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Ailaney N, Barra MF, Schloemann DT, Thirukumaran CP, Kaplan NB. Short-Term (6 Months or Less) Pain in Cemented versus Cementless Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:2137-2146. [PMID: 38387768 DOI: 10.1016/j.arth.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has increased in popularity to potentially improve survivorship. Radiostereometric studies demonstrate increased component migration during the first 3 to 6 months in cementless constructs, generating concern for increased postoperative pain during early osseointegration. The purpose of this study was to evaluate short-term (≤ 6 months) pain and function in cemented versus cementless TKA. We hypothesized that cementless TKA patients report increased pain during the short-term (≤ 6 months) postoperative period. METHODS The MEDLINE, EMBASE, CINAHL, and Cochrane Libraries were searched for studies evaluating short-term (≤ 6 months) outcomes of cemented versus cementless primary TKA. Studies involving hybrid fixation were excluded. A meta-analysis was performed using standardized mean difference for primary outcomes (early postoperative pain) and weighted mean difference (WMD) for secondary outcomes (early postoperative function). RESULTS There were eleven studies included. There was no significant difference in acute postoperative pain between cemented and cementless TKA within 6 months of index TKA (standardized mean difference 0.08 in favor of cemented TKA; P = .10). Early postoperative forgotten joint scores (WMD 0.81; P = .81) and knee injury and osteoarthritis outcome scores for joint replacement (WMD 0.80 in favor of cemented TKA; P = .14) were also similar between groups. CONCLUSIONS There is no difference in short-term (≤ 6 months) pain or early function between patients receiving cemented and cementless TKA. This suggests that surgeons may utilize cementless TKA without fear of increased pain due to micromotion within 6 months of index arthroplasty. However, additional studies with uniform assessment methods are needed to further inform differences in short-term pain and early functional outcomes between cemented and cementless TKA.
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Affiliation(s)
- Nikhil Ailaney
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Matthew F Barra
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Derek T Schloemann
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Caroline P Thirukumaran
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Nathan B Kaplan
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
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2
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Bayoumi T, Burger JA, van der List JP, Sierevelt IN, Spekenbrink-Spooren A, Pearle AD, Kerkhoffs GMMJ, Zuiderbaan HA. Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty. Bone Jt Open 2024; 5:401-410. [PMID: 38767223 PMCID: PMC11103876 DOI: 10.1302/2633-1462.55.bjo-2024-0007.r1] [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] [Indexed: 05/22/2024] Open
Abstract
Aims The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. Methods We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Results Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Conclusion Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A. Burger
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Charité – Department of Orthopaedic Surgery, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Andrew D. Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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3
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Fozo ZA, Hussein Ghazal A, Kamal I, Muhe Eldeen Eshag M, Elhady MM, Hesham Gamal M, Mohamed Fisal K, Ragab KM. A Systematic Review and Network Meta-Analysis of the Outcomes of Patients With Total Knee Arthroplasty Using Cemented, Uncemented, or Hybrid Techniques. Cureus 2023; 15:e47299. [PMID: 37869049 PMCID: PMC10589057 DOI: 10.7759/cureus.47299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/24/2023] Open
Abstract
In this study, we aim to explore the differences among the three types of fixation methods for the components of the knee joint in patients who underwent total knee arthroplasty (TKA). These methods are cemented, uncemented, and hybrid fixation. Cemented fixation means that a special type of grout is used to attach the components to the bone. Uncemented fixation means that the components are designed to fit tightly into the bone and allow new bone growth to secure them. Hybrid fixation means that a combination of cemented and uncemented fixation is used for different components. We searched four online databases to find studies relevant to our research question. We use the R program (R Foundation for Statistical Computing, Vienna, Austria) for network meta-analysis (NMA) to analyze the data from the studies. We calculate the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between methods. We use these measures for continuous outcomes, meaning they can have any value. For dichotomous outcomes, meaning they can only have two values, we use the risk ratio (RR) and the 95% CI, which are statistical measures of the relative risk and the uncertainty between methods. We assess the quality of randomized controlled trials, which are studies that randomly assign participants to different methods, using the Cochrane Risk of Bias Assessment Tool 1, a tool that evaluates the potential biases in the studies. We include 21 studies, and our analysis shows that cemented TKA reveals a statistically significant decrease in pain with hybrid TKA (MD = -2.82). That said, we find no significant differences between uncemented and cemented or hybrid (MD = -0.80 and -2.02, respectively). The results show that there is no significant difference between uncemented TKA and cemented TKA or hybrid technique (RR = 0.87, 95% CI 0.35-2.14; RR = 0.73, 95% CI 0.22-2.39, respectively). Also, we find no significant difference between cemented TKA and hybrid TKA (RR = 0.84, 95% CI 0.24-2.93). Cemented TKA is associated with a lower risk of deep vein thrombosis (DVT) incidence rate. Moreover, it shows a significant decrease in pain compared to hybrid TKA. Future research is needed to compare among the three interventions.
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Affiliation(s)
| | - Ahmed Hussein Ghazal
- Orthopaedics, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
| | - Ibrahim Kamal
- General Medicine, Al-Azhar University, Alexandria, EGY
| | | | - Mahmoud M Elhady
- Orthopaedics, Faculty of Medicine, Benha University, Qalubiya, EGY
| | - Mohamed Hesham Gamal
- Pharmacology and Therapeutics, Faculty of Pharmacy, Tanta University, Elgharbia, EGY
| | - Khalid Mohamed Fisal
- Pharmacology and Therapeutics, Faculty of Pharmacy, Deraya University, Minia, EGY
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4
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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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5
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Goh GS, Wells Z, Ong CB, Small I, Ciesielka KA, Fillingham YA. Does Body Mass Index Influence the Outcomes and Survivorship of Modern Cementless Total Knee Arthroplasty? J Arthroplasty 2022; 37:2171-2177. [PMID: 35644461 DOI: 10.1016/j.arth.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Higher body mass index (BMI) has been associated with higher rates of aseptic loosening following cemented total knee arthroplasty (TKA). However, there is a paucity of evidence on the effect of BMI on the durability of modern cementless TKA. We aimed to assess the association between BMI and clinical outcomes following cementless TKA and to determine if there was a BMI threshold beyond which the risk of revision significantly increased. METHODS We identified 1,408 cementless TKAs of a modern design from an institutional registry. Patients were classified into BMI categories: normal (n = 136), overweight (n = 476), obese class I (n = 423), II (n = 258), and III (n = 115). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and 12-item Short Form Health Survey scores were collected preoperatively and 2 years postoperatively. Survivorship was recorded at minimum 2 years (range, 24 to 88 months). BMI was analyzed as a continuous and categorical variable. RESULTS The improvement in patient-reported outcomes was similar across the groups. Thirty four knees (2.4%) were revised and 14 (1.0%) were for aseptic failure. Mean time-to-revision was 1.2 ± 1.3 years and did not differ across BMI categories (P = .455). Survivorship free from all-cause and aseptic revision was 97.1% and 99.0% at mean 4 years, respectively. Using Cox regression to control for demographics and bilateral procedures, BMI had no association with all-cause revision (P = .612) or aseptic revision (P = .186). Receiver operating characteristic curve analysis found no relationship between BMI and revision risk (c-statistic = 0.51). CONCLUSION BMI did not influence functional outcomes and survivorship of modern cementless TKA, possibly due to improved biological fixation at the bone-implant interface. Longer follow-up is necessary to confirm these findings.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zachary Wells
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian B Ong
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ilan Small
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kerri-Anne Ciesielka
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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6
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van Ooij B, de Keijzer DR, Hoornenborg D, Sierevelt IN, Haverkamp D. Lower revision rates for cemented fixation in a long-term survival analysis of three different LCS designs. Knee Surg Sports Traumatol Arthrosc 2022; 30:2707-2713. [PMID: 33934194 DOI: 10.1007/s00167-021-06587-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In primary Total Knee Arthroplasty (TKA), it is still not clear if cemented or uncemented fixation has the best long-term survival. The Low Contact Stress (LCS) mobile-bearing (MB) knee system was introduced in 1977. The aim of this study is to investigate the long-term survival of this design with a minimum of 15-year follow-up. METHODS A retrospective analysis was performed, with the primary endpoint for survival defined as revision. Cox regression analysis was performed to assess the association between type of fixation and the risk of revision, while correcting for potential confounders (diagnosis, design, age and sex). RESULTS 1271 cases were included with inflammatory joint disease (IJD) (657 cases) and non-IJD (614 cases). TKAs were performed cemented in 522 cases and uncemented in 749 cases. A bicruciate retaining design was used in 180 cases, a rotating platform design in 174 cases and an anterior posterior glide posterior cruciate-retaining (PCR) design in 916 cases. Cumulative incidence of component revision at 15 years was 2.7% (95% CI 1.6; 4.5) for cemented and 10% (95% CI 8.1; 12.4) for uncemented TKA, respectively. The 20-year cumulative incidence was 2.9% (95% CI 1.7; 4.7) for cemented and 10.9% (95% CI 8.8; 13.4) for uncemented TKA, respectively. Age, non-IJD and PCR design were associated with a significantly higher risk of revision, regardless of the type of fixation. CONCLUSION Long-term survival for patients undergoing cemented or uncemented TKA using the LCS MB system revealed lower revision rates for cemented fixation. Revision risk was higher in younger, non-IJD patients who had the PCR design, regardless of the type of fixation. For the LCS MB TKA design, it is recommended to use cemented fixation.
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Affiliation(s)
- Bas van Ooij
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands. .,Cohesie, Occupational Health Service, Baron van Nagellstraat 9, 3781 AP, Voorthuizen, The Netherlands.
| | - Dave R de Keijzer
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Daniël Hoornenborg
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands.,Orthopedic Department, Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Daniël Haverkamp
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands
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Goh GS, Fillingham YA, Sutton RM, Small I, Courtney PM, Hozack WJ. Cemented Versus Cementless Total Knee Arthroplasty in Obese Patients With Body Mass Index ≥35 kg/m 2: A Contemporary Analysis of 812 Patients. J Arthroplasty 2022; 37:688-693.e1. [PMID: 34990755 DOI: 10.1016/j.arth.2021.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cemented total knee arthroplasty (TKA) has been shown to have higher failure rates in obese patients, and cementless TKA may provide more durable fixation. This study compared outcomes and survivorship of obese patients undergoing cemented and cementless TKA of the same modern design. METHODS We identified a consecutive series of 406 primary cementless TKA performed in obese patients with body mass index (BMI) ≥35 kg/m2 in 2013-2018. Each case was matched 1:1 with 406 cemented TKA based on age, sex, BMI, bearing surface, and year of surgery. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Short Form-12 were collected preoperatively, at 6 months and 2 years. Implant survivorship was recorded at mean 4.0 years (range 2.0-7.8). RESULTS There was no difference in mean BMI between the cemented (38.6 ± 3.4 kg/m2; range, 35-60) and cementless cohorts (38.7 ± 3.3 kg/m2; range, 35-54; P = .706). Both groups had similar final postoperative scores and improvement in scores at 2 years. Furthermore, a similar percentage met the minimal clinically important difference (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, 70.0% vs 71.2%, P = .700; Short Form-12 Physical, 74.1% vs 70.4%, P = .240). Both groups demonstrated high 7-year survivorship free from aseptic revision (99.0% vs 99.5%, P = .665). CONCLUSION Obese patients with BMI ≥35 kg/m2 undergoing cementless and cemented TKA of the same modern design had similar outcomes and survivorship at early to mid-term follow-up. Continued surveillance of this high-risk population is necessary.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yale A Fillingham
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ryan M Sutton
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ilan Small
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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8
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Gifstad T, Nordskar JJ, Egeberg T, Wik TS, Winther SB. Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2738-2743. [PMID: 34036403 PMCID: PMC9309142 DOI: 10.1007/s00167-021-06617-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. METHODS From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, "based on your experience to date, would you go through the surgery again?". Duration of surgery was noted and revisions during the first post-operative year were evaluated. RESULTS The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. CONCLUSION UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tone Gifstad
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway.
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jørgen Jebens Nordskar
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tarjei Egeberg
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
| | - Tina Strømdal Wik
- Department of Orthopaedics, Trondheim University Hospital, Postbox 3250, NO 7006, Torgarden, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Bjørgen Winther
- Department of Orthopaedics, Orthopaedic Research Center, Trondheim University Hospital, Trondheim, Norway
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9
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van Hamersveld KT, Marang-van de Mheen PJ, Tsonaka R, Nilsson KG, Toksvig-Larsen S, Nelissen RGHH. Risk Factors for Tibial Component Loosening: A Meta-Analysis of Long-Term Follow-up Radiostereometric Analysis Data. J Bone Joint Surg Am 2021; 103:1115-1124. [PMID: 33886528 DOI: 10.2106/jbjs.20.01454] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiostereometric analysis (RSA) is a highly accurate tool to detect implant migration and predict loosening following total knee arthroplasty (TKA). However, little is known about the predisposing risk factors for implant migration, nor which migration profile should be considered physiological (i.e., merely part of an implant-settling phase) and which should be considered pathological (i.e., having a high probability for implant loosening). By pooling individual participant data from long-term follow-up RSA studies, we aimed to identify predisposing risk factors for tibial component loosening. METHODS Individual data were collected for 630 patients from 11 RSA studies. The repeated measurements were analyzed with use of a linear mixed-effects model, determining the effect of age, sex, body mass index, diagnosis, preoperative and postoperative limb alignment, and prosthesis characteristics on tibial component migration over time, taking into account the clustering of patients within studies. RESULTS High initial migration was found to result in early mechanical loosening in 18 cases (2.9%) and septic loosening in 2 cases (0.3%), whereas stabilization of high initial migration occurred in 17 cases (2.7%). Late loosening occurred in 13 cases (2.1%). All other 580 cases (92.1%) showed early stabilization and remained stable over time. Mixed-effects model analyses showed that for cemented prostheses, sex, diagnosis, and posterior cruciate ligament type had an effect on migration, but these differences were nonsignificant when analyzing migration from 3 months onwards. Uncemented prostheses aligned in varus showed more migration than neutrally and valgus-aligned TKAs (p = 0.031), and this difference increased over time (p < 0.001). Significantly higher migration was observed following uncemented TKA without an osseointegration-promoting surface (p < 0.001). CONCLUSIONS For cemented prostheses, increased migration during the first 3 postoperative months was observed for female patients, patients with rheumatoid arthritis, and patients who underwent a posterior-stabilized TKA. For uncemented prostheses, both postoperative varus alignment of the lower limb and the absence of an osseointegration-promoting surface significantly increased postoperative tibial component migration. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Koen T van Hamersveld
- Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - Perla J Marang-van de Mheen
- Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - Roula Tsonaka
- Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands
| | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences and Department of Orthopaedics, Umeå University, Umeå, Sweden
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rob G H H Nelissen
- Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands
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10
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Asokan A, Plastow R, Kayani B, Radhakrishnan GT, Magan AA, Haddad FS. Cementless knee arthroplasty: a review of recent performance. Bone Jt Open 2021; 2:48-57. [PMID: 33537676 PMCID: PMC7842161 DOI: 10.1302/2633-1462.21.bjo-2020-0172.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article: Bone Jt Open 2021;2(1):48–57.
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Affiliation(s)
- Ajay Asokan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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11
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van Ooij B, Sierevelt IN, van der Vis HM, Hoornenborg D, Haverkamp D. What is the role of cemented fixation in total knee arthroplasty? The two-year results of a randomized RSA controlled trial. Bone Joint J 2021; 103-B:98-104. [PMID: 33380179 DOI: 10.1302/0301-620x.103b1.bjj-2020-0788.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS For many designs of total knee arthroplasty (TKA) it remains unclear whether cemented or uncemented fixation provides optimal long-term survival. The main limitation in most studies is a retrospective or non-comparative study design. The same is true for comparative trials looking only at the survival rate as extensive sample sizes are needed to detect true differences in fixation and durability. Studies using radiostereometric analysis (RSA) techniques have shown to be highly predictive in detecting late occurring aseptic loosening at an early stage. To investigate the difference in predicted long-term survival between cemented, uncemented, and hybrid fixation of TKA, we performed a randomized controlled trial using RSA. METHODS A total of 105 patients were randomized into three groups (cemented, uncemented, and hybrid fixation of the ACS Mobile Bearing (ACS MB) knee system, implantcast). RSA examinations were performed on the first day after surgery and at scheduled follow-up visits at three months, six months, one year, and two years postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and after two years follow-up. Patients and follow-up investigators were blinded for the result of randomization. RESULTS RSA secondary stabilization did not show a significant difference between the three types of fixation. A maximum total point motion of less than 0.2 mm in the second postoperative year was shown in each group, which suggests stabilization of the implant. At 24 months after surgery, PROMs significantly improved compared to baseline in all treatment groups. No significant difference was observed between the three groups. CONCLUSION Secondary stabilization measurements in this study demonstrated no significant difference between the groups. In all groups migration stabilized after initial settling of the implant. For this implant the long-term outcome is not expected to be influenced by the type of fixation to the bone. Cite this article: Bone Joint J 2021;103-B(1):98-104.
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Affiliation(s)
- Bas van Ooij
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Amsterdam, The Netherlands.,Cohesie, Occupational Health Service, Voorthuizen, The Netherlands
| | - Inger N Sierevelt
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Amsterdam, The Netherlands.,Orthopaedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Harm M van der Vis
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Amsterdam, The Netherlands
| | - Daniël Hoornenborg
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Amsterdam, The Netherlands
| | - Daniël Haverkamp
- SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Amsterdam, The Netherlands
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12
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Harwin SF, DeGouveia W, Sodhi N, Gold PA, Garbarino LJ, Ehiorobo JO, Salem HS, Mont MA. Outcomes of Cementless-Backed Patellar Components. J Knee Surg 2020; 33:856-861. [PMID: 32483801 DOI: 10.1055/s-0040-1710378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Because of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the: (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 261 patients who underwent cementless TKA by a single, high-volume academic surgeon were studied. Patients had a mean age of 66 years and were distributed between 192 women (74%) and 69 men. All patients received the same cementless tibial, femoral, and patellar components. Mean follow-up period was 4.5 years (range, 4-5 years). Primary outcomes evaluated included all postoperative complications, with particular emphasis on the patellar component. Only one patellar loosened leading to a patellar aseptic loosening rate of 0.3% (1 of 261). The one patellar loosening was the component being dislodged after a manipulation under anesthesia (MUA) at 6 weeks. This was revised to a cemented component and the patient is doing well 4 years later. A second patient experienced a patellar tendon rupture, later surgically repaired. Another patient sustained a patella fracture that was managed nonoperatively. The fracture healed by 1 year and the patient continued to have an otherwise successful outcome, now at 2 years follow-up. No progressive radiolucencies, subsidence, or changes in initial postoperative axial alignment were observed at final follow-up. The results from this study highlight a 98% success rate at mean 4.5 years follow-up in a large cohort of patients with a diverse spread of demographic details. Specific to the patella, only one patient experienced an adverse event, which was managed nonoperatively. Therefore, based on this data, patellar fixation in cementless TKA can be considered a safe technique.
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Affiliation(s)
- Steven F Harwin
- Department of Orthopaedics, Mount Sinai Hospital West, New York, New York
| | - William DeGouveia
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Nipun Sodhi
- Northwell Health Orthopaedics, Long Island Jewish Medical Center, New York, New York
| | - Peter A Gold
- Northwell Health Orthopaedics, Long Island Jewish Medical Center, New York, New York
| | - Luke J Garbarino
- Northwell Health Orthopaedics, Long Island Jewish Medical Center, New York, New York
| | - Joseph O Ehiorobo
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
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13
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Horváth T, Hanák L, Hegyi P, Butt E, Solymár M, Szűcs Á, Varga O, Thien BQ, Szakács Z, Csonka E, Hartmann P. Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0232378. [PMID: 32396538 PMCID: PMC7217427 DOI: 10.1371/journal.pone.0232378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The potential advantages of hydroxyapatite (HA)-coated cementless total knee arthroplasty (TKA) implants are bone stock preservation and biological fixation. Studies comparing the outcomes of HA-coated cementless, non HA-coated cementless (uncemented) and cemented TKA implants reported contradictory data. Our aim was to provide a comparison of the effects of HA coating of tibial stem on the stability and functionality of TKA implants. METHODS A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the CENTRAL databases up to May 31st, 2019. The primary outcome was Maximum Total Point Motion (MTPM) of the tibial stem. This parameter is determined by radiosterometric analysis and refers to the migration pattern of the prosthesis stems. The clinical outcomes of the implanted joints were evaluated by the Knee Society Knee Score (KSS) and the Knee Society Function Score (KFS). Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated with the random-effects model. RESULTS Altogether, 11 randomized controlled trials (RCTs) with 902 patients for primary TKA implants were included. There was a statistically significant difference in the MTPM values with the use of HA-coated and uncoated uncemented implants (WMD = +0.28, CI: +0.01 to +0.56, P<0.001). However, HA-coated stems showed significantly higher migration when compared with the cemented prostheses (WMD = -0.29, CI: -0.41 to -0.16, P<0.001). The KSS values of HA-coated implants were significantly higher than those for the uncemented implants; moreover, KSS and KFS outcome scores were statistically not different between the HA-coated and cemented prosthesis cases. CONCLUSION HA-coating yields better stability than other, uncemented prostheses. More importantly, the HA-coating is not outperformed by cemented prosthesis in providing good functional outcome.
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Affiliation(s)
- Tamara Horváth
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Edina Butt
- Department of Traumatology, University of Szeged, Szeged, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ákos Szűcs
- Department of Surgery, University of Semmelweis, Budapest, Hungary
| | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Bui Quoc Thien
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Endre Csonka
- Department of Traumatology, University of Szeged, Szeged, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
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14
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Wang K, Sun H, Zhang K, Li S, Wu G, Zhou J, Sun X. Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e18750. [PMID: 32011458 PMCID: PMC7220050 DOI: 10.1097/md.0000000000018750] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of cemented and cementless fixations in primary total knee arthroplasty (TKA) in young patients is controversial. Previous reviews predominantly relied on data from retrospective studies. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the optimal fixation mode in TKA for young patients. METHODS The PubMed, Embase, Medline, Web of Science, and full Cochrane Library electronic databases were searched from inception to July 2018. The outcome measurements consisted of functional outcomes (Knee Society Score [KSS], range of motion [ROM]), radiolucent lines, aseptic loosening, total complications, and reoperation rate. Study data were pooled using a random-effects model. RESULTS Six RCTs were included in the systematic review and meta-analysis. The mean follow-up period was 12 years (range, 2-16.6 years). Cementless TKA was associated with higher KSS-function (P < .0001), higher KSS-pain (P = .005), better ROM recovery (P = .01), and fewer radiolucent lines (<1 mm) (P = .04) compared with cemented TKA. No significant intergroup differences were observed for KSS-knee, total complications, aseptic loosening, or reoperation rate. These results based on a random-effects model were unchanged by sensitivity analysis assumptions. CONCLUSION Cementless TKA was substantially superior to cemented TKA in young patients. Although the complication and survival rates were similar between groups, better clinical outcomes were obtained with cementless fixation. Further well-designed studies with long follow-up durations are necessary to confirm our findings.
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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16
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Wojtowicz R, Henricson A, Nilsson KG, Crnalic S. Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design - a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years' follow-up. Acta Orthop 2019; 90:460-466. [PMID: 31210081 PMCID: PMC6746276 DOI: 10.1080/17453674.2019.1626097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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 - Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients? Patients and methods - 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1-5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs). Results - The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse. Interpretation - The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.
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Affiliation(s)
- Radoslaw Wojtowicz
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
| | | | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; ,Correspondence:
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
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17
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Chen C, Li R. Cementless versus cemented total knee arthroplasty in young patients: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:262. [PMID: 31426816 PMCID: PMC6700781 DOI: 10.1186/s13018-019-1293-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose Optimal type of prosthesis in total knee arthroplasty (TKA) remains controversial for young patients. The objective of this meta-analysis is to compare cementless and cemented fixation in TKA. Methods In this meta-analysis, we conducted electronic searches of PubMed, Embase, Cochrane Library, and Web of Science in December 2018. We collected randomized controlled trials (RCTs) comparing cementless and cemented TKA in young patients. The outcome measurements consisted of functional outcomes, Knee Society Score, range of motion, radiological outcomes, pain score, and complications. Stata 12.0 software was used for our meta-analysis. Quality assessment for RCTs was conducted according to the Cochrane Handbook for systematic review of interventions. Results Four RCTs met our inclusion criteria with 255 patients in cemented groups and 229 patients in cementless groups. The present meta-analysis indicated that there was a significant difference between the groups in terms of radiological outcomes and pain score. No significant difference was found regarding KSS, range of motion, or complications. Conclusion Cementless TKA was associated with superior outcomes in terms of radiological outcomes and pain score compared with cemented fixation. We found no significant difference regarding the functional outcome or aseptic loosening between groups. High-quality RCTs were still required for further investigation.
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Affiliation(s)
- Chengyu Chen
- Department of Orthopedics, People's Hospital of Yuncheng, Heze, 274700, Shandong Province, China
| | - Ruodong Li
- Department of Orthopedics, People's Hospital of Liaocheng Dongchangfu, Liaocheng, 252000, Shandong Province, China.
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18
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Laende EK, Richardson CG, Dunbar MJ. Predictive value of short-term migration in determining long-term stable fixation in cemented and cementless total knee arthroplasties. Bone Joint J 2019; 101-B:55-60. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1493.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Early implant migration measured with radiostereometric analysis (RSA) has been proposed as a useful predictor of long-term fixation of tibial components in total knee arthroplasty. Evaluation of actual long-term fixation is of interest for cemented components, as well as for cementless fixation, which may offer long-term advantages once osseointegration has occurred. The objective of this study was to compare the long-term migration with one- and two-year migration to evaluate the predictive ability of short-term migration data and to compare migration and inducible displacement between cemented and cementless (porous metal monoblock) components at least ten years postoperatively. Patients and Methods Patients who had participated in RSA migration studies with two-year follow-up were recruited to return for a long-term follow-up, at least ten years from surgery. Two cemented tibial designs from two manufacturers and one porous metal monoblock cementless tibial design were studied. At the long-term follow-up, patients had supine RSA examinations to determine migration and loaded examinations (single leg stance) to determine inducible displacement. In total, 79 patients (54 female) returned, with mean time since surgery of 12 years (10 to 14). There were 58 cemented and 21 cementless tibial components. Results Migration at one year and two years was significantly correlated with long-term migration (p < 0.001). Median migration at the long-term follow-up was 0.6 mm (maximum total point motion; interquartile range (IQR) 0.4 to 0.9) for the cemented group and 0.6 mm (IQR 0.3 to 1.1) for the cementless group with no difference between groups (p = 0.99). Inducible displacement was significantly lower for the cementless components (p < 0.001). Conclusion Long-term migration was strongly correlated with two-year migration. Although long-term migration was not different for cemented or cementless tibial components, inducible displacement at the long-term visit was significantly lower for these cementless components, suggesting superior fixation. These findings support the predictive value of short-term migration in determining long-term fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):55–60
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Affiliation(s)
- E. K. Laende
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - C. G. Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - M. J. Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
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Laende EK, Astephen Wilson JL, Mills Flemming J, Valstar ER, Richardson CG, Dunbar MJ. Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties. Acta Orthop 2019; 90:172-178. [PMID: 30669909 PMCID: PMC6461081 DOI: 10.1080/17453674.2018.1562633] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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 - Thresholds of implant migration for predicting long-term successful fixation of tibial components in total knee arthroplasty have not separated cemented and uncemented fixation. We compared implant migration of cemented and uncemented components at 1 year and as the change in migration from 1 to 2 years. Patients and methods - Implant migration of 360 tibial components measured using radiostereometric analysis was compared at 1 year and as the change in migration from 1 to 2 years in 222 cemented components (3 implant designs) and 138 uncemented components (5 implant designs). Results - 1-year maximum total point motion was lower for the cemented tibial components compared with the uncemented components (median = 0.31 mm [0.03-2.98] versus 0.63 mm [0.11-5.19] respectively, p < 0.001, mixed model). The change in migration from 1 to 2 years, however, was equivalent for cemented and uncemented components (mean [SD] 0.06 mm [0.19] and 0.07 mm [0.27] mm respectively, p = 0.6, mixed model). Interpretation - These findings suggest that current thresholds of acceptable migration at 1 year may be better optimized by considering cemented and uncemented tibial components separately as higher early migration of uncemented components was not associated with decreased stability from 1 to 2 years.
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Affiliation(s)
- Elise K Laende
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;; ,Correspondence:
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada;;
| | - Joanna Mills Flemming
- Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada;;
| | - Edward R Valstar
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;;
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;;
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Henricson A, Wojtowicz R, Nilsson KG, Crnalic S. Uncemented or cemented femoral components work equally well in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1251-1258. [PMID: 30361757 DOI: 10.1007/s00167-018-5227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/17/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To study the pattern of migration and clinical results up to 10 years of uncemented versus cemented fixation of the femoral component in total knee arthroplasty. METHODS Randomized controlled trial was conducted of 41 patients (23 women, 18 men) under the age of 60 years using radiostereometric analysis. RESULTS About two-thirds of the cemented implants and half of the uncemented implants stabilized between 2 and 10 years, while the remainder displayed a small annual increase of maximum total point motion of 0.09-0.10 mm/year. At 10 years there were no statistically significant differences in migration or clinical results between the groups. CONCLUSION Uncemented fixation with titanium fiber mesh coating of the femoral component in total knee arthroplasty works equally as well as cemented fixation up to 10 years. An annual migration of 0.1 mm seems compatible with excellent long-term performance. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Anders Henricson
- Department of Orthopaedics, Falu General Hospital, Falun, Sweden.
| | - Radek Wojtowicz
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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21
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Increased Survivorship of Cementless versus Cemented TKA in the Morbidly Obese. A Minimum 5-Year Follow-Up. J Arthroplasty 2019; 34:309-314. [PMID: 30446183 DOI: 10.1016/j.arth.2018.10.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) in the morbidly obese patients can be challenging with an increased risk of complications. Studies have shown increased aseptic failures with well-aligned cemented TKAs in the obese patient. The purpose of this study is to determine if TKA in the morbidly obese (body mass index [BMI] ≥ 40) using cementless implants would demonstrate improved results and survivorship compared to cemented TKA at a minimum 5-year follow-up. METHODS This is a retrospective study comparing clinical results of cemented vs cementless primary TKA with a posterior stabilized design TKA in morbidly obese (BMI ≥ 40) patients with minimal 5-year follow-up. There were 108 patients in the cementless group with a mean BMI of 45.6. In the cemented cohort, there were 85 cemented TKAs with a mean BMI of 45.0. Demographic, clinical, surgical, and radiographic data along with complications were extracted for all study patients. RESULTS There were 5 failures requiring revision in the cementless group, including 1 for aseptic tibial loosening (0.9%). In the cemented group, there were 22 failures requiring revision, including 16 implants for aseptic loosening (18.8%; P = .0001). Survivorship with aseptic loosening as the endpoint was 99.1% in the cementless group vs 88.2% in the cemented cohort at 8 years (P = .02). CONCLUSION Morbidly obese patients (BMI ≥ 40) have a higher failure due to aseptic loosening with cemented TKA with decreasing survivorship over time. The use of cementless TKA in morbidly obese patients with the potential of durable long-term biologic fixation and increased survivorship appears to be a promising alternative to mechanical cement fixation.
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Van Hamersveld KT, Marang-Van De Mheen PJ, Nelissen RGHH, Toksvig-Larsen S. Peri-apatite coating decreases uncemented tibial component migration: long-term RSA results of a randomized controlled trial and limitations of short-term results. Acta Orthop 2018; 89:425-430. [PMID: 29741133 PMCID: PMC6066768 DOI: 10.1080/17453674.2018.1469223] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Biological fixation of uncemented knee prostheses can be improved by applying hydroxyapatite coating around the porous surface via a solution deposition technique called Peri-Apatite (PA). The 2-year results of a randomized controlled trial, evaluating the effect of PA, revealed several components with continuous migration in the second postoperative year, particularly in the uncoated group. To evaluate whether absence of early stabilization is diagnostic of loosening, we now present long-term follow-up results. Patients and methods - 60 patients were randomized to PA-coated or uncoated (porous only) total knee arthroplasty of which 58 were evaluated with radiostereometric analysis (RSA) performed at baseline, at 3 months postoperatively and at 1, 2, 5, 7, and 10 years. A linear mixed-effects model was used to analyze the repeated measurements. Results - PA-coated components had a statistically significantly lower mean migration at 10 years of 0.94 mm (95% CI 0.72-1.2) compared with the uncoated group showing a mean migration of 1.72 mm (95% CI 1.4-2.1). Continuous migration in the second postoperative year was seen in 7 uncoated components and in 1 PA-coated component. All of these implants stabilized after 2 years except for 2 uncoated components. Interpretation - Peri-apatite enhances stabilization of uncemented components. The number of components that stabilized after 2 years emphasizes the importance of longer follow-up to determine full stabilization and risk of loosening in uncemented components with biphasic migration profiles.
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Affiliation(s)
| | | | | | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden
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Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:1811-1822. [PMID: 29185005 DOI: 10.1007/s00167-017-4817-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Due to the lack of comparative studies, a systematic review was conducted to determine revision rates of unicompartmental and total knee arthroplasty (UKA and TKA), and compare functional outcomes, range of motion and activity scores in patients less than 65 years of age. METHODS A literature search was performed using PubMed, Embase, and Cochrane systems since 2000. 27 UKA and 33 TKA studies were identified and included. Annual revision rate (ARR), functional outcomes, and return to activity were assessed for both types of arthroplasty using independent t tests. RESULTS Four level I studies, 12 level II, 16 level III, and 29 level IV were included, which reported on outcomes in 2224 UKAs and 4737 TKAs. UKA studies reported 183 revisions, yielding an ARR of 1.00 and extrapolated 10-year survivorship of 90.0%. TKA studies reported 324 TKA revisions, resulting in an ARR of 0.53 and extrapolated 10-year survivorship of 94.7%. Functional outcomes scores following UKA and TKA were equivalent, however, following UKA larger ROM (125° versus 114°, p = 0.004) and higher UCLA scores were observed compared to TKA (6.9 versus 6.0, n.s.). CONCLUSION These results show that good-to-excellent outcomes can be achieved following UKA and TKA in patients less than 65 years of age. A higher ARR was noted following UKA compared to TKA. However, improved functional outcomes, ROM and return to activity were found after UKA than TKA in this young population. Comparative studies are needed to confirm these findings and assess factors contributing to failure at the younger patient population. Outcomes of UKA and TKA in patients younger than 65 years are both satisfying, and therefore, both procedures are not contraindicated at younger age. UKA has several important advantages over TKA in this young and frequently more active population. LEVEL OF EVIDENCE IV.
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24
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Harwin SF, Levin JM, Khlopas A, Ramkumar PN, Piuzzi NS, Roche M, Mont MA. Cementless Posteriorly Stabilized Total Knee Arthroplasty: Seven-Year Minimum Follow-Up Report. J Arthroplasty 2018; 33:1399-1403. [PMID: 29195849 DOI: 10.1016/j.arth.2017.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/21/2017] [Accepted: 11/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate (1) implant survivorship; (2) patient outcomes; (3) complications; and to (4) perform a radiographic analysis of cementless posteriorly stabilized total knee arthroplasty (TKA) patients at a minimum of 7-year follow-up. METHODS Our original cohort was composed of 114 consecutive cementless posteriorly stabilized total knee arthroplasties (110 patients) performed by a single surgeon between 2008 and 2010. Since our original report, 4 (1 bilateral) patients died and 2 were lost to follow-up. Therefore, there were 104 patients who had 107 knees available for final follow-up. The final cohort included 43 men and 61 women, who had a mean age of 69 years (range 47-87) and were followed from 7 to 9 years (mean 8 years). Patient outcomes and complications were obtained from electronic medical records. Radiographic assessment was done using the Knee Society Radiographic Evaluation System. RESULTS The all-cause survivorship was 98% (95% confidence interval 1.01-0.96). Since the original report, there has been 1 post-traumatic loosening of the tibial baseplate, and 1 revision for instability. There were no femoral revisions or patella revisions. The mean Knee Society pain score was 93 points (range 80-100) and the function score was 78 points (range 68-95). Excluding revisions, there was no evidence of progressive loosening of any implant components. CONCLUSION Based on these 7-year minimum follow-ups, femoral, tibial, and patellar cementless hydroxylapatite-coated beaded implants perform well at up to 9 years postoperatively and offer surgeons and patients a cementless option that may provide long-lasting biological fixation.
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Affiliation(s)
- Steven F Harwin
- Total Hip and Knee Arthroplasty Service, Department of Orthopaedic Surgery, Mount Sinai West, New York, New York
| | - Jay M Levin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Martin Roche
- Department of Orthopaedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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25
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Zhou K, Yu H, Li J, Wang H, Zhou Z, Pei F. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis. Int J Surg 2018; 53:312-319. [PMID: 29656129 DOI: 10.1016/j.ijsu.2018.04.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/25/2018] [Accepted: 04/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a systematic review and meta-analysis to evaluate the optimal mode of fixation (full-cementless vs. full-cemented) in TKA. METHODS PubMed, Embase, and the Cochrane Library databases up to July 2017 were searched to identify randomised controlled trials (RCTs) and quasi-RCTs comparing full-cementless TKA and full-cemented TKA. The primary outcome was implant survivorship. Secondary outcomes included radiological outcomes (maximum total point-motion [MTPM], radiolucent line, rotation degree) and clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, Knee Society Score [KSS] score, postoperative range of movement, blood loss and complications). RESULTS Seven studies were included in the systematic review and meta-analysis. The mean follow-up was 7.1 years (range from 2 to 16.6 years). There was no difference in implant survivorship (RR, 0.98; 95% CI, 0.95-1.01; p = 0.25; I2 = 0%), MTPM (weighted mean difference [WMD], 0.13 mm; 95% CI, -0.69-0.95; p = 0.75; I2 = 89.3%) and radiolucent line (RR, 1.36; 95% CI, 0.57-3.23; p = 0.48; I2 = 54%) between the cementless and cemented methods. There was a mean 0.22° more rotation in the full-cementless fixation group (95% CI, 0.13-0.32; p < 0.01; I2 = 28.5%). There were no significant differences relating to clinical outcomes (WOMAC score, KSS score, postoperative range of movement, blood loss and complications) between the two fixation groups. CONCLUSIONS Although more overall component rotation is found in full-cementless fixation, the implant survivorship and clinical efficacy are likely similar between full-cementless and full-cemented fixation. However, future RCTs with similar cementless prosthetic coating and longer-term follow-up are still needed to confirm our findings.
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Affiliation(s)
- Kai Zhou
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Haoda Yu
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jinglong Li
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Haoyang Wang
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zongke Zhou
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Fuxing Pei
- Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China
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Uncemented vs Cemented Cruciate Retaining Total Knee Arthroplasty in Patients With Body Mass Index Greater Than 30. J Arthroplasty 2018; 33:1082-1088. [PMID: 29248485 DOI: 10.1016/j.arth.2017.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aseptic loosening of cemented and uncemented tibial components continues to be a source of implant failure after total knee arthroplasty (TKA) in the obese population. There is limited literature reviewing uncemented cruciate retaining (CR) components in the obese population. METHODS A clinical and radiographic review was performed on 325 patients who underwent a cemented or uncemented TKA with a CR knee prosthesis and body mass index ≥30 kg/m2 between January 2010 and June 2013. Charts were reviewed for the incidence of revision due to aseptic loosening of the tibial baseplate, revision for any reason, incidence of radiolucent lines around the tibial baseplate, range of motion, and patient reported outcomes. RESULTS There was no statistically significant difference between groups in survivorship for aseptic loosening of the tibial component (99.4% uncemented, 99.3% cemented, P = .94) and overall survivorship (98.1% uncemented, 98.3% cemented, P = .90). The Lower Extremity Activity Scale and Forgotten Joint Score-12 clinical outcome measures were similar between groups (10.2 ± 3.7 vs 9.7 ± 3.4 and 66.1 ± 28.2 vs 64.9 ± 24.3, P = .33, P = .78, respectively). Postoperative knee flexion was similar between groups (114.6 ± 9.3 vs 114.1 ± 9.3, P = .67). CONCLUSION Our study demonstrated similar survivorship of this CR design for aseptic loosening of the tibial baseplate and overall revision rates in obese patients undergoing either an uncemented or cemented TKA. The uncemented and cemented groups had comparable clinical and radiographic short to mid-term outcomes when implanted in good alignment when treating end-stage knee osteoarthritis.
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27
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Ersan Ö, Öztürk A, Çatma MF, Ünlü S, Akdoğan M, Ateş Y. Total knee replacement-cementless tibial fixation with screws: 10-year results. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:433-436. [PMID: 29102502 PMCID: PMC6197464 DOI: 10.1016/j.aott.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/15/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the long term clinical and radiological results of cementless total knee replacement. METHODS A total of 51 knees of 49 patients (33 female and 16 male; mean age: 61.6 years (range, 29-66 years)) who underwent TKR surgery with a posterior stabilized hydroxyapatite coated knee implant were included in this study. All of the tibial components were fixed with screws. The HSS scores were examined preoperatively and at the final follow-up. Radiological assessment was performed with Knee Society evaluating and scoring system. Kaplan-Meier survival analysis was performed to rule out the survival of the tibial component. RESULTS The mean HSS scores were 45.8 (range 38-60) and 88.1 (range 61-93), preoperatively and at the final follow-up respectively. Complete radiological assessment was performed for 48 knees. Lucent lines at the tibial component were observed in 4 patients; one of these patients underwent a revision surgery due to the loosening of the tibial component. The 10-year survival rate of a tibial component was 98%. CONCLUSION Cementless total knee replacement has satisfactory long term clinical results. Primary fixation of the tibial component with screws provides adequate stability even in elderly patients with good bone quality. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Önder Ersan
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Alper Öztürk
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Faruk Çatma
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Serhan Ünlü
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Mutlu Akdoğan
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Yalım Ateş
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
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van Hamersveld KT, Marang-van de Mheen PJ, Tsonaka R, Valstar† ER, Toksvig-Larsen S. Fixation and clinical outcome of uncemented peri-apatite-coated versus cemented total knee arthroplasty. Bone Joint J 2017; 99-B:1467-1476. [DOI: 10.1302/0301-620x.99b11.bjj-2016-1347.r3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/26/2017] [Indexed: 11/05/2022]
Abstract
Aims The optimal method of tibial component fixation remains uncertain in total knee arthroplasty (TKA). Hydroxyapatite coatings have been applied to improve bone ingrowth in uncemented designs, but may only coat the directly accessible surface. As peri-apatite (PA) is solution deposited, this may increase the coverage of the implant surface and thereby fixation. We assessed the tibial component fixation of uncemented PA-coated TKAs versus cemented TKAs. Patients and Methods Patients were randomised to PA-coated or cemented TKAs. In 60 patients (30 in each group), radiostereometric analysis of tibial component migration was evaluated as the primary outcome at baseline, three months post-operatively and at one, two and five years. A linear mixed-effects model was used to analyse the repeated measurements. Results After five years of follow-up, one (cemented) component was revised due to ligament instability. Overall, uncemented PA-coated tibial components migrated significantly more (p = 0.003), with the mean maximum total point motion (MTPM) at five years being 0.62 mm (95% confidence intervals (CI) 0.49 to 0.76) for cemented tibial components and 0.97 mm (95% CI 0.81 to 1.15) for PA-coated tibial components in TKA. However, between three months and five years the cemented TKAs migrated significantly more (p = 0.02), displaying a MTPM of 0.27 mm (95% CI, 0.19 to 0.36) versus 0.13 mm (95% CI, 0.01 to 0.25) for PA-coated tibial components. One implant in each group was considered at risk for aseptic loosening due to continuous migration after five years of follow-up, albeit with different migration patterns for each group (i.e. higher initial migration but diminishing over time for the PA-coated component versus gradually increasing migration for the cemented component). Conclusion The tibial components of PA-coated TKAs showed more overall migration compared with the tibial components of cemented TKAs. However, post hoc analysis showed that this difference was caused by higher migration of PA-coated components in the first three months, after which a stable migration pattern was observed. Clinically, there was no significant difference in outcome between the groups. Cite this article: Bone Joint J 2017;99-B:1467–76.
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Affiliation(s)
- K. T. van Hamersveld
- Department of Orthopaedic Surgery, Leiden
University Medical Center, Post zone J11-R, P.O.
Box 9600, 2300 RC Leiden, The
Netherlands
| | - P. J. Marang-van de Mheen
- Department of Medical Decision Making,
Leiden University Medical Center, Post zone J10-S, P.O.
Box 9600, 2300 RC Leiden, The
Netherlands
| | - R. Tsonaka
- Department of Medical Statistics and BioInformatics,
Leiden University Medical Center, Post zone
S5-P, P.O. Box 9600, 2300
RC Leiden, The Netherlands
| | - E. R. Valstar†
- Department of Orthopaedic Surgery, Leiden
University Medical Center, Post zone J11-R, P.O.
Box 9600, 2300 RC Leiden, The
Netherlands
| | - S. Toksvig-Larsen
- Department of Orthopaedic Surgery, Hässleholm
Hospital and Department of Clinical Sciences, Lund University, P.O.
Box 351, 28125 Hässleholm, Sweden
and P.O. Box 117, 22100, Lund, Sweden
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Good long-term results following cementless TKA with a titanium plasma coating. Knee Surg Sports Traumatol Arthrosc 2017; 25:2801-2808. [PMID: 26334884 DOI: 10.1007/s00167-015-3769-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE While cemented total knee arthroplasty (TKA) is currently the gold standard for primary osteoarthritis, cementless component fixation has achieved increasingly comparable outcomes due to improvements in both implant designs and surgical technique. Long-term outcomes and survivorship with the TC-Plus cementless, titanium plasma-coated TKA system without patella resurfacing were evaluated. METHODS A homogenous population of 171 consecutive patients who received 206 primary TC-Plus TKAs without patella resurfacing over a 19-year period was retrospectively reviewed. Knee Society Clinical Rating System (KSCRS) scores were obtained, and radiographic evaluation was performed after a mean follow-up of 13.2 ± 8.4 years. Survivorship analysis was made with endpoints revision for any reason and aseptic loss of biological fixation. RESULTS One hundred and thirty-six TKAs implanted in 113 patients were available for analysis. Mean KSCRS clinical and functional scores improved significantly versus preoperative values. No radiological loss of biological fixation of femoral and tibial components was observed. Survival with aseptic revision of any component as the endpoint was 95.7 % (95 % confidence interval (CI) 91.7-97.9 %) and 93.6 % (95 % CI 87.8-96.6 %) at 10 and 15 years, respectively. CONCLUSION Titanium plasma-coated cementless TKA without patella resurfacing showed excellent long-term results, with high 10- and 15-year component survival rates. The clinical and radiological results were comparable to those of other cementless TKAs, providing further evidence for the non-cemented resurfacing of the osteoarthritic knee. LEVEL OF EVIDENCE IV.
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30
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Schotanus MGM, Pilot P, Kaptein BL, Draijer WF, Tilman PBJ, Vos R, Kort NP. No difference in terms of radiostereometric analysis between fixed- and mobile-bearing total knee arthroplasty: a randomized, single-blind, controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2978-2985. [PMID: 27120194 DOI: 10.1007/s00167-016-4138-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE A concern that arises with any new prosthesis is whether it will achieve satisfactory long-term implant stability. The gold standard of assessing the quality of fixation in a new or relatively new implant is to undertake a randomized controlled trial using radiostereometric analysis. It was hypothesized that both mobile-bearing total knee arthroplasty and fixed-bearing total knee arthroplasty have comparable migration patterns at 2-year follow-up. This study investigated two types of cemented total knee arthroplasty, the mobile- or fixed-bearing variant from the same family with use of radiostereometric analysis. METHODS This prospective, patient-blinded, randomized, controlled trial was designed to investigate early migration of the tibia component after two years of follow-up with use of radiostereometric analysis. A total of 50 patients were randomized to receive a mobile- or fixed-bearing TKA from the same family. Patients were evaluated during 2-year follow-up, including radiostereometric analysis, physical and clinical examination and patient reported outcome measures (PROMs). RESULTS At two-year follow-up, the mean (±SD) maximum total point motion (MTPM) in the fixed-bearing group was 0.82 (±1.16) versus 0.92 mm (±0.64) in the mobile-bearing group (p = n.s) with the largest migration seen during the first 6 weeks (0.45 ± 0.32 vs. 0.54 ± 0.30). The clinical outcome and PROMs significantly improved within each group, not between both groups. CONCLUSIONS Measuring early micromotion is useful for predicting clinical loosening that can lead to revision. The results of this study demonstrate that early migration of the mobile-bearing is similar to that of the fixed-bearing component at two years and was mainly seen in the first weeks after implantation. LEVEL OF EVIDENCE Randomized, single-blind, controlled trial, Level I.
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Affiliation(s)
- M G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
| | - P Pilot
- Department of Orthopaedic Surgery, Reinier de Graafweg Hospital, Delft, The Netherlands
| | - B L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W F Draijer
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P B J Tilman
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N P Kort
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Outcomes of Newer Generation Cementless Total Knee Arthroplasty: Beaded Periapatite-Coated vs Highly Porous Titanium-Coated Implants. J Arthroplasty 2017; 32:2156-2160. [PMID: 28237217 DOI: 10.1016/j.arth.2017.01.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/05/2017] [Accepted: 01/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Newer generation cementless total knee arthroplasty (TKA) designs are available and have novel implant coatings. We evaluated and compared beaded periapatite (PA)-coated vs highly porous titanium-coated cementless TKAs. Specifically, we compared: (1) survivorship, (2) Knee Society Scores (KSSs) and range of motion, (3) complications, and (4) radiographic findings. METHODS There were 805 TKAs with beaded PA-coated tibial and patellar components (PA group; mean age 67 years; range 41-86 years), and 219 TKAs with highly porous titanium-coated tibial and patella components (mean age 66 years; range 34-88 years). Mean follow-up was 4.4 years (range 2-9 years; median 4 years). Implant survivorship was calculated using Kaplan-Meier curves. Student t-tests and chi-square tests were used as appropriate. Radiographic evaluation was performed using Knee Society Roentgenographic Evaluation and Scoring System. RESULTS All-cause implant survivorship in beaded PA-coated group was 99.5% (95% CI, 97.9%-99.9%) and 99.5% (95% CI, 92.7%-99.9%) in highly porous titanium-coated group. There were no significant differences in the KSS for pain and function. Improvement in flexion and extension was similar in the 2 groups. Overall, complication rate (2.2% vs 2.3%; P = .274) and number of revisions (6 [0.8%] vs 2 [0.2%]; P = .936) were similar in the 2 groups. Excluding the aseptic and septic failures, there were no progressive radiolucencies or osteolysis on radiographic evaluation. CONCLUSION This study has shown good clinical and patient-reported outcomes of cementless TKA for both implants. Future multicenter large scale clinical and cost-effectiveness studies are needed to determine the superiority of one cementless implant type over the other.
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32
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Gudnason A, Adalberth G, Nilsson KG, Hailer NP. Tibial component rotation around the transverse axis measured by radiostereometry predicts aseptic loosening better than maximal total point motion. Acta Orthop 2017; 88:282-287. [PMID: 28266241 PMCID: PMC5434596 DOI: 10.1080/17453674.2017.1297001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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 - Maximal total point motion (MTPM) measured by radiostereometry (RSA) is widely used as a predictor of total knee arthroplasty (TKA) loosening. We compared the ability of different RSA measurements at different time points to predict loosening of tibial TKA components in the long term. Patients and methods - 116 TKAs in 116 patients were included in our analysis. 16 (14.8-17.4) years after surgery, 5 tibial components had been revised due to aseptic loosening. Receiver operating characteristic curves were calculated in order to investigate the specificity and sensitivity of different RSA parameters at different thresholds. Results - Rotation around the transverse (x-) axis measured 2 years postoperatively had the best predictive value of all parameters, with an area under the curve (AUC) of 80%. Using a threshold of 0.8 degrees, a specificity of 85% and a sensitivity of 50% were reached. The AUC for tibial component distal translation was 79% and it was 77% for proximal translation, whereas it was only 68% for MTPM. Interpretation - Rotation of the cemented tibial component around the transverse axis, proximal translation, and distal translation are slightly better at predicting aseptic loosening than MTPM, and tibial component migration measured after 2 years gives a good prediction of aseptic loosening up to 15 years.
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Affiliation(s)
- Asgeir Gudnason
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala;,Correspondence:
| | - Gunnar Adalberth
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala
| | - Kjell-Gunnar Nilsson
- Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden
| | - Nils P Hailer
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala
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Cementless vs Cemented Tibial Fixation in Primary Total Knee Arthroplasty. J Arthroplasty 2017; 32:1510-1515. [PMID: 28082042 DOI: 10.1016/j.arth.2016.12.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up. METHODS A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics. RESULTS Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores. CONCLUSION It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components.
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Hu B, Chen Y, Zhu H, Wu H, Yan S. Cementless Porous Tantalum Monoblock Tibia vs Cemented Modular Tibia in Primary Total Knee Arthroplasty: A Meta-Analysis. J Arthroplasty 2017; 32:666-674. [PMID: 27776898 DOI: 10.1016/j.arth.2016.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/20/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With the introduction of new fixation systems and designs, there has been a recent reemergence of interest in cementless fixation of the tibial component in total knee arthroplasty. However, little is known regarding the clinical features and survivorship of the cementless porous tantalum monoblock tibial component compared to the conventional cemented modular tibial component. METHODS We conducted a literature search of multiple databases for comparative studies published before June 2015 that investigated the outcomes of cementless porous tantalum monoblock tibia vs conventional cemented modular tibia. A pooled analysis was performed. The outcomes of interest were postoperative functional score, range of motion, Western Ontario and McMaster University Osteoarthritis Index, total complications, reoperation, radiolucent lines, loosening of the tibial component, and length of operation. RESULTS Six studies involving 977 patients were eligible for the meta-analysis. The use of a cementless porous tantalum monoblock tibial component may associate with a slightly higher functional score, fewer radiolucent lines, and shorter operation. No significant difference was seen in regard to the range of motion, Western Ontario and McMaster University Osteoarthritis Index, total complications, reoperation, and loosening of the component between the 2 groups. CONCLUSION However, due to variation among the included studies, the use of cementless porous tantalum monoblock tibia seems to achieve no substantial superiority over that of the conventional cemented modular tibia at 5-year follow-up. Data concerning the long-term prognosis of this novel implant should continue to be collected and analyzed.
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Affiliation(s)
- Bin Hu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunlin Chen
- Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Hanxiao Zhu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Comparison of a novel porous titanium construct (Regenerex®) to a well proven porous coated tibial surface in cementless total knee arthroplasty - A prospective randomized RSA study with two-year follow-up. Knee 2016; 23:1002-1011. [PMID: 27769563 DOI: 10.1016/j.knee.2016.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Regenerex is a novel porous titanium construct with a three-dimensional porous structure and biomechanical characteristics close to that of normal trabecular bone. The aim of this study was to compare this novel construct to a well-proven porous plasma sprayed tibial (PPS) implant after total knee arthroplasty. METHODS Sixty-one patients scheduled for an uncemented TKA were randomized to receive either a novel highly porous titanium construct Regenerex or the PPS tibial component. Radiostereometric analysis of the tibial components was performed postoperatively and at three, six, 12, and 24months with measurements of migration (segment motion and maximum total point motion (MTPM)). RESULTS Knee and function scores improved significantly from preoperatively to two-year follow-up. For both the Regenerex and the PPS the majority of migration appeared during the first three months and then stabilized. No statistically significant differences in MTPM were found in any follow-up between three and 24months. The Regenerex group had a lower migration rate between 12 and 24months compared with the PPS implants (p=0.03) but the PPS group had an initial significantly lower subsidence (p=0.04). CONCLUSION In conclusion the Regenerex implant could prove an effective scaffold material for coating of uncemented implants but did no better than the PPS component at 24months of follow-up. ClinicalTrials.gov identifier: NCT01936415.
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Abstract
Background and purpose - Total knee replacement (TKR) in younger patients using cemented components has shown inferior results, mainly due to aseptic loosening. Excellent clinical results have been reported with components made of trabecular metal (TM). In a previous report, we have shown stabilization of the TM tibial implants for up to 5 years. In this study, we compared the clinical and RSA results of these uncemented implants with those of cemented implants. Patients and methods - 41 patients (47 knees) aged ≤ 60 years underwent TKR. 22 patients (26 knees) received an uncemented monoblock cruciate-retaining (CR) tibial component (TM) and 19 patients (21 knees) received a cemented NexGen Option CR tibial component. Follow-up examination was done at 10 years, and 16 patients (19 knees) with TM tibial components and 17 patients (18 knees) with cemented tibial components remained for analysis. Results - 1 of 19 TM implants was revised for infection, 2 of 18 cemented components were revised for knee instability, and no revisions were done for loosening. Both types of tibial components migrated in the first 3 months, the TM group to a greater extent than the cemented group. After 3 months, both groups were stable during the next 10 years. Interpretation - The patterns of migration for uncemented TM implants and cemented tibial implants over the first 10 years indicate that they have a good long-term prognosis regarding fixation.
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Affiliation(s)
- Anders Henricson
- Department of Orthopaedics and Center for Clinical Research, Falu General Hospital, Falun;,Correspondence:
| | - Kjell G Nilsson
- Institution of Surgical and Perioperative Sciences, Department of Orthopaedics, Umeå University, Umeå, Sweden
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Initial stability of a new cementless fixation method of a tibial component with polyaxial locking screws: a biomechanical in vitro examination. Arch Orthop Trauma Surg 2016; 136:1309-1316. [PMID: 27473204 DOI: 10.1007/s00402-016-2517-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Cementless fixation of the tibial component is critical as reduced initial stability leads to implant failure. In this experimental in vitro study, a new fixation method of the tibial component using polyaxial locking screws is evaluated using Roentgen stereophotogrammetric analysis (RSA). MATERIALS AND METHODS A special prototype of a tibial component with four polyaxial locking screws was tested on 10 fresh-frozen human tibia specimens. The components were tested with an axial load of 2000 N for 10,000 cycles. Radiographs in two views were performed before loading, after 1000 and after 10,000 cycles, respectively. Besides rotation and translation along the x-, y-, and z-axes, endpoints for RSA were maximum subsidence (MaxSub), maximum lift off (MaxLiftOff) and maximum total point motion (MTPM). RESULTS MaxSub increased from -0.5 mm (SD = 0.2) after 1000 cycles to -0.9 mm (SD = 1.1). MaxLiftOff was 0.1 mm after 1000 cycles and did not increase after 10,000 cycles. The MTPM was 0.7 mm (SD = 0.3) after 1000 cycles and 1.1 mm (SD = 1.1) after 10,000 cycles. Two out of nine implants showed an MTPM ≥ 1.0 mm after 10,000 cycles. CONCLUSIONS Polyaxial locking screws can potentially improve the initial stability of tibial components. The results of this study indicate that the use of such screws in total knee arthroplasty may be of interest in the future. Further experimental and clinical investigation is needed.
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Abstract
As the number of younger and more active patients treated with total knee arthroplasty (TKA) continues to increase, consideration of better fixation as a means of improving implant longevity is required. Cemented TKA remains the reference standard with the largest body of evidence and the longest follow-up to support its use. However, cementless TKA, may offer the opportunity of a more bone-sparing procedure with long lasting biological fixation to the bone. We undertook a review of the literature examining advances of cementless TKA and the reported results. Cite this article: Bone Joint J 2016;98-B:867–73.
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Affiliation(s)
- D. F. Dalury
- University of Maryland St. Joseph Medical
Center, Towson Orthopaedic Associates, Ruxton
Professional Center, 8322 Bellona Avenue, Suite
100, Towson, MD, 21204, USA
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Spear RL, Symeonidou A, Skepper JN, Brooks RA, Markaki AE. Fibrin affects short-term in vitro human mesenchymal stromal cell responses to magneto-active fibre networks. BIOMATERIALS AND BIOMECHANICS IN BIOENGINEERING 2015. [DOI: 10.12989/bme.2015.2.3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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40
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Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A prospective randomized study. INTERNATIONAL ORTHOPAEDICS 2015; 40:285-94. [PMID: 26183139 DOI: 10.1007/s00264-015-2852-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Regenerex is a novel porous titanium construct with a three-dimensional porous structure and biomechanical characteristics close to that of normal trabecular bone. The aim of this study was to evaluate the adaptive bone remodeling of the proximal tibia after uncemented total knee arthroplasty (TKA) using a tibial tray with this novel coating compared to a well-proven standard porous coated (PPS) tibial tray. MATERIALS Sixty patients scheduled for TKA were randomized to receive either a Regenerex (n = 31) or a PPS tibial component (n = 29). Changes in bone mineral density (BMD) of the proximal tibia were measured at three, six, 12 and 24 months by dual-energy X-ray absorptiometry (DEXA). RESULTS In the lateral region (ROI 3), a significant increase in BMD was seen in both groups at three, six, and 12 months after surgery. The relative increase at 12 months was 8.1 % (P = 0.007) for the PPS group and 6.5 % (P = 0.002) for the Regenerex group. Positive values were retained at 24 months in both groups. At 24 months BMD in the distal region below the central stem (ROI 1) had decreased in the PPS group by 3.4 % (P = 0.005) and in the Regenerex group by 2.4 % (P = 0.17). In the medial region (ROI 2) BMD remained unchanged at all follow-up evaluations in both groups. There were no significant differences between the two groups (P = 0.45) in any ROI at any follow-up evaluation. CONCLUSION The significant increase in BMD of the lateral proximal tibia plateau with very limited changes medially and distally seen in both implants suggests that the novel porous titanium construct Regenerex and the PPS implant have a pronounced beneficial effect with regard to maintaining periprosthetic BMD in all regions of interest investigated.
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41
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Koenig JH, Hepinstall MS. Available Robotic Platforms in Partial and Total Knee Arthroplasty. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.oto.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kendrick BJL, Kaptein BL, Valstar ER, Gill HS, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis. Bone Joint J 2015; 97-B:185-91. [DOI: 10.1302/0301-620x.97b2.34331] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most common reasons for revision of unicompartmental knee arthroplasty (UKA) are loosening and pain. Cementless components may reduce the revision rate. The aim of this study was to compare the fixation and clinical outcome of cementless and cemented Oxford UKAs. A total of 43 patients were randomised to receive either a cemented or a cementless Oxford UKA and were followed for two years with radiostereometric analysis (RSA), radiographs aligned with the bone–implant interfaces and clinical scores. The femoral components migrated significantly during the first year (mean 0.2 mm) but not during the second. There was no significant difference in the extent of migration between cemented and cementless femoral components in either the first or the second year. In the first year the cementless tibial components subsided significantly more than the cemented components (mean 0.28 mm (sd 0.17) vs. 0.09 mm (sd 0.19 mm)). In the second year, although there was a small amount of subsidence (mean 0.05 mm) there was no significant difference (p = 0.92) between cemented and cementless tibial components. There were no femoral radiolucencies. Tibial radiolucencies were narrow (< 1 mm) and were significantly (p = 0.02) less common with cementless (6 of 21) than cemented (13 of 21) components at two years. There were no complete radiolucencies with cementless components, whereas five of 21 (24%) cemented components had complete radiolucencies. The clinical scores at two years were not significantly different (p = 0.20). As second-year migration is predictive of subsequent loosening, and as radiolucency is suggestive of reduced implant–bone contact, these data suggest that fixation of the cementless components is at least as good as, if not better than, that of cemented devices. Cite this article: Bone Joint J 2015; 97-B:185–91.
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Affiliation(s)
| | - B. L. Kaptein
- Biomechanics and Imaging Group, Leiden
University Medical Center, PO Box 9600, 2300
RC Leiden, The Netherlands
| | - E. R. Valstar
- Biomechanics and Imaging Group, Leiden
University Medical Center, PO Box 9600, 2300
RC Leiden, The Netherlands
| | - H. S. Gill
- University of Bath, Claverton
Down, Bath BA2 7AY, UK
| | | | - C. A. F. Dodd
- NDORMS, University of Oxford, Windmill
Road, OX3 7LD, UK
| | - A. J. Price
- NDORMS, University of Oxford, Windmill
Road, OX3 7LD, UK
| | - D. W. Murray
- NDORMS, University of Oxford, Windmill
Road, OX3 7LD, UK
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Similar survival between screw cementless and cemented tibial components in young patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22:1585-90. [PMID: 23135413 DOI: 10.1007/s00167-012-2291-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes of tibial fixation with either a cemented or cementless with screw augmentation component in young patients with non-inflammatory arthritis. METHODS Ninety-three patients aged 55 or younger with non-inflammatory arthritis were randomized to compare outcomes between cemented tibial fixation (48 patients) and cementless fixation with screw augmentation (45 patients). The femoral component was cementless in both groups. Post-operative evaluation was assessed by the clinical and radiological criteria of The Knee Society and WOMAC questionnaire. RESULTS The median follow-up was 6.7 (5-12) years. Significant differences were found for knee score (p = 0.02), range of motion (p = 0.04), and WOMAC score (p = 0.03). In the cemented group, there was one deep wound infection, four tibial aseptic loosening, and one polyethylene wear, all of which were revised. In the cementless group there was one tibial aseptic loosening and one polyethylene wear, both being revised. There was no difference in revision rate, and the cumulative survival at 9-year for aseptic reason was 93.7 % (95 % CI, 82-100 %) in the cementless group and 90.0 % (95 % CI, 80-100 %) in the cemented group (n.s.). CONCLUSIONS Cementless total knee arthroplasty was found to be a reliable option in younger patients with osteoarthritis. Although the revision rate and survival were similar in both groups, better clinical outcomes were obtained with cementless tibial components.
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Henricson A, Rösmark D, Nilsson KG. Trabecular metal tibia still stable at 5 years: an RSA study of 36 patients aged less than 60 years. Acta Orthop 2013; 84:398-405. [PMID: 23992142 PMCID: PMC3768041 DOI: 10.3109/17453674.2013.799418] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Clinical results of total knee replacement (TKR) are inferior in younger patients, mainly due to aseptic loosening. Coating of components with trabecular metal (TM) is a new way of enhancing fixation to bone. We have previously reported stabilization of TM tibial components at 2 years. We now report the 5-year follow-up of these patients, including RSA of their TM tibial components. PATIENTS AND METHODS 22 patients (26 knees) received an uncemented TM cruciate-retaining tibial component and 19 patients (21 knees) a cemented NexGen Option cruciate-retaining tibial component. Follow-up with RSA, and clinical and radiographic examinations were done at 5 years. In bilaterally operated patients, the statistical analyses included only the first-operated knee. RESULTS Both groups had most migration within the first 3 months, the TM implants to a greater extent than the cemented implants. After 3 months, both groups stabilized and remained stable up to the 5-year follow-up. INTERPRETATION After a high initial degree of migration, the TM tibia stabilized. This stabilization lasted for at least 5 years, which suggests a good long-term performance regarding fixation. The cemented NexGen CR tibial components showed some migration in the first 3 months and then stabilized up to the 5-year follow-up. This has not been reported previously.
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Affiliation(s)
- Anders Henricson
- Department of Orthopaedics and Center for Clinical Research, Falu General Hospital, Falun
| | - Dan Rösmark
- Department of Orthopaedics and Center for Clinical Research, Falu General Hospital, Falun
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Abstract
As a result of reading this article, physicians should be able to :1. Understand the rationale behind using uncemented fixation in total knee arthroplasty.2.Discuss the current literature comparing cemented and uncemented total knee arthroplasty3. Describe the value of radiostereographic analysis in assessing implant stability.4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options.
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Affiliation(s)
- Thomas E Brown
- Division of Adult Reconstruction, Department of Orthopaedics, University of Virginia, Charlottesville, Virginia 22903, USA.
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A perspective on robotic assistance for knee arthroplasty. Adv Orthop 2013; 2013:970703. [PMID: 23738083 PMCID: PMC3657445 DOI: 10.1155/2013/970703] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/30/2013] [Indexed: 11/17/2022] Open
Abstract
Knee arthroplasty is used to treat patients with degenerative joint disease of the knee to reduce pain and restore the function of the joint. Although patient outcomes are generally quite good, there are still a number of patients that are dissatisfied with their procedures. Aside from implant design which has largely become standard, surgical technique is one of the main factors that determine clinical results. Therefore, a lot of effort has gone into improving surgical technique including the use of computer-aided surgery. The latest generation of orthopedic surgical tools involves the use of robotics to enhance the surgeons' abilities to install implants more precisely and consistently. This review presents an evolution of robot-assisted surgical systems for knee replacement with an emphasis on the clinical results available in the literature. Ever since various robotic-assistance systems were developed and used clinically worldwide, studies have demonstrated that these systems are as safe as and more accurate than conventional methods of manual implantation. Robotic surgical assistance will likely result in improved surgical technique and improved clinical results.
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Lass R, Kubista B, Holinka J, Pfeiffer M, Schuller S, Stenicka S, Windhager R, Giurea A. Comparison of cementless and hybrid cemented total knee arthroplasty. Orthopedics 2013; 36:e420-7. [PMID: 23590780 DOI: 10.3928/01477447-20130327-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cementless total knee arthroplasty (TKA) implants were designed to provide long-term fixation without the risk of cement-associated complications. The purpose of this study was to evaluate the outcome of titanium-coated cementless implants compared with hybrid TKA implants with a cemented tibial and a cementless femoral component. The authors performed a case-control, single-center study of 120 TKAs performed between 2003 and 2007, including 60 cementless and 60 hybrid cemented TKAs. The authors prospectively analyzed the radiographic and clinical data and the survivorship of the implants at a minimum follow-up of 5 years. Ninety patients who underwent TKA completed the 5-year assessment. Knee Society Scores increased significantly in both groups (P<.001). In both groups, 2 patients underwent revision due to aseptic tibial component loosening, resulting in a 96% implant survival rate. Radiographs showed significantly less radiolucent lines around the tibial baseplate in the cementless group (n=12) than in the hybrid cemented group (n=26) (P=.009).At 6-year mean follow-up, no significant difference existed between the cementless and hybrid cemented tibial components in TKA in terms of clinical and functional results and postoperative complications. The significantly smaller number of radiolucent lines in the cementless group is an indicator of primary stability with the benefit of long-term fixation durability of TKA.
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Affiliation(s)
- Richard Lass
- Department of Orthopaedics, Vienna Medical University, Vienna General Hospital, Vienna, Austria.
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Drexler M, Dwyer T, Marmor M, Abolghasemian M, Sternheim A, Cameron HU. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes. ACTA ACUST UNITED AC 2013; 94:85-9. [PMID: 23118390 DOI: 10.1302/0301-620x.94b11.30827] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time.
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Affiliation(s)
- M Drexler
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Holland Orthopaedic & Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario M4Y 1H1, Canada.
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Pijls BG, Valstar ER, Nouta KA, Plevier JW, Fiocco M, Middeldorp S, Nelissen RG. Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties. Acta Orthop 2012; 83:614-24. [PMID: 23140091 PMCID: PMC3555454 DOI: 10.3109/17453674.2012.747052] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 09/04/2012] [Indexed: 01/31/2023] Open
Abstract
PURPOSE We performed two parallel systematic reviews and meta-analyses to determine the association between early migration of tibial components and late aseptic revision. METHODS One review comprised early migration data from radiostereometric analysis (RSA) studies, while the other focused on revision rates for aseptic loosening from long-term survival studies. Thresholds for acceptable and unacceptable migration were determined according to that of several national joint registries: < 5% revision at 10 years. RESULTS Following an elaborate literature search, 50 studies (involving 847 total knee prostheses (TKPs)) were included in the RSA review and 56 studies (20,599 TKPs) were included in the survival review. The results showed that for every mm increase in migration there was an 8% increase in revision rate, which remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. Consequently, migration up to 0.5 mm was considered acceptable during the first postoperative year, while migration of 1.6 mm or more was unacceptable. TKPs with migration of between 0.5 and 1.6 mm were considered to be at risk of having revision rates higher than 5% at 10 years. INTERPRETATION There was a clinically relevant association between early migration of TKPs and late revision for loosening. The proposed migration thresholds can be implemented in a phased, evidence-based introduction of new types of knee prostheses, since they allow early detection of high-risk TKPs while exposing only a small number of patients.
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Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Bio Imaging Group, Leiden University Medical Center, Leiden, the Netherlands.
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