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AlShehri Y, Megaloikonomos PD, Neufeld ME, Howard LC, Greidanus NV, Garbuz DS, Masri BA. Cementless Total Knee Arthroplasty: A State-of-the-Art Review. JBJS Rev 2024; 12:01874474-202407000-00004. [PMID: 38968372 DOI: 10.2106/jbjs.rvw.24.00064] [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: 07/07/2024]
Abstract
» The demographic profile of candidates for total knee arthroplasty (TKA) is shifting toward younger and more active individuals.» While cemented fixation remains the gold standard in TKA, the interest is growing in exploring cementless fixation as a potentially more durable alternative.» Advances in manufacturing technologies are enhancing the prospects for superior long-term biological fixation.» Current research indicates that intermediate to long-term outcomes of modern cementless TKA designs are comparable with traditional cemented designs.» The selection of appropriate patients is critical to the success of cementless fixation techniques in TKA.» There is a need for high-quality research to better understand the potential differences and relative benefits of cemented vs. cementless TKA systems.
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Affiliation(s)
- Yasir AlShehri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Tidd JL, Huffman N, Oyem PC, Pasqualini I, Hadad MJ, Klika AK, Deren ME, Piuzzi NS. Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty. J Knee Surg 2024; 37:545-554. [PMID: 38113913 DOI: 10.1055/a-2232-7657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
As obesity becomes more prevalent, more patients are at risk of lower extremity osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to test (1) the association of preoperative weight change with health care utilization and (2) the association of pre- and postoperative weight changes with failure to achieve satisfaction and minimal clinically important difference (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and function (KOOS-PS) 1 year after TKA. Prospectively collected monocentric data on patients who underwent primary TKA were retrospectively reviewed. Multivariable logistic regression assessed the influence of BMI and weight change on outcomes while controlling for confounding variables. Outcomes included prolonged length of stay (LOS >3 days), nonhome discharge, 90-day readmission rate, satisfaction, and achievement of MCID for KOOS-Pain and KOOS-PS. Preoperative weight change had no impact on prolonged LOS (gain, p = 0.173; loss, p = 0.599). Preoperative weight loss was associated with increased risk of nonhome discharge (odds ratio [OR]: 1.47, p = 0.003). There was also increased risk of 90-day readmission with preoperative weight gain (OR: 1.27, p = 0.047) and decreased risk with weight loss (OR: 0.73, p = 0.033). There was increased risk of nonhome discharge with obesity class II (OR: 1.6, p = 0.016) and III (OR: 2.21, p < 0.001). Weight change was not associated with failure to achieve satisfaction, MCID in KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of failure to reach MCID in KOOS-Pain (OR: 0.43, p = 0.005) and KOOS-PS (OR: 0.7, p = 0.007). Overall, pre- and postoperative weight change has little impact on the achievement of satisfaction and clinically relevant differences in pain and function at 1 year. However, preoperative weight gain was associated with a higher risk of 90-day readmissions after TKA. Furthermore, patients categorized in Class III obesity were at increased risk of nonhome discharge but experienced a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results raise awareness of the dangers of using weight changes and BMI alone as a measure of TKA eligibility.
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Affiliation(s)
- Joshua L Tidd
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Nickelas Huffman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Precious C Oyem
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | | | - Matthew J Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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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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Choi KY, Kim YD, Cho N, Kim MS, In Y, You HY, Koh IJ. Postoperative Hemodynamics of Total Knee Arthroplasty Unaffected by Cementless Approach under Contemporary Patient Blood Management Protocol: A Propensity Score-Matched Study. J Clin Med 2023; 12:6980. [PMID: 38002595 PMCID: PMC10672580 DOI: 10.3390/jcm12226980] [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: 09/20/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: A cementless total knee arthroplasty (TKA) is a recent and an increasingly popular innovation that enhances porous fixation surfaces. However, the lack of cemented sealing of an exposed resected bone has raised concerns about the potential for greater blood loss. The goals of this study were to determine if a cementless approach impacts post-TKA hemodynamics and to identify risk factors for blood loss in instances of cementless (vs. cemented) TKAs under a contemporary patient blood management (PBM) protocol. (2) Methods: We recruited 153 consecutive patients undergoing unilateral TKAs between 2019 and 2023. All enrollees received cementless or cemented prostheses of the same design (cementless, 87; cemented, 66). After propensity score matching for demographics, there were 46 patients in each group. We then compared blood loss metrics (total [TBL] and estimated [EBL]), drainage volumes, hemoglobin (Hb) levels, and transfusion rates by group. (3) Results: Post-TKA hemodynamics (i.e., TBL, EBL, drainage, Hb level, and transfusion rate) of cementless (n = 46) and cemented (n = 46) TKA groups did not differ significantly. In addition, the proportions of patients with Hb drops > 3.0 g/dL were similar for the two groups. A logistic regression analysis revealed that only preoperative Hb and EBL during the early postoperative period were predictive of a substantial fall in Hb levels. The fixation method was not associated with Hb decline > 3.0 g/dL by postoperative Day 3. (4) Conclusion: The cementless TKA has no impact on customary post-TKA hemodynamics and is not associated with greater TKA-related blood loss when implementing a contemporary PBM protocol.
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Affiliation(s)
- Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea; (K.Y.C.); (M.S.K.); (Y.I.)
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
| | - Yong Deok Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
| | - Nicole Cho
- Lauren E. Wiznia MD PLLC, 1016 Fifth Avenue, New York, NY 10028, USA;
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea; (K.Y.C.); (M.S.K.); (Y.I.)
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea; (K.Y.C.); (M.S.K.); (Y.I.)
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
| | - Hwang Yong You
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (Y.D.K.); (H.Y.Y.)
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
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Sohn S, Cho N, Oh H, Kim YD, Jo H, Koh IJ. No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1458. [PMID: 37629748 PMCID: PMC10456672 DOI: 10.3390/medicina59081458] [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: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone surface after cementless TKA raises concerns regarding the potential for greater blood loss compared to cemented TKA. The aim of this study was to (1) compare blood loss and transfusion rates between cementless and cemented TKAs and (2) identify the risk factor for higher blood loss in patients who underwent 1-week-interval staggered bilateral (SB) TKA. Materials and Methods: This retrospective, propensity-matched study included 54 cementless and 53 cemented SB TKAs performed by a single surgeon from 2019 to 2023 with a single implant that has similar design features in both cementless and cemented implants. All patients underwent 1-week-interval SB TKA and received the same patient blood management (PBM) and rehabilitation protocol. The estimated total blood loss (TBL), transfusion rate, and total hemoglobin drop were assessed. Patients were categorized according to TBL into average TBL and higher TBL groups. Univariate and multiple logistic regression analyses were performed to identify risk factors for higher blood loss. Results: There was no difference in TBL between cementless and cemented TKA groups (1233 ± 299 and 1282 ± 309 mL, respectively; p > 0.05). In addition, no between-group differences in the transfusion rate and mean total hemoglobin drop were observed. The logistic regression analyses revealed that whether TKA was cementless or cemented was not associated with higher blood loss; rather, the only identified risk factor was the pre-TKA patient blood volume (odd ratio 1.001, 95% confidence interval 1.000-1002, p = 0.026). Conclusions: Contemporary cementless fixation does not increase blood loss or transfusion rates compared to cemented fixation in patients undergoing 1-week-interval staggered bilateral TKA.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Seoul 01757, Republic of Korea;
| | - Nicole Cho
- Lauren E Wiznia MD PLLC, 1016 Fifth Avenue, New York, NY 10028, USA;
| | - Hyunjoo Oh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea; (H.O.); (Y.D.K.)
| | - Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea; (H.O.); (Y.D.K.)
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hoon Jo
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Seoul 01757, Republic of Korea;
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea; (H.O.); (Y.D.K.)
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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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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Ko H, Pelt CE, Martin BI, Pellegrini VD. Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching. BMC Musculoskelet Disord 2022; 23:934. [PMID: 36303136 PMCID: PMC9608915 DOI: 10.1186/s12891-022-05899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cemented versus cementless TKA. Methods With PROs prospectively collected through Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.gov: NCT02810704), we examined pre- and post-operative (1, 3, and 6-months) outcomes in 5,961 patients undergoing primary TKA enrolled by 28 medical centers between December 2016 and August 2021. Outcomes included the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). To minimize selection bias, we performed a 1-to-1 propensity score matched analysis to assess relative pre- to post-operative change in outcomes within and between cemented and cementless TKA groups. Results With greater than 90% follow-up, significant pre to- post-operative improvements were observed in both groups. At 6 months, the cemented TKA group achieved a 3.3 point (55% of the Minimum Clinically Important Difference) greater improvement in the mean KOOS-Jr. (95%CI: 0.36, 6.30; P = 0.028) than did the cementless group with no significant between-group differences in PROMIS-PH and NPRS. Conclusions In a large cohort of primary TKAs, patients with cemented fixation reported early incremental benefit in KOOS-Jr. over those with cementless TKA. Future studies are warranted to capture longer follow-up of PROs. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05899-1.
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Affiliation(s)
- Hyunkyu Ko
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University Orthopaedic Center, University of Utah, Salt Lake City, UT USA
| | - Christopher E. Pelt
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University Orthopaedic Center, University of Utah, Salt Lake City, UT USA
| | - Brook I. Martin
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University Orthopaedic Center, University of Utah, Salt Lake City, UT USA
| | | | - Vincent D. Pellegrini
- grid.413480.a0000 0004 0440 749XDepartment of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
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