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Moya-Angeler J, Akkaya M, Innocenti M, Bergadano D, Martin-Alguacil J, León-Muñoz V. Fixation options for total knee arthroplasty: a comprehensive literature review. J Orthop Surg Res 2024; 19:463. [PMID: 39107795 PMCID: PMC11304998 DOI: 10.1186/s13018-024-04966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024] Open
Abstract
Total knee arthroplasty is a consistently successful, cost-efficient, and highly effective surgical procedure for treating severe knee osteoarthritis. The success and longevity of total knee arthroplasty depend significantly on the fixation method used to secure the prosthetic components. This comprehensive review examines the primary fixation methods (cemented, cementless, and hybrid fixation), analysing their biomechanics, clinical outcomes, advantages, and disadvantages, focusing on recent advances and trends in total knee arthroplasty fixation.
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Affiliation(s)
- J Moya-Angeler
- Department of Orthopaedic Surgery, Hospital General Universitario Reina Sofía, Avenida Intendente Jorge Palacios 1, 30003, Murcia, Spain.
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), C/ Barítono Marcos Redondo 1, 7b, 30005, Murcia, Spain.
| | - M Akkaya
- Department of Orthopaedic Surgery, Ankara Güven Hospital, Cayyolu Health Campus, Alacaatli street No:15, Cayyolu, Ankara, Turkey
| | - M Innocenti
- Department of Orthopaedic Surgery, Università degli Studi di Firenze, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, FI, Italy
| | - D Bergadano
- Medacta International SA, Via alla Rossa 6, 6862, Rancate, Switzerland
| | - J Martin-Alguacil
- Hospital Vithas Granada, Av. Santa María de la Alhambra, 6, Genil, 18008, Granada, Spain
- Clínica Martín Gómez, C/ San Marcos, 8, 1º A, Centro, 18005, Granada, Spain
| | - V León-Muñoz
- Department of Orthopaedic Surgery, Hospital General Universitario Reina Sofía, Avenida Intendente Jorge Palacios 1, 30003, Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), C/ Barítono Marcos Redondo 1, 7b, 30005, Murcia, Spain
- Department of Surgery, Paediatrics and Obstetrics and Gynaecology, Faculty of Medicine, University of Murcia, Avda. Buenavista 32, El Palmar, 30120, Murcia, Spain
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Monarrez R, Dubin J, Bains SS, Hameed D, Moore MC, Chen Z, Mont MA, Delanois RE, Nace J. Cemented is not superior to cementless total knee arthroplasty for complications: a propensity score matched analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1825-1830. [PMID: 38429555 DOI: 10.1007/s00590-024-03847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There is continued debate regarding the survivorship and revision rate of cementless versus cemented total knee arthroplasty (TKA) prostheses. This includes the assessment of early revision surgery due to aseptic loosenings and periprosthetic joint infections (PJIs). Studies have not always taken into account the impact of comorbidities, such as diabetes, obesity, and tobacco. Therefore, we compared revisions in a large population of patients undergoing cemented or cementless TKAs at 90 days, 1 year, and 2 years. METHODS A review of an administrative claims database was used to identify patients undergoing primary TKA, either cementless (n = 8,890) or cemented (n = 215,460), from October 1, 2015 to October 31, 2020. Revision surgery for PJI and aseptic loosening were identified with diagnosis and associated procedural codes at 90 days, 1 year, and 2 years and then compared between groups. A propensity matched-analysis was performed for age, sex, Charles Comorbidity Index (CCI) > 3, alcohol abuse, tobacco use, obesity, and diabetes. Chi square tests assessed statistical significance of differences in the matched cohorts using odds ratios (ORs) with 95% confidence intervals (CIs). A P < 0.05 was defined as statistically significant. RESULTS Cementless TKA was associated with similar revisions rates due to PJIs at 90 days (OR, 1.04, 95% CI 0.79-1.38, p = 0.83), 1 year (OR, 0.93, 95% CI 0.75-1.14, p = 0.53, and 2 years (OR, 0.87, 95% CI 0.73-1.05, p = 0.17) in comparison to the cemented TKA cohort. The odds ratio of revision due to aseptic loosening was similar as well at 90 days (OR, 0.67, 95% CI 0.34-1.31, 0.31), 1 year (OR, 1.09, 95% CI 0.73-1.61, p = 0.76), and 2 years (OR, 1.00, 95% CI 0.73-1.61, p = 0.99). CONCLUSIONS This study found a comparable risk of PJI and aseptic loosening in cementless and cemented TKA when controlling for several comorbidities, such as tobacco, diabetes, and alcohol. Therefore, with proper patient selection, cementless TKAs can be performed with expectation of low risks of infections and aseptic loosenings.
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Affiliation(s)
- Ruben Monarrez
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
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Schnetz M, Hofmann L, Ewald L, Klug A, Hoffmann R, Gramlich Y. Midterm results of modular hinge total knee arthroplasty using cementless osseointegrating stems: low fixation associated complications and good functional outcome in primary and revision knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:831-845. [PMID: 38063882 DOI: 10.1007/s00402-023-05148-7] [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: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE This study aimed to investigate functional outcome and complications after primary and revision modular H-TKA using hybrid fixation with cementless stems. METHODS Between 2015 and 2018, 48 patients with 50 implants were included after hybrid implantation of a single design H-TKA system using cementless osseointegrating stems and modular components. Complications and clinical outcome were analysed using Knee Society Score (KSS), the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) and the Short-Form Health Survey 12 (SF-12) score. RESULTS Indications for implantation were aseptic revision (n = 29, 58%), primary TKA (n = 19, 38%) and two-stage septic revisions (n = 2, 4%). Complications were reported in 26% (n = 12), whereas complications associated with hybrid fixation occurred in 5 (10%) cases, with 2 (4%) requiring revision surgery for aseptic loosening and 3 (6%) treated with an adapted postoperative protocol for perioperative fractures. Implant survivorship was 84% after a mean follow-up of 54 months. Postoperative KSS significantly improved from 51.50 (12-100) to 78.36 (41-99; p < 0.001). The mean WOMAC score was 19.26 (0-55), SF-12 PCS was 41.56 points (22.67-57.66) and SF-12 MCS was 49.21 points (23.87-63.21). CONCLUSION Hybrid modular implantation in H-TKA provides satisfactory clinical and functional results in primary and revision TKA. Clinical outcomes significantly improve with reduced pain, increased mobility, and good-to-excellent functional scores after implantation. Whilst implant survival is comparable to previous studies and complications associated with hybrid fixation are low, general complication rates are comparably high.
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Affiliation(s)
- M Schnetz
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
| | - L Hofmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - L Ewald
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - A Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Y Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
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van Es LJM, Sierevelt IN, Hoornenborg D, van Ooij B, Haverkamp D. The mid-term survival of cemented, uncemented, and hybrid fixation of the ACS mobile bearing total knee arthroplasty. Indian J Orthop 2022; 56:1767-1773. [PMID: 36187581 PMCID: PMC9485357 DOI: 10.1007/s43465-022-00715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
Background Till today, Cemented Fixation in Total Knee Arthroplasty (TKA) is significantly more used than Hybrid or Uncemented Fixation. The purpose of this study was to compare Cemented, Uncemented and Hybrid Fixation of the ACS Mobile Bearing TKA at Mid-term follow-up. Methods This study was an extended data report of our prospective single-center, single-blinded randomized controlled clinical trial comprising 105 patients. The primary outcome was survival at five years of follow-up calculated by Kaplan-Meier and Log-rank test. The secondary outcome was function based on patient-reported outcome measures (PROMs). Results Eighty-three patients were included, of which 25 belonged into group A (Cemented), 28 in group B (Uncemented), and 30 in group C (Hybrid). Mean follow-up was 5.8 ± 0.7 (range 5-7) years. The 5-year survival rates were 96.8% (95%CI: 90.5; 100) in the Cemented group, 94.2% (95%CI: 86.4; 100) in the Uncemented group, and 93.8% (95%CI: 85.4; 100) in the Hybrid group for revision for any reason (p = 0.80). Functional outcome was similar among the groups. Conclusion In our cohort of ACS Mobile Bearing TKA, there was no difference between Cemented, Uncemented, and Hybrid Fixation with regard to survival and function at Mid-term follow-up. Trial registration Dutch Trial Register (NTR3893), 2013-03-12. Level of evidence II.
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Affiliation(s)
- Laurian J. M. van Es
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Noordwest Ziekenhuis, Alkmaar, The Netherlands
| | - Inger N. Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Orthopaedic department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Daniël Hoornenborg
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
| | - Bas van Ooij
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
- Cohesie, Occupational Health Service, Voorthuizen, The Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE Amsterdam, The Netherlands
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