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Kohring A, Parikh N, Hobbs J, Lowitz S, Gold P, Krueger CA. The Effect of Cemented Implants Placed During Initial TKA on Surgical Time and Expenses in Revision TKA. J Am Acad Orthop Surg 2024:00124635-990000000-00991. [PMID: 38759227 DOI: 10.5435/jaaos-d-23-01184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Revision total knee arthroplasty (rTKA) is a complex procedure that often requires the removal of previous implants. There is little information evaluating the difference between removing cemented or noncemented knee prostheses in revision surgeries. The purpose of this study was to determine whether removing cemented or noncemented implants would affect surgical time and expenses incurred during revision procedures. METHODS This retrospective cohort study used a single-institution database to identify 300 patients who underwent femoral and tibial implant rTKA from 2016 to 2022 because of mechanical complications (infection cases excluded). Radiographs and surgical reports were used to confirm whether the fixation technique was cemented (N = 243) or noncemented (N = 57). The primary outcomes were surgical time and surgery costs. Secondary outcomes included readmission rates, revision implants used, stem usage, and insurance type. RESULTS The average surgical time was 121 minutes for noncemented and 128 minutes for cemented procedures (P = 0.118). The 90-day readmission rates for each group were similar at 7.00% for the cemented cohort and 8.77% for the noncemented cohort (P = 0.643). For patients with Medicare Advantage, the respective surgery costs were $1,966 for noncemented and $1,968 for cemented TKA (P = 0.988). For patients with commercial insurance, the respective surgery costs were $4,854 for noncemented and $5,660 for cemented TKA (P = 0.330). CONCLUSION Primary knee fixation type, cemented or noncemented, did not appear to influence the surgical duration or surgical costs of both-implant revision knee surgery indicated for mechanical complications.
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Affiliation(s)
- Adam Kohring
- From the Jefferson Health New Jersey (Kohring), Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Parikh, Hobbs, and Krueger), Midwestern University, Downers Grove, IL (Lowitz), and Panorama Orthopedic & Spine Center, Golden, CO (Gold)
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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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Press-Fit Dual-Pivot Total Knee Arthroplasty: Early Results With a Minimum 2-Year Follow-Up. J Arthroplasty 2022; 37:S238-S244. [PMID: 35197199 DOI: 10.1016/j.arth.2022.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/24/2021] [Accepted: 01/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent (UC) tibial bearings are being used with increasing frequency in the United States. Evidence suggests that the use of certain UC bearings may lead to improved patient satisfaction when compared with using conventional inserts. However, little is known as to what effect the use of UC tibial inserts has on bone ingrowth in uncemented total knee arthroplasty (TKA). The purpose of this study was to determine the early clinical and radiographic results of TKA using a press-fit dual-pivot design. METHODS Between 2017 and 2019, a consecutive series of 232 TKAs were implanted using a press-fit tibial and femoral component and a UC dual-pivot tibial insert. Sixty-two percent of patients were male. The average age was 56 years. Patients were followed for a minimum of 2 years (range, 24-42 months) using KOOS-JR and Knee Society clinical and radiographic evaluation. RESULTS No patient had more than mild knee stiffness at the final follow-up. Two patients reported moderate knee pain with stair climbing. All other patients reported either mild or no pain with activity. Knee Society pain scores averaged 42 points. Flexion averaged 118 degrees. Three knees (1.3%) were revised (one each for flexion instability, tibial plateau fracture, and suspected femoral component loosening). No other cases of femoral or tibial loosening were identified. CONCLUSION Although the success of uncemented TKA is determined by a variety of factors, the use of this dual-pivot knee design did not appear to influence tibial or femoral component fixation at early follow-up, yielding acceptable clinical and radiographic outcomes.
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Vajapey SP, Fitz W, Iorio R. The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty. JBJS Rev 2022; 10:01874474-202205000-00001. [PMID: 35749640 DOI: 10.2106/jbjs.rvw.22.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Total knee arthroplasty (TKA) is an effective treatment option for many patients, but a small group of patients are dissatisfied following TKA. » Alignment, in combination with balance, stability, and knee kinematics, is an important modifiable surgical factor that can affect patient outcomes. » Driven by the subset of dissatisfied patients after TKA, new techniques have evolved in the search for a more anatomic reconstruction of individual knee morphology and a more accurate approximation of the individual lower-extremity alignment. » There is a need to optimize 3 aspects of TKA to improve patient outcomes-mechanical tooling processes, implants that resurface the epiphysis, and techniques that respect the variable anatomy of patients.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Quispel CR, van Egmond JC, Bruin MM, Spekenbrink-Spooren A, Verburg H, Pasma JH. No effect of fixation type on early and late mortality after total knee arthroplasty: a Dutch arthroplasty register study. Knee Surg Sports Traumatol Arthrosc 2022; 30:1231-1238. [PMID: 33834256 DOI: 10.1007/s00167-021-06552-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Postoperative mortality is commonly reported as outcome measurement after total knee arthroplasty (TKA). Mortality might be influenced by multiple factors including cementation of the prosthesis. Until now, the influence of cementation on early and late mortality after TKA is unknown. The aim of the present study was to determine the effect of fixation on early and late mortality after primary TKA. METHODS All patients in the Dutch Arthroplasty Register (LROI) with a primary TKA for osteoarthritis were eligible for inclusion. Data collected from 2007 to 2014 with follow-up until January 2020 were used. Survival analysis was performed by using Kaplan-Meier and Cox survival analysis to determine the mortality rate according to fixation. Adjustments were made for age at time of surgery, gender, American Society of Anaesthesiologists class, and year of surgery. RESULTS In total 108,687 TKA were included for analysis, which comprised 95,857 cemented, 6,140 cementless and 6,690 hybrid TKA. The early and late mortality rate in cemented TKA was statistically not different compared to cementless or hybrid TKA at 30 days, 31-90 days, 91 days-1 year and 1-5 years. The hazard ratio at 30 days was 1.05 (CI 0.49-2.25) for hybrid fixation, and 1.46 (CI 0.74-2.90) for cementless fixation compared to cemented fixation. The 1-5 years hazard ratio was 1.06 (CI 0.96-1.17) and 0.97 (CI 0.87-1.08), respectively. CONCLUSION Based on register data, method of fixation does not influence early mortality after primary TKA. This suggests that there is no preferred fixation technique for primary TKA based on the mortality rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Casper R Quispel
- Orthopedic Department, Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands
| | - Jeroen C van Egmond
- Orthopedic Department, Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands.
| | - Maarten M Bruin
- Orthopedic Department, Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands
| | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten/LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - Hennie Verburg
- Orthopedic Department, Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, The Netherlands
| | - Jantsje H Pasma
- Orthopedic Department, Reinier Haga Orthopedisch Centrum, Toneellaan 2, 2725 NA, Zoetermeer, 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: 9] [Impact Index Per Article: 4.5] [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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Goh GS, Fillingham YA, Ong CB, Krueger CA, Courtney PM, Hozack WJ. Redefining Indications for Modern Cementless Total Knee Arthroplasty: Clinical Outcomes and Survivorship in Patients >75 Years Old. J Arthroplasty 2022; 37:476-481.e1. [PMID: 34843909 DOI: 10.1016/j.arth.2021.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Most studies on cementless total knee arthroplasty (TKA) have excluded patients >75 years due to concerns that older patients have poorer bone mineral density and osteogenic activity. This study compared the midterm outcomes and survivorship of cemented and cementless TKA of the same modern design performed in patients >75 years. METHODS We identified a consecutive series of 120 primary cementless TKA performed in patients >75 years. Each case was propensity score matched 1:3 with 360 cemented TKA of the same modern design based on age, sex, body mass index, Charlson Comorbidity Index, bilateral procedures, liner type, and year of surgery. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and Short Form-12 (SF-12) were collected preoperatively, at 6 months and 2 years. Implant survivorship was recorded at mean 4.2 years (range, 2.0-7.9). RESULTS Mean age was 79.0 ± 3.4 years (range, 75-92) in the cemented cohort and 78.9 ± 3.5 (range, 75-91) in the cementless cohort (P = .769). There was no difference in final postoperative scores or improvement in scores at 2 years. The percentage of patients that met the minimal clinically important difference was also similar (KOOS-JR, 68.9% vs 69.2%, P = .955; SF-12 Physical, 71.7% vs 66.7%, P = .299). Seven-year survivorship free from aseptic revision was 99.4% for cemented knees and 100% for cementless knees (log-rank, P = .453). CONCLUSION Patients over 75 years undergoing cementless or cemented TKA of the same modern design had comparable outcomes and survivorship in the midterm. The theoretical risks of cementless fixation in this age group were not realized in this study.
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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
| | - Christian B Ong
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- 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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