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Van Meirhaeghe JP, Harris IA, Cuthbert A, Lorimer M, McAuliffe M, Adie S, Molnar R. The influence of implant factors on patient outcomes in primary total knee arthroplasty. J Orthop 2024; 58:154-160. [PMID: 39157416 PMCID: PMC11326491 DOI: 10.1016/j.jor.2024.07.011] [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: 05/02/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024] Open
Abstract
Background The influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA. Methods Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders. Results At six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06-1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11-1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06-1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02-1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01-1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05-1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.034) were associated. Conclusion Utilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.
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Affiliation(s)
- Jan Peter Van Meirhaeghe
- Sydney Orthopaedic Trauma and Reconstructive Surgery (SOTRS), Sydney, Australia
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Ian A. Harris
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Alana Cuthbert
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michelle Lorimer
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michael McAuliffe
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Australia
- Queensland University of Technology (QUT - Gardens Point), Australia
| | - Sam Adie
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
| | - Robert Molnar
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
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Sheridan GA, Neufeld ME, Howard LC, Garbuz DS, Masri BA. Short-term survival of the cementless triathlon total knee arthroplasty in a young patient cohort. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05481-5. [PMID: 39249136 DOI: 10.1007/s00402-024-05481-5] [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: 01/31/2024] [Accepted: 07/23/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The purpose of this study is to assess the short-term survivorship of a new cementless total knee arthroplasty (TKA) design in comparison to its cemented predecessor design in a young patient cohort less than 65 years of age. METHODS We performed a retrospective cohort study of all primary TKAs (cemented and cementless) in patients under the age of 65 at the time of the index procedure, in a single institution between May 2018 and May 2019. Primary outcome variables included aseptic revision and all-cause revision. Operative time was a secondary variable. Independent variables considered included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, implant type (cruciate-retaining (CR) or posterior-stabilised (PS)) and the use of cemented or cementless implants. RESULTS There were 106 cemented TKAs and 152 cementless TKAs (Triathlon, Stryker Inc, Mahwah, NJ ) implanted. The minimum follow-up for all cases was 2 years (mean cementless 32.5 months, mean cemented 34.9 months). Of the entire 258 implants only 2 were revised. Both revisions occurred in the cemented cohort for prosthetic joint infection (PJI). The all-cause revision rate in the cementless cohort was 0% compared to 1.8% in the cemented cohort (p = 0.168). Operative times were significantly reduced from 62 min in the cemented cohort to 52.2 min in the cementless cohort (p < 0.001). CONCLUSION In a young patient cohort, the cementless Triathlon TKA demonstrates excellent survivorship at short-term follow-up with significant reductions in operative times when compared to the cemented Triathlon TKA.
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Affiliation(s)
- Gerard A Sheridan
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
| | - Michael E Neufeld
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Lisa C Howard
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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Chen AG, Sogbein OA, McCalden RW, Bohm ER, Lanting BA. Survivorship of Modern Cementless Total Knee Arthroplasty: Analysis From the Canadian Joint Replacement Registry. J Arthroplasty 2024:S0883-5403(24)00808-8. [PMID: 39127311 DOI: 10.1016/j.arth.2024.08.003] [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: 04/01/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is rising in popularity. The literature supporting its use over cemented TKA remains sparse. Using the Canadian Joint Replacement Registry (CJRR), we sought to investigate cementless versus cemented fixation in modern primary TKA and (1) determine whether there is an overall difference in revision by fixation, (2) perform a subanalysis of the most-commonly used cementless TKA brand in Canada, and (3) identify the reasons for revision. METHODS The CJRR data was used to analyze TKA designs with cemented and cementless versions. Revision risk is reported as all-cause cumulative percent revision (CPR). Reasons for revision were analyzed. Cox proportional hazards models were used to report adjusted hazard ratios (HR) controlling for age, sex, patella resurfacing, and bearing constraints. We included 202,880 primary TKAs performed between 2012 and 2021. Of those, 9,163 (4.5%) were cementless. RESULTS The CPR at 8 years was 4.49% for cementless and 3.14% for cemented implants. After adjusting for confounders, we did not detect a difference in revision risk overall (HR 0.87 [95% CI (confidence interval) 0.73 to 1.04], P = 0.128). However, the most commonly used cementless TKA brand demonstrated a CPR of 1.95% compared to 2.19% for its cemented version at 4 years. Furthermore, we detected a significantly lower revision risk compared to its cemented version after adjusting for confounders (HR 0.66 [95% CI 0.51 to 0.85], P = 0.001). The 4 most common reasons for revision in both groups were the following: (1) infection, (2) instability, (3) aseptic loosening, and (4) pain of unknown origin. CONCLUSIONS Using CJRR data adjusted for confounding factors, no difference in revision risk was detected between cemented and cementless implants overall. However, for the most common brand of cementless TKA used in Canada, there was a lower risk of revision than its corresponding cemented version. The reasons for revision were similar.
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Affiliation(s)
- Aaron G Chen
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Olawale A Sogbein
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Eric R Bohm
- Division of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Concordia Hip and Knee Institute, Winnipeg, Manitoba, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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4
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Humez M, Kötter K, Skripitz R, Kühn KD. Evidence for cemented TKA and THA based on a comparison of international register data. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:597-607. [PMID: 38568216 PMCID: PMC11329679 DOI: 10.1007/s00132-024-04489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Hip and knee implants can either be fixed without cement, press-fit, or with bone cement. Real-world data from arthroplasty registers, as well as studies provide a broad database for the discussion of cemented versus uncemented arthroplasty procedures. OBJECTIVE What does current evidence from international arthroplasty registries and meta-analyses recommend regarding cemented or cementless fixation of hip and knee implants? METHODS A recommendation is generated by means of direct data comparison from the arthroplasty registries of eight countries (USA, Germany, Australia, UK, Sweden, Norway, New Zealand, Netherlands), the comparison of 22 review studies and meta-analyses based on registry data, as well as an evaluation of recommendations of healthcare systems from different nations. For this purpose, reviews and meta-analyses were selected where the results were statistically significant, as were the annual reports of the arthroplasty registries that were current at the time of writing. RESULTS For knee arthroplasties, long survival time as well as lower risk of revision can be achieved with the support of cemented fixation with antibiotic-loaded bone cement. In patients aged 70 years and older, cemented fixation of hip stem implants significantly reduces risk of intraoperative or postoperative periprosthetic fracture (quadruple). This applies both to elective total hip arthroplasties and to hemiarthroplasty after femoral neck fractures. Antibiotic-loaded bone cement significantly (p = 0.041) reduces the risk of periprosthetic infection, especially in patients with femoral neck fractures. CONCLUSION Total knee replacement with antibiotic-loaded bone cement is well established internationally and is evidence-based. Registry data and meta-analyses recommend cemented fixation of the hip stem in older patients. In Germany, USA and Australia these evidence-based recommendations still must be transferred to daily practice.
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Affiliation(s)
- Martina Humez
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstraße 81, 35392, Giessen, Germany.
| | | | - Ralf Skripitz
- Centre for Endoprosthetics, Foot Surgery, Paediatric and General Orthopaedics, Roland-Klinik Bremen, Bremen, Germany
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Graz, Germany
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Molho D, Vaidya S, O’Sullivan D, Vye D, Nelson S, Bernstein J. Cemented vs Cementless Robotic-Assisted Total Knee Arthroplasty Yield Similar Short-Term Clinical Outcomes. Arthroplast Today 2024; 27:101360. [PMID: 38690095 PMCID: PMC11058072 DOI: 10.1016/j.artd.2024.101360] [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: 10/24/2023] [Revised: 01/04/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background In primary total knee arthroplasty (TKA), there is ongoing controversy about optimal fixation (cemented vs cementless). Cemented TKA remains the gold standard, with the largest body of long-term evidence available to support it. However, cementless TKA implants are gaining popularity due to potential biomechanical advantages and a growing body of literature supporting survivorship. Due to paucity of literature investigating fixation methods in robotic-assisted TKA (Ra-TKA), we aim to compare clinical outcomes of cementless Ra-TKA with those of cemented Ra-TKA. Methods This is a retrospective cohort study of patients who underwent Ra-TKA by 19 surgeons comparing results of cases using cementless vs cemented fixation. We observed short-term complications, emergency room visits, and readmissions. We collected patient-reported outcomes measurement information system and knee injury and osteoarthritis outcome scores preoperatively and 12 weeks after surgery. Results A total of 582 TKA cases were included: 335 cementless and 247 cemented. The patients in the cementless group were younger and had a higher body mass index. The cemented group had a higher rate of return to the operating room, with manipulation under anesthesia for stiffness being the most common indication in both groups. There were no statistically significant differences in 30-day readmissions, 90-day emergency room visits, or patient-reported outcomes. Conclusions Our retrospective study demonstrated higher return to operating room in the cemented group vs the cementless group. We reported no differences in any other short-term outcomes between the cementless and cemented Ra-TKA. Our data support efficacy and safety of cementless Ra-TKA at 3-month follow-up.
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Affiliation(s)
- David Molho
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Swaroopa Vaidya
- Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - David O’Sullivan
- Hartford HealthCare Research Program, Hartford Healthcare, Hartford, CT, USA
| | - Dianne Vye
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Stephen Nelson
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Jenna Bernstein
- Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA
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Aguado HJ, Castillón-Bernal P, Teixidor-Serra J, García-Sánchez Y, Muñoz-Vives JM, Camacho-Carrasco P, Jornet-Gibert M, Ojeda-Thies C, García-Portabella P, Pereda-Manso A, Mateos-Álvarez E, Manzano-Mozo J, Carrillo-Gómez R, País-Ortega S, García-Virto V, Noriega-González D, Álvarez-Ramos BA, Ganso-Pérez A, Cervera-Díaz C, Plata-García M, Ortega-Briones A, Berrocal-Cuadrado J, Criado del Rey-Machimbarrena D, Salvador J, Rey L, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Querolt-Coll J, Triana G, Vives-Barquiel M, Renau-Cerrillo M, Campuzano-Bitterling B, Hernández JM, Ostilla R, Carreras-Castañer A, Torner P, Díaz-Suárez R, Fernández EA, Olaya-González C, Fernández-Villán M, García de Cortázar U, Arrieta M, Escobar D, Castrillo E, Balvis P, Rodríguez-Arenas M, García-Pérez Á, Moreta J, Bidea I, Jiménez-Urrutia X, Olías-López B, Boluda-Mengod J, González-Martín D, Bárcena-Goitiandia L, López-Dorado D, Borrás-Cebrián JC, García-Aguilera D, Freile-Pazmiño PA, Suárez-Suárez MÁ, Lanuza-Lagunilla L, García-Arias A, Sánchez-Saz J, García-Coiradas J, Valle-Cruz J, Mora-Fernández J, Cano-Leira MÁ, Rieiro G, Benjumea-Carrasco A, Priego-Sánchez RJ, Sánchez-Pérez C, Guadilla-Arsuaga J, Fernández-Juan A, Sánchez P, Ricón J, Fuentes-Díaz A, García-García EM, Cuadrado-Abajo F, García-Portal G, del PozoManrique P, Castillo del Pozo V, Garcia-Navas FM, García-Paredero E, Beteta-Robles T, Guijarro-Valtueña A, Gutiérrez-Baiget G, Alonso-García N, Navas-Pernía I, Ariza-Herrera D, Vilanova J, Videla-Cés M, Serra-Porta T, Vázquez-García C, Carrasco-Becerra C, Pena-Paz S, Otero-Naveiro V, Fernández-Billón-Castrillo I, Martínez-Menduiña A, Hernández-Galera C, Fernández-Dorado F, Madrigal-López M, Murcia-Asensio A, Galián-Muñoz E, Castro-Sauras Á, Espallargas-Doñate T, Royo-Agustín M, Plaza-Salazar N, Gámez-Asunción C, Muñoz-Vicente A, Pareja-Sierra T, Benito-Santamaría J, Cuenca-Copete A, Verdejo-González A, González-Montero B, Giraldo-Vegas LA, Alonso-Viana L, Díez-Pérez EJ, Briso-Montiano R, Andrés AI, Mingo-Robinet J, Naharro-Tobío M, Escudero-Martínez E, Serrano-Sanz J, Peñalver-Matamoros JM, Fernàndez-Poch N, Martínez-Carreres L, Macho-Mier M, Martín-Hernández C, Laclériga-Giménez AF, Saló-Cuenca JC, Salamanca-Ontiveros C, Espona-Roselló J, Altemir-Martínez V, Criado-Albillos G, Cunchillos-Pascual J, Millán-Cid M, Cabello-Benavides HG, Martínez-Íñiguez-Blasco J, Sevilla-Ortega P, Cano JR, Ramírez A, Marqués-López F, Martínez-Díaz S, Carabelli GS, Slullitel PA, Astore I, Boietti BR, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Dot-Pascuet I, Pereira-Mosquera E, Martín-Antúnez J, Pérez JM, Mandía-Martínez A, De Caso J, Martín-Marcuello J, Benito-Mateo M, Murillo-Vizuete AD, Delgado LG, dela Herrán G, Nunes N, Pérez-Coto I, González-Panisello MR, Iglesias-Fernández S, Ruete-Gil GL, Ramos-García S, Villarreal JP. Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 2024; 25:13. [PMID: 38451303 PMCID: PMC10920552 DOI: 10.1186/s10195-024-00746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. METHODS PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. RESULTS The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. CONCLUSIONS Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. TRIAL REGISTRATION registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.
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Humez M, Kötter K, Skripitz R, Kühn KD. [Register data on cemented arthroplasty : A proof for cementless fixation?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:163-175. [PMID: 37889315 PMCID: PMC10896946 DOI: 10.1007/s00132-023-04451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Hip and knee implants can be either fixated without cement, press-fit, or with bone cement. Real-world data from arthroplasty registers, as well as studies, provide a broad database for the discussion of cemented versus uncemented arthroplasty procedures. OBJECTIVES What is the recommendation for cemented or cementless anchorage of hip and knee implants based on the current evidence from international arthroplasty registries and meta-analyses? METHODS A recommendation is generated by means of a direct comparison of data from the arthroplasty registries of eight different countries (USA, Germany, Australia, UK, Sweden, Norway, New Zealand, and The Netherlands), the comparison of 22 review studies and meta-analyses based on registry data, as well as the evaluation of the recommendation of healthcare systems of different nations. For this purpose, reviews and meta-analyses whose results were statistically significant were selected, as were the annual reports of the arthroplasty registries that were current at the time of writing. RESULTS For knee endoprostheses, a long survival time, as well as a lower risk of revision can be achieved with the help of cemented anchorage with antibiotic-laden bone cement. In patients aged 70 years and older, cemented anchorage of the hip stem implant significantly reduces the risk of intraoperative or postoperative periprosthetic fracture (times four), this applies both to elective total hip arthroplasties (TEPs) and to hemiarthroplasty after femoral neck fractures. Antibiotic-loaded bone cement significantly (p = 0.041) reduces the risk of periprosthetic infection, especially in patients with femoral neck fractures. CONCLUSIONS Total knee replacement with antibiotic-loaded bone cement is well established in Germany and evidence based. Registry data and meta-analyses recommend cemented fixation of the hip stem in older patients-in Germany the evidence-based recommendations must still be transferred to daily practice.
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Affiliation(s)
- Martina Humez
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland.
| | - Katharina Kötter
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland
| | - Ralf Skripitz
- Zentrum für Endoprothetik, Fußchirurgie, Kinder- und Allgemeine Orthopädie, Roland-Klinik Bremen, Bremen, Deutschland
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Österreich
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Wilczyński M, Bieniek M, Krakowski P, Karpiński R. Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1136. [PMID: 38473607 DOI: 10.3390/ma17051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Knee osteoarthritis (OA) is one of the leading causes of disability around the globe. Osteoarthritis is mainly considered a disease affecting the elderly. However, more and more studies show that sports overuse, obesity, or congenital disorders can initiate a pathologic cascade that leads to OA changes in the younger population. Nevertheless, OA mostly affects the elderly, and with increasing life expectancy, the disease will develop in more and more individuals. To date, the golden standard in the treatment of the end-stage of the disease is total joint replacement (TJR), which restores painless knee motion and function. One of the weakest elements in TJR is its bonding with the bone, which can be achieved by bonding material, such as poly methyl-methacrylate (PMMA), or by cementless fixation supported by bone ingrowth onto the endoprosthesis surface. Each technique has its advantages; however, the most important factor is the revision rate and survivor time. In the past, numerous articles were published regarding TJR revision rate, but no consensus has been established yet. In this review, we focused on a comparison of cemented and cementless total knee replacement surgeries. We introduced PICO rules, including population, intervention, comparison and outcomes of TJR in a PubMed search. We identified 783 articles published between 2010 and 2023, out of which we included 14 in our review. Our review reveals that there is no universally prescribed approach to fixate knee prostheses. The determination of the most suitable method necessitates an individualized decision-making process involving the active participation and informed consent of each patient.
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Affiliation(s)
- Mikołaj Wilczyński
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Michał Bieniek
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Przemysław Krakowski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
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Edgar M, Harvey J, Jiang S, Walters J, Kozina E, Kaplan N, Redondo M, Zabawa L, Chmell S. Cemented total knee arthroplasty provides greater knee range of motion at 2 years than cementless technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3561-3568. [PMID: 37231309 DOI: 10.1007/s00590-023-03596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Optimal fixation method between cemented, cementless, and hybrid techniques for total knee arthroplasty (TKA) is still debated. The purpose of this study is to evaluate the clinical outcomes of patients undergoing cemented versus cementless TKA. METHODS We reviewed 168 patients who underwent a primary TKA at a single academic institution between January 2015 and June 2017. Patients were categorized into cemented (n = 80) or cementless (n = 88) groups. Only patients with greater than or equal to 2-year follow-up were included in the study. Multivariate regressions were performed to analyze the relationship between the surgical fixation technique and the clinical outcomes. RESULTS There were no differences in demographics or baseline operative characteristics between the two groups. The cemented group had fewer manipulations under anesthesia (MUA) (4 vs. 15, p = 0.01), longer intraoperative tourniquet times (101.30 vs. 93.55 min, p = 0.02), and increased knee range of motion (ROM) at final follow-up (111.48 vs. 103.75°, p = 0.02) compared to the cementless group. DISCUSSION AND CONCLUSION Both cemented and cementless component fixation are viable options for (TKA). This study found that patients who underwent a cemented TKA required fewer MUA's and had greater final ROM compared to patients undergoing cementless TKA. Additional research is required regarding cementless and cemented fixation. We believe that the choice of which fixation technique to use ultimately comes down to patient characteristics and surgeon preference.
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Affiliation(s)
- Michael Edgar
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA.
| | - Jack Harvey
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Sam Jiang
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Jhunelle Walters
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Erik Kozina
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Nicholas Kaplan
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Michael Redondo
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Luke Zabawa
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Samuel Chmell
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
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10
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Connolly P, Coombs S, Schwarzkopf R. Mechanical complications after total knee arthroplasty. Expert Rev Med Devices 2023; 20:1105-1117. [PMID: 37950354 DOI: 10.1080/17434440.2023.2282744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for patients, it is extremely important for surgeons to be able to anticipate and prevent TKA mechanical complications. Surgeons must be familiar with the different causes and mechanisms of TKA complications so that they can properly treat patients with failed TKAs and better avoid these complications. AREAS COVERED This review addresses TKA mechanical complications and provides context for the topic. A detailed review of surgical factors, implant factors, and patient factors that contribute to mechanical complications after TKA is provided. All of the literature cited in this review was gathered from the PubMed online database using different keywords based on the section of the manuscript. EXPERT OPINION As surgeons and engineers solve certain issues in TKA, new challenges will inevitably arise. We must continue to push forward and innovate from both a surgical technique and implant design perspective.
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Affiliation(s)
- Patrick Connolly
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Stefan Coombs
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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11
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Gibbons JP, Cassidy RS, Bryce L, Napier RJ, Bloch BV, Beverland DE. Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? J Arthroplasty 2023; 38:691-699. [PMID: 36272510 DOI: 10.1016/j.arth.2022.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. METHODS This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. RESULTS There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. CONCLUSION Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.
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Affiliation(s)
- John P Gibbons
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Roslyn S Cassidy
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Leeann Bryce
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Richard J Napier
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - David E Beverland
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
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Powell D, Comer B, Hallstrom B, Zheng H, Hughes R, Markel D. Early Survivorship of Uncemented Total Knee Arthroplasty Varies by Age and Sex based on Data from the Michigan Arthroplasty Registry Collaborative Quality Initiative. J Arthroplasty 2023:S0883-5403(23)00204-8. [PMID: 36889526 DOI: 10.1016/j.arth.2023.02.073] [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: 11/28/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Outcome data for newer uncemented total knee arthroplasty designs has been mixed. Registry studies showed worse survivorship, but clinical trials have not demonstrated differences compared to cemented designs. There has been renewed interest in uncemented TKA with modern designs and improved technology. The utilizations of uncemented knees in Michigan, 2-year outcomes, and the effects of age and sex were evaluated. METHODS A statewide database from 2017 through 2019 was analyzed for incidence, distribution, and early survivorship of cemented vs. uncemented TKAs. There was 2-year minimum follow-up. Kaplan-Meier survival analysis was used to generate time to first revision cumulative percent revision (CPR) curves. The impacts of age and sex were examined. RESULTS Use of uncemented TKAs increased from 7.0 to 11.3%. Uncemented TKAs were more commonly men, younger, heavier, American Society of Anesthesiologists (ASA) Score>2, and opioid users (p<0.05). At 2 years, overall CPR was higher in uncemented (2.44% [2.00, 2.99] versus cemented (1.76% [1.64, 1.89]), particularly in women (uncemented (2.41 [1.87, 3.12]) vs cemented (1.64 [1.50, 1.80]). Revision rates were greater with uncemented women >70 years (1.2% 1 year, 1.02% 2 years) vs <70 years (0.56%, 0.53%), notably uncemented were inferior in both groups (p<0.05). Men, regardless of age, had similar survivorships with both cemented and uncemented designs. CONCLUSION The use of an uncemented TKA had an increased risk of early revision compared to cemented. This finding, however, was only apparent in women, especially those >70 years old. Surgeons should consider cement fixation in women >70 years.
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Affiliation(s)
- Dexter Powell
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America.
| | - Brendan Comer
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America
| | - Brian Hallstrom
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Huiyong Zheng
- MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - Richard Hughes
- University of Michigan Department of Orthopaedic Surgery, 1500 E. Medical Center Drive, 2912 Taubman Center - Box 5328, Ann Arbor, MI 48109, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America
| | - David Markel
- Ascension-Providence Hospital Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI 48075, United States of America; MARCQI Coordinating center, 2929 Plymouth Rd. #300, Ann Arbor, MI 48105, United States of America; The Core Institute, 26750 Providence Pkwy, Novi, MI 48374
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13
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Grace TR, Goh GS, Runyon RS, Small I, Gibian JT, Nunley RM, Lonner JH. Manipulation Under Anesthesia is Safe After Cementless Total Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2023; 38:372-375. [PMID: 36038070 DOI: 10.1016/j.arth.2022.08.035] [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: 04/22/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is thought to facilitate durable, biological fixation between the bone and implant. However, the 4-12 weeks required for osseointegration coincides with the optimal timeframe to perform a manipulation under anesthesia (MUA) if a patient develops postoperative stiffness. This study aims to determine the impact of early MUA on cementless fixation by comparing functional outcomes and survivorship of cementless and cemented TKAs. METHODS A consecutive series of patients who underwent MUA for postoperative stiffness within 90 days of primary, unilateral TKA at 2 academic institutions between 2014 and 2018 were identified. Cases involving extensive hardware removal were excluded. Cementless TKAs undergoing MUA (n = 100) were propensity matched 1:1 to cemented TKAs undergoing MUA (n = 100) using age, gender, body mass index, and year of surgery. Both groups had comparable baseline Knee Injury and Osteoarthritis Outcome Scores (KOOS), Short Form (SF)-12 Physical, and SF-12 Mental scores. MUA-related complications as well as postoperative KOOS and SF-12 scores were compared. RESULTS MUA-related complications were equivalently low in both groups (P = .324), with only 1 patella component dissociation in the cementless group. No tibial or femoral components acutely loosened in the perioperative period. Postoperative KOOS (P = .101) and SF-12 Mental scores (P = .380) were similar between groups. Six-year survivorship free from any revision after MUA was 98.0% in both groups (P = 1.000). CONCLUSION Early postoperative MUA after cementless TKA was not associated with increased MUA-related complications or worse patient-reported outcomes compared to cemented TKA. Short-term survivorship was also comparable, suggesting high durability of the bone-implant interface.
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Affiliation(s)
- Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Scott Runyon
- Department of Orthopedic Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Ilan Small
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph T Gibian
- Department of Orthopedic Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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14
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Ryu JJ, Kim YH, Choi CH. The additional tibial stem extension is not mandatory for the stability of 5 mm metal block augmented tibial prosthesis construct in primary total knee arthroplasty: 5-year minimum follow-up results. Knee Surg Relat Res 2023; 35:5. [PMID: 36726180 PMCID: PMC9890779 DOI: 10.1186/s43019-023-00174-6] [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: 08/08/2022] [Accepted: 12/31/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine whether additional stem extension for stability is necessary, we performed mid-term follow-up of patients who had been managed with 5-mm metal block augmentation for a tibial defect, where tibial prosthesis was fixed using bone cement without stem extension. Also, we evaluated clinical and radiologic results including survival rate of patients without stem extension. METHODS We retrospectively analyzed patients with tibial bone defect, had undergone primary total knee arthroplasty, and had been treated with 5-mm metal block augmentation without stem extension between March 2003 and September 2013. Among 74 patients (80 cases), 47 patients (52 cases) were followed up for at least 5 years. RESULTS Mean flexion contracture improved from 8.8° (0-40°) preoperatively to 0.4° (-5° to 15°) at final follow-up (P < 0.01), but there was no significant change in the mean angle of great flexion: 124.6° (75-150°) preoperatively and 126.2° (90-145°) at final follow-up (P = 0.488). Mean range of motion improved from 115.8° (35-150°) preoperatively to 125.5° (90-145°) at final follow-up (P < 0.01). Mean knee score improved from 38.7 points (0-66 points) preoperatively to 93.2 points (79-100 points) at final follow-up (P < 0.01), and mean functional score also improved from 50.4 points (10-70 points) preoperatively to 81.8 points (15-100 points) at final follow-up (P < 0.01). The mean postoperative Western Ontario and McMaster University osteoarthritis score was 19.5 points (0-66.0 points). The mean femorotibial angle was corrected from 9.0° varus (23.0° varus-6.3° valgus) preoperatively to 5.5° valgus (2.2° varus-11.1° valgus) at final follow-up (P < 0.01). There was no change in the mean β-angle, which was 90.7° (87.2-94.9°) immediately postoperative and 90.8° (87.2-94.9°) at final follow-up (P = 0.748) and in the mean δ-angle, which was 86.2° (81.3-90.0°) immediately postoperative and 87.2° (83.1-96.5°) at final follow-up (P = 0.272). Radiolucent lines (RLL) were observed in ten cases (26.3%), and the mean RLL scores at final follow-up were 0.34 points (0-3 points) in the anteroposterior view and 0.42 points (0-6 points) in the lateral view. Scores for the RLL were ≤ 4 points in 36 cases, 5-9 points in two cases. Revision surgery due to aseptic loosening (three cases) is rarely required, and the Kaplan-Meier survival rate at 10 postoperative years was 96.4% CONCLUSION: When performing 5-mm metal block augmentation for a proximal tibial defect, no additional tibial stem extension can be a good surgical option for the stability of tibial prosthetic construct and mid-term clinical and radiologic results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jae Joon Ryu
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yeong Hwan Kim
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Choong Hyeok Choi
- grid.49606.3d0000 0001 1364 9317Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Schonhoff M, Beckmann NA, Schwarze M, Eissler M, Kretzer JP, Renkawitz T, Jaeger S. Is TKA femoral implant stability improved by pressure applied cement? a comparison of 2 cementing techniques. BMC Musculoskelet Disord 2023; 24:51. [PMID: 36670400 PMCID: PMC9863212 DOI: 10.1186/s12891-023-06151-0] [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: 10/02/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The majority of knee endoprostheses are cemented. In an earlier study the effects of different cementing techniques on cement penetration were evaluated using a Sawbone model. In this study we used a human cadaver model to study the effect of different cementing techniques on relative motion between the implant and the femoral shaft component under dynamic loading. METHODS Two different cementing techniques were tested in a group of 15 pairs of human fresh frozen legs. In one group a conventional cementation technique was used and, in another group, cementation was done using a pressurizing technique. Under dynamic loading that simulated real life conditions relative motion at the bone-implant interface were studied at 20 degrees and 50 degrees flexion. RESULTS In both scenarios, the relative motion anterior was significantly increased by pressure application. Distally, it was the same with higher loads. No significant difference could be measured posteriorly at 20°. At 50° flexion, however, pressurization reduced the posterior relative motion significantly at each load level. CONCLUSION The use of the pressurizer does not improve the overall fixation compared to an adequate manual cement application. The change depends on the loading, flexion angle and varies in its proportion in between the interface zones.
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Affiliation(s)
- Mareike Schonhoff
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Nicholas A. Beckmann
- grid.5253.10000 0001 0328 4908Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Martin Schwarze
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Marvin Eissler
- grid.5253.10000 0001 0328 4908Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Philippe Kretzer
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Tobias Renkawitz
- grid.5253.10000 0001 0328 4908Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Sebastian Jaeger
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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16
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The Knee-Fix study: study protocol for a randomised controlled trial evaluating cemented and cementless components in total knee arthroplasty. Trials 2022; 23:1032. [PMID: 36539805 PMCID: PMC9764727 DOI: 10.1186/s13063-022-06974-7] [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: 12/09/2021] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an effective procedure for patients with a variety of knee conditions. The main cause of aseptic TKA failure is implant loosening, which has been linked to poor cement mantle quality. Cementless components were introduced to offer better longer-term biological fixation through osseointegration; however, early designs led to increased rate of revision due to a lack of initial press-fit and bony ingrowth. Newer highly porous metal designs may alleviate this issue but randomised data of fully uncemented TKA (tibial, femoral, patella) is lacking. The aim of the Knee-Fix study is to investigate the long-term implant survival and patient outcomes of fully uncemented compared with cemented fixation in TKA. Our study hypothesis was that uncemented TKA would be as clinically reliable and durable as the gold-standard cemented TKA. METHODS The Knee-Fix study is a two-arm, single-blinded, non-inferiority randomised controlled trial with 160 patients in each arm and follow-up at 6 weeks, 6 months, 12 months, 24 months, 5 years and 10 years. The primary outcome of interest is implant fixation, which will be measured by assessment of postoperative progressive radiolucencies with the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Secondary outcome measures are patient-reported outcomes, measured using Oxford Knee Score (OKS), International Knee Society System (IKSS), Forgotten Joint Score-12 (FJS-12), EuroQol (EQ-5D-5L), VAS Pain, Patient Satisfaction Score and Net Promoter Score. DISCUSSION While cemented fixation remains the gold standard, a growing proportion of TKA are now implanted cementless. Highly porous metal cementless components for TKA can offer several benefits including potentially improved biological fixation; however, long-term outcomes need further investigation. This prospective study will help discern long-term differences between the two techniques. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001624471 . Registered trial name: Knee-Fix study (Cemented vs Uncemented Total Knee Replacement). Registered on 24 November 2016.
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Prill R, Kayaalp ME, Królikowska A, Becker R, Ayeni O, Langaufová A, Klugar M. Effects of physiotherapy interventions for home-based rehabilitation on physical function after primary total knee arthroplasty: a systematic review protocol. JBI Evid Synth 2022; 20:3017-3024. [PMID: 35976230 DOI: 10.11124/jbies-21-00355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to provide a systematic and transparent overview of the effects of common physiotherapy techniques and exercises for the rehabilitation of patients following total knee arthroplasty. INTRODUCTION Many protocols exist for the rehabilitation of patients after total knee arthroplasty, but there is a lack of systematic evidence on rehabilitation components, including precise exercise descriptions and their parameters. This review will fill in some of the gaps in reporting on scientific rehabilitation protocol components and the evaluation of their effectiveness. INCLUSION CRITERIA We will include randomized controlled trials investigating active and passive physiotherapy techniques and exercises employed after primary total knee arthroplasty, and which report concrete parameters, such as dosage, duration, frequency, intensity, and function-related measurements. We will exclude other study types and randomized controlled trials reporting on techniques and exercises without precise descriptions. METHODS This review will aim to find both published and unpublished studies. The key information sources to be searched are MEDLINE (PubMed), Embase (Ovid), CINAHL (EBSCO), PEDro, Cochrane CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two independent reviewers will screen titles, abstracts, and full texts; assess the methodological quality; and extract the data. We will perform narrative synthesis, followed by meta-analyses for pooled studies, where possible. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022309185.
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Affiliation(s)
- Robert Prill
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mahmut Enes Kayaalp
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
- Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Roland Becker
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, University of Brandenburg an der Havel Theodor Fontane, Brandenburg an der Havel, Germany
| | - Olufemi Ayeni
- Division of Orthopedics, McMaster University, Hamilton, ON, Canada
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Sheridan GA, Garbuz DS, Nazaroff H, Howard LC, Masri BA. Short-term results of the uncemented triathlon total knee arthroplasty: a large cohort single-centre comparative study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03422-9. [PMID: 36352307 DOI: 10.1007/s00590-022-03422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The purpose of this study is to assess the short-term survivorship of a new uncemented TKA design in a high-volume centre to evaluate the safety of this design prior to widespread adoption. METHODS We performed a retrospective cohort study of all primary TKAs (cemented and uncemented) between May 2018 and May 2019. Primary outcome variables included aseptic revision, all-cause revision, time to revision, operative time and radiological outcomes. Predictor variables considered included age, gender, BMI, ASA, implant type (cruciate-retaining, posterior-stabilised or totally-stabilised) and the use of cemented or uncemented implants. RESULTS There were 300 cemented TKAs and 249 uncemented TKAs (Triathlon, Stryker Inc., Mahwah, NJ) implanted. The mean follow-up for all cases was 31.6 months (minimum follow-up 2 years). Of the entire 549 implants only 4 were revised. Two of these were for infection, 1 was for patellar maltracking and 1 was for knee stiffness. All 4 revisions occurred in the cemented cohort. The aseptic revision rate in the cemented cohort was 0.7% compared to 0.0% in the uncemented cohort (p = 0.298). Operative times were significantly reduced in the uncemented cohort from 57.9 to 51.7 min (p < 0.001). There were 8/300 (2.6%) patients with RLLs in the cemented cohort and 4/249 (1.6%) patients with RLLs in the uncemented cohort (p = 0.56). CONCLUSION The uncemented Triathlon TKA demonstrates excellent survivorship at short-term follow-up when compared to the cemented Triathlon TKA, thus eliminating any potential clinical concerns with this novel implant in the early post-operative phase.
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Affiliation(s)
- G A Sheridan
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
| | - D S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - H Nazaroff
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - L C Howard
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - B A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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19
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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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van Es LJM, Sierevelt IN, Hoornenborg D, van Ooij B, Haverkamp D. The mid-term survival of cemented, uncemented, and hybrid fixation of the ACS mobile bearing total knee arthroplasty. Indian J Orthop 2022; 56:1767-1773. [PMID: 36187581 PMCID: PMC9485357 DOI: 10.1007/s43465-022-00715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
Background Till today, Cemented Fixation in Total Knee Arthroplasty (TKA) is significantly more used than Hybrid or Uncemented Fixation. The purpose of this study was to compare Cemented, Uncemented and Hybrid Fixation of the ACS Mobile Bearing TKA at Mid-term follow-up. Methods This study was an extended data report of our prospective single-center, single-blinded randomized controlled clinical trial comprising 105 patients. The primary outcome was survival at five years of follow-up calculated by Kaplan-Meier and Log-rank test. The secondary outcome was function based on patient-reported outcome measures (PROMs). Results Eighty-three patients were included, of which 25 belonged into group A (Cemented), 28 in group B (Uncemented), and 30 in group C (Hybrid). Mean follow-up was 5.8 ± 0.7 (range 5-7) years. The 5-year survival rates were 96.8% (95%CI: 90.5; 100) in the Cemented group, 94.2% (95%CI: 86.4; 100) in the Uncemented group, and 93.8% (95%CI: 85.4; 100) in the Hybrid group for revision for any reason (p = 0.80). Functional outcome was similar among the groups. Conclusion In our cohort of ACS Mobile Bearing TKA, there was no difference between Cemented, Uncemented, and Hybrid Fixation with regard to survival and function at Mid-term follow-up. Trial registration Dutch Trial Register (NTR3893), 2013-03-12. Level of evidence II.
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Affiliation(s)
- Laurian J. M. van Es
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Noordwest Ziekenhuis, Alkmaar, The Netherlands
| | - Inger N. Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Orthopaedic department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Daniël Hoornenborg
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
| | - Bas van Ooij
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Cohesie, Occupational Health Service, Voorthuizen, The Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
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Clinical Results in Posterior-Stabilized Total Knee Arthroplasty with Cementless Tibial Component in Porous Tantalum: Comparison between Monoblock and Two Pegs vs. Modular and Three Pegs. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4020016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nowadays, total knee arthroplasty (TKA) is widely considered to be the gold standard for treatment of end-stage knee osteoarthritis. Although the optimal mode of fixation in TKA continues to be an important area of investigation, cementless fixation offers the possibility to gain biologic fixation, preserve bone stock and mineral density, and potentially improve survivorship. The purpose of this retrospective study was to evaluate the clinical results of a posterior-stabilized total knee arthroplasty with cementless tibial component in porous tantalum, comparing two groups: Group A (30 patients), TKA with a monoblock component and two pegs, and Group B (22 patients), with a modular component and three pegs. Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were submitted to the patients, and radiographs were collected at the last follow-up. The mean follow-up was 26.32 (20–40) months. Significant differences were not detected between the postoperative KSS values in the two groups (p = 0.44). Evaluating KOOS outcomes, we found in Group A that the rating system showed a statistically significant improvement from a preoperative average rating of 51.4 (SD ± 15) to an average of 72.66 (SD ± 19) at final follow-up (p < 0.05). In Group B, the KOOS rating system showed a statistically significant improvement from a preoperative average rating of 48.3 (SD ± 18) to an average of 79.54 (SD ± 17) postoperatively (p < 0.05). Comparing KOOS final outcomes between groups, we found no statistically significant difference at the mean final follow-up (p = 0.20), with the exception of the sport-related section (p < 0.05). Radiological evaluation at the final follow-up did not show any sign of polyethylene wear, radiolucency, septic or aseptic loosening, or change in alignment in either group. The current study demonstrates an excellent survivorship of cementless tibial components in porous tantalum and the possibility of osseous integration, without significant differences between the two groups under investigation.
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Mäkelä K, Hailer NP. Editorial: Different, yet strong together: the Nordic Arthroplasty Register Association (NARA). Acta Orthop 2021; 92:635-637. [PMID: 34231441 PMCID: PMC8648399 DOI: 10.1080/17453674.2021.1947006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Keijo Mäkelä
- Past NARA Chairman, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Nils P. Hailer
- Co-Editor/NARA Chairman, Department of Surgical Sciences—Orthopaedics, Uppsala University, Uppsala, Sweden,Correspondence: Nils P. Hailer, Department of Surgical Sciences—Orthopaedics, Uppsala University, Uppsala, Sweden,
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Rubinger L, Khalik HA, Gazendam A, Wolfstadt J, Khoshbin A, Tushinski D, Johal H. Very Distal Femoral Periprosthetic Fractures: Replacement Versus Fixation: A Systematic Review. J Orthop Trauma 2021; 35:573-583. [PMID: 33993176 DOI: 10.1097/bot.0000000000002080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR). DATA SOURCES MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines. STUDY SELECTION Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III. DATA EXTRACTION Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery. DATA SYNTHESIS Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9-88.3 years) and 209 knees in the DFR group (mean age range: 71.0-84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized. CONCLUSIONS vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%-45% vs. 0%-77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada; and
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Daniel Tushinski
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada
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Rodriguez S, Ranawat AS. The Future is Non-cemented Total Knee Arthroplasty: Volume Trends at the Hospital for Special Surgery. Indian J Orthop 2021; 55:1096-1100. [PMID: 34629497 PMCID: PMC8487231 DOI: 10.1007/s43465-021-00508-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The optimal fixation method for total knee arthroplasty (TKA) is still a debate. Cemented fixation has excellent long-term results and is the gold standard. However, longevity in the younger, heavier, and more active population is suboptimal. Cementless TKA offers the opportunity to gain biological fixation and overcome these shortcomings. METHODS This is a retrospective review of all consecutive cementless TKA procedures performed at a single academic institution from 2016 until 2020. Demographics, aseptic revisions, and septic revisions were pulled from the electronic medical record. The number of yearly implanted cementless TKA prosthesis was determined to analyze utilization trends. RESULTS Eight-hundred and two patients were identified with a mean age of 61.57 ± 7.78 years, and a mean of BMI 32.12 ± 5.98 kg/m2. The mean time to revision was 12.31 ± 13.91 months. There were four septic failures and nine aseptic failures during the study period. Of these nine aseptic failures only five were due to mechanical loosening. There was a yearly linear increase in the use of cementless fixation. CONCLUSION Cementless fixation is here to stay, and its use will continue to increase. Early and mid-term outcomes have been excellent thus far. Changing clinical practice takes time but we have already seen this transition take place in total hip arthroplasty. As technology and design continue to evolve, we believe it is a possibility.
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Affiliation(s)
- Samuel Rodriguez
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E70th Street, New York, NY 10021 USA
| | - Amar S. Ranawat
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E70th Street, New York, NY 10021 USA
- Weill Cornell Medical College, New York, USA
- NewYork-Presbyterian Hospital, New York, USA
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Wyatt MC, Frampton CF, Whitehouse MR, Deere KC, Sayers A, Kieser D. Benchmarking total knee replacement constructs using noninferiority analysis: the New Zealand joint registry study. BMC Musculoskelet Disord 2021; 22:721. [PMID: 34425821 PMCID: PMC8381520 DOI: 10.1186/s12891-021-04606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. METHODS All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. RESULTS In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. CONCLUSIONS We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery.
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Affiliation(s)
- M C Wyatt
- Massey University, Palmerston North, New Zealand.
| | | | | | | | - A Sayers
- University of Bristol, Bristol, UK
| | - D Kieser
- University of Otago, Dunedin, New Zealand
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Total Knee Arthroplasty for the Oldest Old. Geriatrics (Basel) 2021; 6:geriatrics6030075. [PMID: 34449627 PMCID: PMC8395921 DOI: 10.3390/geriatrics6030075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
The present study describes and compares the early functional results after total knee arthroplasty (TKA) of the oldest-old population (aged over 84 years) and a randomly matched younger septuagenarian cohort so treated. We aimed to evaluate the early functional outcomes after patients’ rehabilitation and the yearly requirements for hospital readmission and emergency room visits after TKA. We noted a similar length of hospital stay for octogenarian and septuagenarian patients, and we determined that both groups of patients were improving ROM (both flexion and extension) after the rehabilitation program (p < 0.05, in all cases), but there were no significant differences between octogenarian and septuagenarian improvement of the knee function (p > 0.05, in all cases). Patients from both age groups behaved similarly in terms of mobility before starting rehabilitation and after completion of the rehabilitation program. We noted that older octogenarian patients showed a higher one-year hospital readmission rate than younger septuagenarian patients, but similar early emergency room visits for both age groups. The findings of this study allow us to conclude that advanced age in itself should not be a contraindication for TKA.
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High Rate of Re-Revision in Patients Less Than 55 Years of Age Undergoing Aseptic Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:2348-2352. [PMID: 33390338 DOI: 10.1016/j.arth.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/14/2020] [Accepted: 12/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are limited data on the outcomes of revision total knee arthroplasty in young patients. We sought to characterize the re-revision-free survival and risk factors for re-revision in patients less than 55 years who underwent aseptic revision TKA. METHODS We retrospectively reviewed 197 revision TKAs at a mean follow-up of 5 years. Mean age was 49 years; mean body mass index was 31 kg/m2. Twenty-seven (14%) patients had at least 1 prior revision TKA. The most common indications for revision included instability (29%), arthrofibrosis (26%), and aseptic loosening (24%). Constraint included the following: 59 posterior-stabilized (30%), 123 varus-valgus constrained (62%), and 15 hinged (8%). Components revised included the following: 93 femur/tibia (47%), 68 polyethylene-only (35%), 19 femur-only (10%), and 17 other (9%). Survivorship free from re-revision was calculated via the Kaplan-Meier method and a multivariate Cox proportional regression was utilized to identify risk factors for re-revision. RESULTS Survivorship free from any re-revision at 5 years was 80%. In the multivariate analysis, patients with a prior revision (hazard ratio [HR] = 2.78, P = .02), an isolated polyethylene exchange (HR = 3.0, P = .004), and a hinged prosthesis (HR = 3.47, P = .05) were significant risk factors for lower revision-free survival. Forty-two patients (21%) underwent re-revision, most commonly for periprosthetic joint infection (7%), instability (6%), and aseptic loosening (5%). Re-revision occurred in 18/68 (26%) patients undergoing an isolated polyethylene exchange. CONCLUSION Patients less than 55 years undergoing revision TKA have a modest 5-year revision-free survival of 80%. Patients with prior revision TKAs (HR = 2.78), hinge type prostheses (HR = 3.47), and polyethylene-only revisions (HR = 3.0) had higher revision rates.
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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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Kim YH, Park JW, Jang YS. The 22 to 25-Year Survival of Cemented and Cementless Total Knee Arthroplasty in Young Patients. J Arthroplasty 2021; 36:566-572. [PMID: 32843257 DOI: 10.1016/j.arth.2020.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite cementless total knee arthroplasties (TKAs) have potential advantages over cemented TKAs, there are conflicting results. The purpose of the present study is to determine the long-term clinical and radiographic results, the survival rate, and the prevalence of osteolysis of cemented vs cementless TKAs. METHODS A total of 261 patients (522 knees) who underwent bilateral simultaneous TKAs were included in the present study (mean age, 62.5 ± 5.5 years). Patients were evaluated clinically, radiographically, and also using computed tomography scans. A mean follow-up period was 23.8 years (range, 22-25 years). RESULTS There were no significant differences between the Knee Society total score, change in total score, knee function score, and Western Ontario and McMaster Universities Osteoarthritis Index score in the 2 groups. In total, 8 knees (3%) were revised in the cementless group and 5 knees (2%) in the cemented group. Radiographs and computed tomography scans showed no femoral, tibial, or patellar osteolysis in either group. The rate of survival at 25 years was 97% (95% confidence interval [CI], 92%-100%) in the cementless group and 98% (95% CI, 94%-100%) in the cemented group, with reoperation for any reason as the end point. The rate of survival at 25 years was 98% (95% CI, 94%-100%), with reoperation for aseptic loosening as the end point in both groups. CONCLUSIONS At this length of follow-up, cementless TKA has comparable outcomes and survivorship to cemented TKA.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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Irmola T, Ponkilainen V, Mäkelä KT, Robertsson O, W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, Schrøder HM, Eskelinen A, Niemeläinen MJ. Association between fixation type and revision risk in total knee arthroplasty patients aged 65 years and older: a cohort study of 265,877 patients from the Nordic Arthroplasty Register Association 2000-2016. Acta Orthop 2021; 92:91-96. [PMID: 33143501 PMCID: PMC7919873 DOI: 10.1080/17453674.2020.1837422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The population of the Nordic countries is aging and the number of elderly patients undergoing total knee arthroplasty (TKA) is also expected to increase. Reliable fixation methods are essential to avoid revisions. We compared the survival of different TKA fixation concepts with cemented fixation as the gold standard.Patients and methods - We used data from the Nordic Arthroplasty Register Association (NARA) database of 265,877 unconstrained TKAs performed for patients aged ≥ 65 years with primary knee osteoarthritis between 2000 and 2016. Kaplan-Meier (KM) survival analysis with 95% confidence intervals (CI) and the Cox multiple-regression model were used to compare the revision risk of the fixation methods.Results - Cemented fixation was used in 243,166 cases, uncemented in 8,000, hybrid (uncemented femur with cemented tibia) in 14,248, and inverse hybrid (cemented femur with uncemented tibia) fixation in 463 cases. The 10-year KM survivorship (95% CI) of cemented TKAs was 96% (96 - 97), uncemented 94% (94 - 95), hybrid 96% (96 - 96), and inverse hybrid 96% (94 - 99), respectively. Uncemented TKA was associated with increased risk of revision compared with the cemented TKA; the adjusted hazard ratio was 1.3 (95% CI 1.1 - 1.4).Interpretation - Cemented, hybrid, and inverse hybrid TKAs showed 10-year survival rates exceeding 95%. Uncemented fixation was associated with an increased risk of revision in comparison with cemented fixation. As both hybrid and inverse hybrid fixation were used in only a limited number of TKAs, indicating possibility of selection bias in their favor, cemented TKA still remains the gold standard, as it works reliably in the hands of many.
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Affiliation(s)
- Tero Irmola
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; ,Correspondence:
| | - Ville Ponkilainen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Keijo T Mäkelä
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, and University of Turku, Turku, Finland;
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden. Department of Clinical Sciences, Orthopedics, Lund University, Sweden;
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden. Department of Clinical Sciences, Orthopedics, Lund University, Sweden;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Anne M Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital. Denmark and Danish Knee Arthroplasty Registry;
| | | | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Mika J Niemeläinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
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Davis MS, Marrero-Berrios I, Perez XI, Radhakrishnan P, Manchikalapati D, Ahmed K, Kamath H, Schloss RS, Yarmush J. A controlled release bupivacaine-alginate construct: Effect on chondrocyte hypertrophy conversion. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2. [PMID: 35392127 PMCID: PMC8986124 DOI: 10.1016/j.ocarto.2020.100125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: Osteoarthritis is a degenerative disease of the joint, affecting over 30 million people in the US1. A key characteristic of OA is chondrocyte hypertrophy, characterized by chondrocyte changes to a more rounded and osteoblastic phenotype, characterized by increased IL-6 and IL-8 secretion2. While there are no cures for OA, treatments focus on mitigating pain and inflammation, the two main symptoms of OA. However, the analgesics, NSAIDS and corticosteroids commonly used, do not target regeneration and have negative side effects. Local anesthetics (LA) can be used as a pain management alternative but are usually short lasting and therefore, not suited for chronic conditions such as OA. Our engineered sustained release local anesthetic construct successfully delivers bupivacaine for an extended period of time3–5. This study is designed to evaluate the effect of the LA system on chondrocytes in an inflammatory OA-like environment. Design: Chondrocytes were cultured with bolus, liposomal, or construct LA and either untreated or treated with TNF-α and IL-1α for 24 hrs, 48 hrs, or 96 hrs. Chondrocyte viability, interleukin-8 (IL-8), interleukin-6 (IL-6), collagenase activity and proteoglycan deposition were assessed. Results: In the presence of the engineered construct, the chondrocytes retained viability and regenerative function. Moreover, the construct allowed for higher initial doses to be used, which promoted more regeneration and decreased inflammation without compromising cellular viability. Conclusions: The construct promotes a less hypertrophic chondrocyte environment while promoting a more anti-inflammatory environment. These two factors are consistent with a less OA progressive environment when using the engineered construct, compared to bolus LA.
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Affiliation(s)
- Mollie S Davis
- Rutgers University, Department of Biomedical Engineering, Piscataway, NJ, USA
| | | | - Xiomara I Perez
- Rutgers University, Department of Biomedical Engineering, Piscataway, NJ, USA
| | | | | | - Khaja Ahmed
- Department of Anesthesiology, NYP Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Rene S Schloss
- Rutgers University, Department of Biomedical Engineering, Piscataway, NJ, USA
| | - Joel Yarmush
- Department of Anesthesiology, NYP Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Gupta V, Kejriwal R, Frampton C. Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements: A 19-Year Analysis from the New Zealand Joint Registry. J Bone Joint Surg Am 2020; 102:1777-1783. [PMID: 33086344 DOI: 10.2106/jbjs.19.01443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA. METHODS Data on all Oxford-III primary UKRs (n = 8,733) completed for isolated medial compartment OA from January 2000 to December 2018 were obtained from the New Zealand Joint Registry (NZJR). Revision rates were documented for each fixation type and analyzed for associations with patient sex and age at surgery. A multivariate Cox proportional-hazards analysis was completed to determine if type of fixation was an independent risk factor for revision of Oxford-III UKRs. RESULTS Statistical analysis revealed a >1.8-fold greater revision risk for cemented Oxford-III UKRs compared with uncemented Oxford-III UKRs (p = 0.001) when considered independently of other risk factors. Furthermore, compared with uncemented fixation, cemented fixation was associated with a 2.9-fold (p < 0.001) increase in revision risk for women <65 years old and a 1.7-fold (p = 0.008) increase in revision risk for men 55 to 74 years old. There was no significant difference in the risk of revision between fixation methods for women ≥65 years old and men ≥75 years old. CONCLUSIONS We found that the type of fixation was an independent risk factor for revision of Oxford-III UKRs used in the treatment of isolated medial compartment OA. Uncemented Oxford-III primary UKRs had superior implant survivorship in women <65 years old and men 55 to 74 years old. Age and sex are important factors to consider when determining the type of fixation for Oxford-III primary UKRs used to treat isolated medial compartment OA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vikesh Gupta
- Department of Orthopaedic Surgery, Whangarei Base Hospital, Whangarei, New Zealand
| | - Ritwik Kejriwal
- Department of Orthopaedic Surgery, Taranaki Base Hospital, New Plymouth, New Zealand
| | - Chris Frampton
- Department of Medicine, The University of Otago, Christchurch, New Zealand
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Reich MS, Baer MR. Is Cementless Superior?: Commentary on an article by Vikesh Gupta, MBChB, et al.: "Revision Following Cemented and Uncemented Oxford-III Primary Medial Unicompartmental Knee Replacements. A 19-Year Analysis from the New Zealand Joint Registry". J Bone Joint Surg Am 2020; 102:e118. [PMID: 33086356 DOI: 10.2106/jbjs.20.01473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael S Reich
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Michael R Baer
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Pacoret V, Kalk E, Labattut L, Girardot G, Baulot E, Martz P. Survival rate of cemented versus cementless tibial component in primary total knee arthroplasty over 5 years of follow-up: comparative study of 109 prostheses. SICOT J 2020; 6:36. [PMID: 32902376 PMCID: PMC7480167 DOI: 10.1051/sicotj/2020028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/28/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis is the main indication for primary total knee arthroplasty (TKA). It is now accepted that cementless implantation of the femoral component provides equivalent results to cemented one, however, the optimal fixation method of the tibial component remains controversial. The purpose of this study was to compare the survivorship of cemented versus cementless tibial baseplate in primary total knee arthroplasty. MATERIALS AND METHODS We carried out a retrospective, monocentric study, including 109 TKA (Zimmer® Natural Knee II ultra-congruent mobile-bearing) implanted between 2004 and 2010 for primary osteoarthritis, comparing 2 groups depending on tibial component fixation method, one cemented (n = 68) and one cementless (n = 41). Clinical (Knee Society Rating System (KSS), Hospital for Special Surgery (HSS) scores, range of motion) and radiodiological outcomes were assessed at last follow-up with a minimal follow-up of 5 years. RESULTS Mean follow-up were 8.14 [5.31-12.7] and 8.06 [5.22-12.02] years, respectively, in cemented and cementless groups. The tibial component survival rate was 100% [95CI: 91.4-100] in the cementless group and 97.1% [95CI: 89.78-99.42] in the cemented group (2 aseptic loosenings) (p = 0.27). Radiolucent lines were present in 31.7% (n = 13) of the cementless and 44.1% (n = 30) of the cemented baseplates (p = 0.2). The postoperative KSS knee score was higher in the cementless group (99 ± 3 vs. 97 ± 7.5; p = 0.02), but there was no significant difference in KSS function, global KSS and HSS scores. Mean range of flexion was 120 ± 10° in the cementless group and 122.5 ± 15° in the cemented group (p = 0.37). No significant differences were found on the radiographic data or on complications. CONCLUSION In this study, the survival rate of the tibial component is not influenced by its fixation method at a mean follow-up of 8 years in osteoarthritis, which confirms the reliability of cementless fixation in primary TKA.
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Affiliation(s)
- Victor Pacoret
- Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France
| | | | - Ludovic Labattut
- Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France
| | - Guillaume Girardot
- Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France
| | - Emmanuel Baulot
- Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France - INSERM UMR1093-CAPS, Burgundy Franche-Comté University, 21000 Dijon, France
| | - Pierre Martz
- Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France - INSERM UMR1093-CAPS, Burgundy Franche-Comté University, 21000 Dijon, France
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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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