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Jabbouri SS, Jones B, Alemayehu G, Jimenez E, Mullen K, Bernstein J. The Utilization of Press-Fit Total Knee Arthroplasty is Not Evenly Distributed: A National Registry Review. J Am Acad Orthop Surg 2024; 32:495-502. [PMID: 38470986 DOI: 10.5435/jaaos-d-23-01035] [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] [Received: 10/29/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND This study evaluates trends of cemented versus press-fit total knee arthroplasty (TKA). We hypothesized that press-fit TKA is more common in younger and obese patients. There may also be racial, geographic, and institutional variation. METHODS The American Joint Replacement Registry was used to conduct a retrospective review of primary TKA procedures for osteoarthritis in the United States between January 2019 and March 2022. The objective was to identify differences in incidence, demographics, body mass index (BMI), Charlson Comorbidity Index (CCI), and institutional teaching status (teaching vs. non-teaching) between press-fit and cemented TKAs. RESULTS Two hundred ninety-seven thousand four hundred two patients (61% female, average age 68 years, 88.3% White) underwent cemented TKA versus 50,880 patients (52% female, average age 65 years, 89% White) underwent press-fit TKA. Overall, 20.8% of press-fit versus 19.9% of cemented TKA had a BMI of 35 to 39.9 and 15.2% of press-fit versus 12.5% of cemented TKA had BMI >40 ( P < 0.001). Patients undergoing press-fit TKA were less likely Black (OR = 0.727; P < 0.0001), Asian (OR = 0.651, P < 0.0001), and Native Hawaiian/other Pacific Islander (OR = 0.705, P < 0.02) with White as the reference group. Northeastern and Southern United States were more likely to use press-fit TKA than the Midwest (OR = 1.89 and OR = 1.87, P < 0.0001) and West (OR = 1.67; and OR = 1.65; P < 0.0001). Press-fit TKA incidence in 2019 was 9.9% versus 20.6% in 2022 ( P < 0.001). CONCLUSION Press-fit TKA is increasingly more common in Northeastern and Southern United States, and patients are older than expected. Patients with BMI >35 had a slightly higher rate of undergoing press-fit than cemented TKA. Notable racial differences also exist. Additional research addressing racial disparities and evaluating longevity of press-fit designs is needed.
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Affiliation(s)
- Sahir S Jabbouri
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Jabbouri); Washington State University Elson S. Floyd College of Medicine, Spokane, WA (Jones and Alemayehu), the American Academy of Orthopaedic Surgeons, Rosemont, IL (Jimenez and Mullen), and the Connecticut Orthopaedics, Trumbull, CT (Bernstein)
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Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh 2023; 15:327-338. [PMID: 38020721 PMCID: PMC10676205 DOI: 10.2147/jhl.s383916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100 Bolzano, Italy
| | - Martina Feierabend
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
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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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Mohammad HR, Judge A, Murray DW. A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements: An Analysis from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. J Bone Joint Surg Am 2021; 103:2270-2280. [PMID: 34543254 DOI: 10.2106/jbjs.21.00179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total knee replacements (TKRs) can be implanted with or without the use of cement. It is currently uncertain how cemented and cementless TKRs compare overall and in different age groups of the population in the long term. METHODS The National Joint Registry collects information on knee replacements inserted in England, Wales, Northern Ireland, and the Isle of Man and was linked for multiple confounders to the National Health Service Hospital Episode Statistics database. With use of propensity score matching techniques, 44,954 cemented and cementless TKRs were compared. Regression models were used to compare the outcomes of revision, reoperation, and mortality both overall and in different age strata. RESULTS The 10-year implant survival rate with revision as the end point for cemented and cementless TKRs was 96.0% and 95.5%, respectively (hazard ratio [HR] = 1.14; p = 0.01). The 10-year survival rate with reoperation as the end point was 82.7% and 81.4%, respectively (HR = 1.08; p = 0.001). The rate of revision for pain was higher for cementless TKRs (0.5% [cemented] compared with 0.7% [cementless]; p = 0.002), but the rate of revision for infection was lower (0.7% [cemented] compared with 0.5% [cementless]; p = 0.003). No significant interactions with age existed for the outcomes of revision (p = 0.24), reoperation (p = 0.30), or mortality (p = 0.58). CONCLUSIONS We found that matched cemented and cementless TKRs both have 10-year implant survival rates of >95%. Cementless TKRs had a higher revision rate (absolute difference, 0.5%) and reoperation rate (absolute difference, 1.3%). The rate of revision for infection was lower in the cementless group, although the rate of revision for pain was higher. Age did not significantly affect the relative performances. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
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Prasad AK, Tan JHS, Bedair HS, Dawson-Bowling S, Hanna SA. Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2020; 5:793-798. [PMID: 33312706 PMCID: PMC7722941 DOI: 10.1302/2058-5241.5.200030] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over 100,000 total knee replacements (TKRs) are carried out in the UK annually, with cemented fixation accounting for approximately 95% of all primary TKRs. In Australia, 68.1% of all primary TKRs use cemented fixation, and only 10.9% use cementless fixation. However, there has been a renewed interest in cementless fixation as a result of improvements in implant design and manufacturing technology. This meta-analysis aimed to compare the outcomes of cemented and cementless fixation in primary TKR. Outcome measures included the revision rate and patient-reported functional scores. MEDLINE and EMBASE were searched from the earliest available date to November 2018 for randomized controlled trials of primary TKAs comparing cemented versus cementless fixation outcomes. Six studies met our inclusion criteria and were analysed. A total of 755 knees were included; 356 knees underwent cemented fixation, 399 underwent cementless fixation. They were followed up for an average of 8.4 years (range: 2.0 to 16.6). This study found no significant difference in revision rates and knee function in cemented versus cementless TKR at up to 16.6-year follow-up.
Cite this article: EFORT Open Rev 2020;5:793-798. DOI: 10.1302/2058-5241.5.200030
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Affiliation(s)
- Anoop K Prasad
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jaimee H S Tan
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Hany S Bedair
- Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Kaplan Joint Center, Department of Orthopaedics, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Sebastian Dawson-Bowling
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sammy A Hanna
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
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De Wilde L, Dayerizadeh N, De Neve F, Basamania C, Van Tongel A. Fully uncemented glenoid component in total shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22:e1-7. [PMID: 23619247 DOI: 10.1016/j.jse.2013.01.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Loosening of the glenoid component remains the most common problem in total shoulder arthroplasty. It has been described that the round-backed, all-polyethylene components with cemented peg fixation perform better biomechanically and clinically than flat-backed, metal-backed, or keeled components. However, side effects of cementing have been described. We hypothesized that cementing of a specific type of all-polyethylene glenoid component with 3 peripheral pegs and 1 central anchor peg is not necessary to obtain good clinical and radiologic results. MATERIALS AND METHODS Thirty-four shoulders (34 patients), with a mean follow-up of 28.3 months, were evaluated clinically with the Constant-Murley score and the SF-12 Health Survey score. The fixation of the glenoid component was evaluated with computed tomography scan. RESULTS The Constant-Murley score increased from 40.2 points (range, 13-73 points) preoperatively to 72 points (range, 54-93 points) postoperatively. The SF-12 Physical Component Summary score was 45, and the SF-12 Mental Component Summary score was 50. No signs of loosening were seen around the pegs or glenoid in 30 shoulders. Signs of loosening were seen around the central anchor peg and the peripheral pegs in 4 shoulders. There was no statistical difference between the clinical outcome of patients with and without signs of loosening. CONCLUSION The clinical and radiologic evaluation of an uncemented all-polyethylene glenoid is promising, with good clinical results and with no signs of loosening in 88% of the patients on computed tomography scans.
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Affiliation(s)
- Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
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Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RGHH. All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 2012; 470:3549-59. [PMID: 22972656 PMCID: PMC3492632 DOI: 10.1007/s11999-012-2582-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 08/22/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones. QUESTIONS/PURPOSES We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate. METHODS We systematically reviewed the literature for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason. RESULTS Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Meta-regression showed strong evidence that the all-polyethylene design has improved with time compared with the metal-backed design. CONCLUSIONS The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs. LEVEL OF EVIDENCE Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Klaas Auke Nouta
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Wiebe C. Verra
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Bart G. Pijls
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
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Uncemented total knee arthroplasty: 2-year follow-up of 100 knees with a rotating platform, cruciate-retaining design. J Arthroplasty 2011; 26:427-31. [PMID: 20149580 DOI: 10.1016/j.arth.2010.01.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 01/13/2010] [Indexed: 02/01/2023] Open
Abstract
Review of the literature shows mixed results regarding uncemented total knee arthroplasty (TKA). To our knowledge, there are no reports of results for uncemented TKA that incorporates a cruciate-retaining and rotating platform design. It is theorized that these design features could decrease the stress at the bone-implant interface. This study reports results on 100 uncemented TKAs at a minimum of 2-year follow-up. Average Knee Society clinical score improved from 52.9 to 95.1; average Knee Society functional score improved from 60.5 to 82.0. Ninety-eight percent of patients had excellent and 2% had good results based on Knee Society scores. There was 99% implant survival; 1 patient required revision of a loose tibial component after a motor vehicle accident. The promising short-term results support the continued use of this implant and suggest a prospective randomized study comparing cemented vs uncemented TKA of this design is warranted.
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Tarkin IS, Bridgeman JT, Jardon OM, Garvin KL. Successful biologic fixation with mobile-bearing total knee arthroplasty. J Arthroplasty 2005; 20:481-6. [PMID: 16124964 DOI: 10.1016/j.arth.2004.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Accepted: 06/21/2004] [Indexed: 02/01/2023] Open
Abstract
A popular rotating-platform total knee implanted with a cementless technique was studied to determine long-term durability of fixation. A total of 70 knees in 59 patients (34 men, 25 women) was included. The primary indication for surgery was osteoarthritis (80%). A total of 23 of the 70 knees was available at final follow-up (average, 16 years). Clinical and radiographic data suggested durable fixation. In addition, the entire cohort of patients was studied with Kaplan-Meier statistics. Survivorship with respect to aseptic loosening was 97% at 17 years. Only 1 of the 70 knees was revised for aseptic loosening. However, overall survivorship was 76%, which was primarily because of failures of the metal-backed rotating patella.
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Affiliation(s)
- Ivan S Tarkin
- Department of Orthopedic Surgery, University of Nebraska Medical Center, Omaha, NE 68198-1080, USA
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Kim T, Suzuki M, Ohtsuki C, Masuda K, Tamai H, Watanabe E, Osaka A, Moriya H. Enhancement of bone growth in titanium fiber mesh by surface modification with hydrogen peroxide solution containing tantalum chloride. J Biomed Mater Res B Appl Biomater 2003; 64:19-26. [PMID: 12474243 DOI: 10.1002/jbm.b.10469] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A tight fixation between bone and implant materials is of great importance for a successful outcome of procedures such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Surface modification of titanium metal and titanium alloy is one of the attractive methods to improve the biological affinity of orthopedic prostheses. Recent studies reported that titanium substrates were provided with bone-bonding ability, that is, osteoconductivity, through a chemical treatment with hydrogen peroxide solution containing tantalum chloride. The present study investigated the histological and mechanical effects of such treatment of the surface of titanium fiber mesh. Titanium alloy rods of 7.6 x 7.6 x 20 mm that had a titanium fiber mesh of 250 microm were implanted bilaterally into the distal aspect of the femur of adult beagle dogs. At 3, 5, and 8 weeks after implantation, the rods were removed to examine their bonding strength and histological compatibility with bone. Bonding strength was evaluated by the pull-out test. The bonding strength of the treated specimen with bone increased with time, and was faster than that of untreated specimens. At 8 weeks postoperative, the bonding strength of both the treated and untreated specimens became almost equal. The amount of newly formed bone on and in the titanium fiber mesh was significantly increased by the chemical treatment (p<0.05). The rate of bone formation in the fiber mesh was accelerated after chemical treatment. These results indicated that the surface treatment enhanced bone formation in the initial stage thank to the osteoconductive property of the titanium fiber mesh conferred by the chemical treatment so that faster bonding strength was achieved. Surface treatment providing titanium mesh with osteoconductivity has the advantages of the fast healing and tight bonding for prostheses in TKA and THA.
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Affiliation(s)
- Taeseong Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba 260-8677, Japan
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Hartford JM, Hunt T, Kaufer H. Low contact stress mobile bearing total knee arthroplasty: results at 5 to 13 years. J Arthroplasty 2001; 16:977-83. [PMID: 11740751 DOI: 10.1054/arth.2001.27670] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A total of 139 mobile bearing knee arthroplasties in 104 patients were evaluated at a mean follow-up of 7.8 years (range, 5-13 years). There were 80 cemented knees, 50 uncemented, and 9 hybrid (cemented tibia, uncemented femur). Ten knees were revised. Four knees were revised for aseptic loosening of an uncemented tibial component, and 1 knee was revised for loosening of an uncemented femoral component. One knee was revised for a recurrent dislocating bearing, and 1 knee was revised for instability. No mechanical loosening occurred in the cemented components. Three knee arthroplasties were revised for infection. A total of 66 patients (92 knees) were evaluated clinically and radiographically. Radiographic evaluation showed a 27% incidence of radiolucent lines for the femur and a 31% incidence of radiolucent lines for the tibia. No components were considered radiographically loose. The survivorship of mobile bearing knee arthroplasties was 93% at an average follow-up of 7.8 years. Aseptic loosening was statistically higher in uncemented components (P=.0051).
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Affiliation(s)
- J M Hartford
- Division of Orthopaedic Surgery, Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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Cement versus cementless total knee replacement: is there a place for cementless fixation in 2001? ACTA ACUST UNITED AC 2001. [DOI: 10.1097/00001433-200102000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Regnér L, Carlsson L, Kärrholm J, Herberts P. Tibial component fixation in porous- and hydroxyapatite-coated total knee arthroplasty: a radiostereo metric evaluation of migration and inducible displacement after 5 years. J Arthroplasty 2000; 15:681-9. [PMID: 11021442 DOI: 10.1054/arth.2000.8103] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A total of 51 knees (45 patients) with osteoarthrosis were stratified in a randomized study to receive a hydroxyapatite-coated Freeman-Samuelson (FS HA) or a porous-coated Miller-Galante II (MG II) uncemented total knee arthroplasty. Repeated clinical, radiographic, and radiostereometric analysis (RSA) evaluations of the tibial components were done for 5 years. The clinical outcome was equal at the 5-year follow-up (mean Hospital for Special Surgery score, 93). Standard radiographs displayed more zones around the tibial stem in the MG II group. RSA revealed that the FS HA components migrated less (smaller maximum total point motion and maximum subsidence) after 5 years and showed less inducible displacements at the 1-year follow-up. The stability of the implants obtained is equal to or better than cemented implants after 5 years. Key words: knee prosthesis, cementless, hydroxyapatite, radiostereometry, inducible displacement.
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Affiliation(s)
- L Regnér
- Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg University, Sweden
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