential solution for aseptic loosening via biologic fixation and to increase operative efficiency. However, postoperative radiolucent lines (RLLs) remain a concern for some clinicians. We report on a multicenter analysis of these RLLs over a 2-year period to identify their incidence, progression, and clinical significance. Material and methods Institutional review board approval was obtained for this retrospective, multicenter case series. A total of 312 patients treated with a single cruciate-retaining, fully porous coated femoral and tibial component design were included in the study. All patients were evaluated clinically and radiographically in the early postoperative period and at final follow-up (average 2.0 years). Average age of the study group was 58.2 years, and average body mass index was 30.7. Of the total, 66% were male, and 34% were female. Two independent surgeons evaluated the radiographs at the initial postoperative visit and at the most recent follow-up for RLLs. Knee Society Scores and range of motion (ROM) were collected at each visit. Results We identified RLLs in 25% of patients. All RLLs were less than 1 mm in size and located at the periphery of the tibial implant. None of the RLLs were progressive. At the final follow-up, compared with early postoperative imaging, no new RLLs were identified. Average ROM in flexion was 124 degrees, and the average Knee Society Scores at the most recent clinical follow-up was 96. Conclusion RLLs are commonly seen following cementless TKA, most commonly underneath the tibial tray. Based on this data set, there does not appear to be progression of these RLLs with time, and they do not appear to have an effect on ROM or clinical outcome at 2 years.
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Affiliation(s)
| | | | | | | | | | | | - Robert S. Gorab
- Hoag Orthopedic Institute, Irvine, CA, USA
- Corresponding author. Hoag Orthopedic Institute, 16300 Sand Canyon Ave, Suite 511, Irvine, CA 92618, USA. Tel.: +1 714 318 7716.
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12
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Goh GS, Fillingham YA, Sutton RM, Small I, Courtney PM, Hozack WJ. Cemented Versus Cementless Total Knee Arthroplasty in Obese Patients With Body Mass Index ≥35 kg/m 2: A Contemporary Analysis of 812 Patients. J Arthroplasty 2022; 37:688-693.e1. [PMID: 34990755 DOI: 10.1016/j.arth.2021.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cemented total knee arthroplasty (TKA) has been shown to have higher failure rates in obese patients, and cementless TKA may provide more durable fixation. This study compared outcomes and survivorship of obese patients undergoing cemented and cementless TKA of the same modern design. METHODS We identified a consecutive series of 406 primary cementless TKA performed in obese patients with body mass index (BMI) ≥35 kg/m2 in 2013-2018. Each case was matched 1:1 with 406 cemented TKA based on age, sex, BMI, bearing surface, and year of surgery. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Short Form-12 were collected preoperatively, at 6 months and 2 years. Implant survivorship was recorded at mean 4.0 years (range 2.0-7.8). RESULTS There was no difference in mean BMI between the cemented (38.6 ± 3.4 kg/m2; range, 35-60) and cementless cohorts (38.7 ± 3.3 kg/m2; range, 35-54; P = .706). Both groups had similar final postoperative scores and improvement in scores at 2 years. Furthermore, a similar percentage met the minimal clinically important difference (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, 70.0% vs 71.2%, P = .700; Short Form-12 Physical, 74.1% vs 70.4%, P = .240). Both groups demonstrated high 7-year survivorship free from aseptic revision (99.0% vs 99.5%, P = .665). CONCLUSION Obese patients with BMI ≥35 kg/m2 undergoing cementless and cemented TKA of the same modern design had similar outcomes and survivorship at early to mid-term follow-up. Continued surveillance of this high-risk population is necessary.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yale A Fillingham
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ryan M Sutton
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ilan Small
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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13
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Erossy MP, Emara AK, Rothfusz CA, Klika AK, Bloomfield MR, Higuera CA, Jin Y, Krebs VE, Mesko NW, Molloy RM, Murray TG, Patel PD, Stearns KL, Schaffer JL, Strnad GJ, Piuzzi NS. Similar Healthcare Utilization and 1-Year Patient-Reported Outcomes between Cemented and Cementless Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis. J Knee Surg 2021; 36:530-539. [PMID: 34781394 DOI: 10.1055/s-0041-1739201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cementless fixation for total knee arthroplasty (TKA) has gained traction with the advent of newer fixation technologies. This study assessed (1) healthcare utilization (length of stay (LOS), nonhome discharge, 90-day readmission, and 1-year reoperation); (2) 1-year mortality; and (3) 1-year joint-specific and global health-related patient-reported outcome measures (PROMs) among patients who received cementless versus cemented TKA. Patients who underwent cementless and cemented TKA at a single institution (July 2015-August 2018) were prospectively enrolled. A total of 424 cementless and 5,274 cemented TKAs were included. The cementless cohort was propensity score-matched to a group cemented TKAs (1:3-cementless: n = 424; cemented: n = 1,272). Within the matched cohorts, 76.9% (n = 326) cementless and 75.9% (n = 966) cementless TKAs completed 1-year PROMs. Healthcare utilization measures, mortality and the median 1-year change in knee injury and osteoarthritis outcome score (KOOS)-pain, KOOS-physical function short form (PS), KOOS-knee related quality of life (KRQOL), Veteran Rand (VR)-12 mental composite (MCS), and physical composite (PCS) scores were compared. The minimal clinically important difference (MCID) for PROMs was calculated. Cementless TKA exhibited similar rates of median LOS (p = 0.109), nonhome discharge disposition (p = 0.056), all-cause 90-day readmission (p = 0.226), 1-year reoperation (p = 0.597), and 1-year mortality (p = 0.861) when compared with cemented TKA. There was no significant difference in the median 1-year improvement in KOOS-pain (p = 0.370), KOOS-PS (p = 0.417), KOOS-KRQOL (p = 0.101), VR-12-PCS (p = 0.269), and VR-12-MCS (p = 0.191) between the cementless and cemented TKA cohorts. Rates of attaining MCID were similar in both cohorts for assessed PROMs (p > 0.05, each) except KOOS-KRQOL (cementless: n = 313 (96.0%) vs. cemented: n = 895 [92.7%]; p = 0.036). Cementless TKA provides similar healthcare-utilization, mortality, and 1-year PROM improvement versus cemented TKA. Cementless fixation in TKA may provide value through higher MCID improvement in quality of life. Future episode-of-care cost-analyses and longer-term survivorship investigations are warranted.
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Affiliation(s)
- Michael P Erossy
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Ahmed K Emara
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | | | - Alison K Klika
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Michael R Bloomfield
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Carlos A Higuera
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Viktor E Krebs
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Nathan W Mesko
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Robert M Molloy
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Trevor G Murray
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Preetesh D Patel
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Kim L Stearns
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Jonathan L Schaffer
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Gregory J Strnad
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
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14
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Forgotten Joint Score Post Total Knee Arthroplasty and Its Correlation with the New Knee Society Score. Indian J Orthop 2021; 55:1175-1179. [PMID: 34824717 PMCID: PMC8586356 DOI: 10.1007/s43465-021-00452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND/PURPOSE Forgotten Joint Score (FJS) is designed to asses patient recovery post Total Knee Arthroplasty (TKA) in a new dimension. It assess the ability to forget the operated joint as artificial during activities of daily living. New Knee Society Score (NKSS) is developed to encompass objective and subjective outcome as well as an assessment of patient expectation and satisfaction. Our purpose was (1) to determine FJS at 1 year post TKA in Indian Patients, and (2) to assess convergent validity between FJS and the NKSS. We hypothesised that FJS should strongly correlate with the Satisfaction (SS) and Knee perception(KPS) sub-component of NKSS. METHODS We enrolled 181 patients who underwent primary TKA during an 8-month duration. They were prospectively followed up at 1-year review clinic when FJS and NKSS were administered. 169 patients completed the assessment forms and 13 patients were lost to follow-up. Statistical evaluation was done with Spearman correlation test. RESULTS Mean FJS at 1 year was 66.6 ± 25.9 with 14% ceiling and 1% floor effects. There was a mild to moderate correlation of FJS with NKSS (p < 0.001, r = 0.47) and its sub-scores (p < 0.001; r = 0.43 and r = 0.44). There was a weak correlation of FJS with NKSS sub-components of SS and KPS (p < 0.001; r = 0.37 and 0.25, respectively). CONCLUSION Mean FJS at 1 year post TKA showed convergent validity with NKSS; however, the correlation was not strong enough to use them interchangeably. Hypothesis that FJS should strongly correlate with the NKSS sub-components of satisfaction and joint perception was refuted. We conclude, FJS provides unique evaluation in recovery post TKA, different from NKSS. LEVEL OF EVIDENCE Level III.
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15
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Liu Y, Zeng Y, Wu Y, Li M, Xie H, Shen B. A comprehensive comparison between cementless and cemented fixation in the total knee arthroplasty: an updated systematic review and meta-analysis. J Orthop Surg Res 2021; 16:176. [PMID: 33673850 PMCID: PMC7934367 DOI: 10.1186/s13018-021-02299-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/10/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Whether the cement should be used in the total knee arthroplasty (TKA) was still in controversy. This meta-analysis was performed to compare the efficacy of two kinds of fixation. METHODS Randomized controlled trials (RCTs), prospective/retrospective observational studies from PubMed (on 2019 September), EMBASE (on 2019 September), and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science (on 2019 September) were searched. Only studies followed more than 2 years was included for the review. The PRISMA guidelines and Cochrane Handbook were adopted to assess the quality of the results reported in included studies to ensure that the results of our meta-analysis were reliable and veritable. The continuous and dichotomous outcomes were collected in a standard form, and the data were analyzed by Review Manager 5.3 software. Finally, the results were presented in the Forest plots. RESULTS Twenty-six studies involving 2369 patients in cementless TKA and 2654 patients in cemented TKA were included. The rate of revision was not significantly different in two groups (p = 0.55). More than eight reasons caused revision were found in our study, the aseptic loosing was the most common, followed by the periprosthetic joint infection (PJI), neither was significantly different (p = 0.88 and 0.45, respectively). While significantly better long-term functional recovery was found in cementless TKA in terms of Knee Society Function Score (p = 0.004) and manipulation under anesthesia (p = 0.007). CONCLUSION Cementless fixation did not decrease the rate of revision after the total knee arthroplasty compared with the cemented fixation, while the long-term functional recovery was significantly better in the cementless group.
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Affiliation(s)
- Yuan Liu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China.,Department of Orthopaedic surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Mingyang Li
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Huiqi Xie
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China.
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16
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Is obesity associated with short-term revision after total knee arthroplasty? An analysis of 121,819 primary procedures from the Dutch Arthroplasty Register. Knee 2020; 27:1899-1906. [PMID: 33220579 DOI: 10.1016/j.knee.2020.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of obesity is increasing. The association with knee osteoarthritis is well documented, resulting in the population requesting total knee arthroplasty (TKA) for invalidating symptoms to be heavier in nature. The purpose of the current analysis was to assess the association between preoperative body mass index (BMI) and short-term revision rate after TKA. The secondary aim was to investigate the influence of implant fixation method on the association between BMI and survivorship. METHODS This is a retrospective analysis of prospectively collected registry data (Dutch Arthroplasty Register; LROI). All primary TKA procedures in patients >18 years of age with registered BMI were selected (n = 121,819). Non-obese patients (BMI 18-25) were compared with overweight (BMI 25-30) and class I-III obese (BMI >30, >35, >40) patients. Crude all-cause revision rates were calculated using competing risk analysis. Adjusted hazard ratios (HRs) were determined with Cox multivariable regression analyses for all-cause, septic and aseptic revision and secondary patellar resurfacing. RESULTS Revision rates were 3.3% for non-obese patients, 3.5% for overweight patients, 3.7% for class I obese patients, 3.6% for class II obese patients and 3.7% for class III obese patients. Class III obese patients had a significant higher risk for septic revision compared with non-obese patients (HR 1.53, 95% confidence interval (CI) 1.06-2.22). Class I obese patients had a higher risk for secondary patellar resurfacing (HR 1.52, 95% CI 1.12-2.08). All-cause and aseptic revision rates were similar between BMI groups. CONCLUSIONS Obesity appeared to be associated with some short-term revision risks after TKA, but was not associated with an overall increase in revision rate.
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17
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Salem HS, Tarazi JM, Ehiorobo JO, Marchand KB, Mathew KK, Sodhi N, Mont MA. Cementless Fixation for Total Knee Arthroplasty in Various Patient Populations: A Literature Review. J Knee Surg 2020; 33:848-855. [PMID: 32259851 DOI: 10.1055/s-0040-1708880] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The number of total knee arthroplasties (TKAs) performed in the United States has increased considerably in recent years, with a major contribution from younger patients. Maximizing survivorship of these implants has always been a point of emphasis. Early TKA designs with cementless fixation were associated with high rates of complications and implant failures. However, recent advances in cementless designs have shown excellent results. The decision to use cemented or cementless fixation for patients undergoing TKA is typically based on the surgeon's experience and preference. However, several patient characteristics must also be taken into account. The purpose of this review was to describe the clinical outcomes of studies in which a cementless TKA system was utilized for patients who (1) were less than 60 years of age, (2) were greater than 75 years of age, (3) were obese, (4) had rheumatoid arthritis, and (5) had osteonecrosis of the knee. Based on the studies included in this review, it appears that cementless fixation is a viable option for patients who have all of the above demographics.
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Affiliation(s)
- Hytham S Salem
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - John M Tarazi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Kevin B Marchand
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
| | - Kevin K Mathew
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
| | - Nipun Sodhi
- Department of Orthopaedic surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
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18
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Batailler C, Malemo Y, Demey G, Kenney R, Lustig S, Servien E. Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up. J Arthroplasty 2020; 35:2090-2096. [PMID: 32312645 DOI: 10.1016/j.arth.2020.03.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The type of total knee arthroplasty (TKA) fixation (cemented or uncemented) is still subject to debate. The aim of this study is to assess the survival rate, clinical outcomes, and radiological results of TKA according to the fixation type. METHODS A total of 130 patients were randomly assigned to either the cement group (cemented femoral and tibial implants) or the hybrid group (cemented tibial implant, uncemented femoral implant). The inclusion criteria were patients between 50 and 90 years old who underwent primary TKA for osteoarthritis between 2004 and 2005 without a history of open knee surgery. Revisions and complications were reported, as well as clinical scores and radiological signs of loosening. RESULTS One hundred eighteen patients had complete data at 10 years of minimum follow-up (59 in each group). The mean age was 72 years old. The mean follow-up was 13 years. The survival rate was 98% at 13 years in both groups (1 aseptic loosening at 2 years in the cement group, 1 septic loosening in the hybrid group). The complication rate in the cement group was 8.5% (n = 5) vs 12.1% (n = 7) in the hybrid group (P = .8). The clinical results were not significantly different. In the cement group, 25% of patients (n = 15) had radiolucent lines at 10 years. In the hybrid group, 33% of patients had bone transparencies, not evolving or symptomatic. CONCLUSION At a minimum follow-up of 10 years, there were no significant differences between cemented TKA and hybrid TKA for the survivorship, the complication rate, the clinical scores, or the radiological signs of loosening. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Yves Malemo
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Guillaume Demey
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Raymond Kenney
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, Villeurbanne, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Ryu DJ, Sonn CH, Hong DH, Kwon KB, Park SJ, Ban HY, Kwak TY, Lim D, Wang JH. Titanium Porous Coating Using 3D Direct Energy Deposition (DED) Printing for Cementless TKA Implants: Does It Induce Chronic Inflammation? MATERIALS 2020; 13:ma13020472. [PMID: 31963803 PMCID: PMC7014007 DOI: 10.3390/ma13020472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
Because of the recent technological advances, the cementless total knee arthroplasty (TKA) implant showed satisfactory implant survival rate. Newly developed 3D printing direct energy deposition (DED) has superior resistance to abrasion as compared to traditional methods. However, there is still concern about the mechanical stability and the risk of osteolysis by the titanium (Ti) nanoparticles. Therefore, in this work, we investigated whether DED Ti-coated cobalt-chrome (CoCr) alloys induce chronic inflammation reactions through in vitro and in vivo models. We studied three types of implant surfaces (smooth, sand-blasted, and DED Ti-coated) to compare their inflammatory reaction. We conducted the in vitro effect of specimens using the cell counting kit-8 (CCK-8) assay and an inflammatory cytokine assay. Subsequently, in vivo analysis of the immune profiling, cytokine assay, and histomorphometric evaluation using C57BL/6 mice were performed. There were no significant differences in the CCK-8 assay, the cytokine assay, and the immune profiling assay. Moreover, there were no difference for semi-quantitative histomorphometry analysis at 4 and 8 weeks among the sham, smooth, and DED Ti-coated samples. These results suggest that DED Ti-coated printing technique do not induce chronic inflammation both in vitro and in vivo. It has biocompatibility for being used as a surface coating of TKA implant.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.J.R.); (K.B.K.); (S.J.P.)
| | - Chung-Hee Sonn
- Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (C.-H.S.); (D.H.H.)
| | - Da Hee Hong
- Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (C.-H.S.); (D.H.H.)
| | - Kyeu Back Kwon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.J.R.); (K.B.K.); (S.J.P.)
| | - Sang Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.J.R.); (K.B.K.); (S.J.P.)
| | - Hun Yeong Ban
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Korea; (H.Y.B.); (T.Y.K.)
| | - Tae Yang Kwak
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Korea; (H.Y.B.); (T.Y.K.)
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Korea; (H.Y.B.); (T.Y.K.)
- Correspondence: (D.L.); (J.H.W.); Tel.: +82-2-3408-3672 (D.L.); +82-2-3410-3507 (J.H.W.); Fax: +82-2-3408-4333 (D.L.); +82-2-3410-0061 (J.H.W.)
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.J.R.); (K.B.K.); (S.J.P.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Correspondence: (D.L.); (J.H.W.); Tel.: +82-2-3408-3672 (D.L.); +82-2-3410-3507 (J.H.W.); Fax: +82-2-3408-4333 (D.L.); +82-2-3410-0061 (J.H.W.)
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20
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Costales TG, Chapman DM, Dalury DF. The Natural History of Radiolucencies Following Uncemented Total Knee Arthroplasty at 9 Years. J Arthroplasty 2020; 35:127-131. [PMID: 31537374 DOI: 10.1016/j.arth.2019.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aseptic loosening remains a common cause of failure in total knee arthroplasty (TKA). There is an increased interest in using uncemented TKA to reduce this complication. Radiolucencies (RLs) following uncemented TKA can be concerning. We report on the 9-year history of RLs in patients with uncemented TKA. METHODS Twenty-one patients (26 knees) were treated with a cruciate-retaining fully porous coated femur/tibia and cemented patella. At final follow-up, 17 patients (22 knees) were available for review. Average follow-up was 9.6 years, average age was 59.1, and average body mass index was 34.1. X-rays were taken at 6 weeks, 1 year, and at final follow-up. RLs were measured using the Knee Society scoring system and read by two separate surgeons. RESULTS At 6 weeks, we identified RL in all patients on both the tibia and femur. The majority were beneath the tibial tray and femoral chamfer. At 1 year, 4 femurs and 4 tibias showed new RLs (<2 mm) in similar zones. Eighteen femurs and 18 tibias showed fewer or no change in RLs. At final follow-up, no new tibia or femur developed a new RL. In total, 9 of the 22 tibias and 17 of the 22 femurs had remaining RLs, all less than 2 mm and none were progressive or new. Knee Society Score averaged 92.5 (6 weeks), 95.1 (1 year), and 97.3 (final). CONCLUSION RLs are common following uncemented TKA. Many resolve by 1 year. There does not appear to be any association between the presence of RLs and long-term follow-up function in this group of patients.
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Affiliation(s)
- Timothy G Costales
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MA
| | - Danielle M Chapman
- Orthopaedic Institute at St. Joseph's Medical Center, Towson Orthopaedic Associates, Towson, MA
| | - David F Dalury
- Orthopaedic Institute at St. Joseph's Medical Center, Towson Orthopaedic Associates, Towson, MA
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