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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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Polizzotti G, Lamberti A, Mancino F, Baldini A. New Horizons of Cementless Total Knee Arthroplasty. J Clin Med 2023; 13:233. [PMID: 38202240 PMCID: PMC10780266 DOI: 10.3390/jcm13010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation. DISCUSSION Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young's modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability. CONCLUSIONS Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients.
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Affiliation(s)
- Giuseppe Polizzotti
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Sapienza University of Rome, 00185 Rome, Italy
| | | | - Fabio Mancino
- University College London Hospital, London NW1 2BU, UK
- The Princess Grace Hospital, London W1U 5NY, UK
| | - Andrea Baldini
- Istituto Fiorentino di Cura e Assistenza, 50139 Florence, Italy
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BIAZZO A, ZANCHINI F, SARACCO M, RICCIARDELLO S, SARACCO A, POLA E, VERDE F. One-staged hip and knee arthroplasty: a retrospective clinical and radiographical study. MINERVA ORTHOPEDICS 2023; 74. [DOI: 10.23736/s2784-8469.23.04220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
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Aujla RS, Woodhouse J, Ebert JR, Finsterwald M, Jones CW, Yates P, D'Alessandro P, Wood DJ. Journey-Deuce bicompartmental knee arthroplasty with the addition of computer navigation achieves good clinical outcomes and implant survival at 10 years. Knee Surg Sports Traumatol Arthrosc 2022; 30:3168-3175. [PMID: 33974113 DOI: 10.1007/s00167-021-06579-8] [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: 01/08/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To report 10-year outcomes and survivorship in patients undergoing bicompartmental knee arthroplasty (BCKA) using the Journey-Deuce prosthesis in a consecutive prospective case series. METHODS Between November 2006 and November 2009, 41 patients with a mean age of 69.6 years (range 51-86) underwent 51 bicompartmental knee arthroplasties with the Journey-Deuce knee prosthesis. All patients presented with symptomatic medial and patellofemoral compartment osteoarthritis, with intact cruciate ligaments and a preserved lateral compartment on plain radiographs and Magnetic Resonance Imaging. Clinical assessment was undertaken pre-surgery and at 1, 2, 5 and 10 years post-surgery using the Oxford Knee Score (OKS), EuroQol Group 5-Dimension self-reported questionnaire (EQ-5D) and maximal active range of motion (ROM). RESULTS 30 patients (37 knees) were followed-up at a mean time of 11.4 years (SD 1.1; range 10.5-14.0). Eight patients (ten knees) were deceased and three could not be contacted at final review. No major component revision was performed. Pre-operative OKS 25.4 (SD 5.2; range 15-40), knee flexion 116.4° (SD 10.3°; range 100°-140°) and EQ-5D 70.5 (SD 19.9; range 25-95). 10-year OKS 43.5 (SD 4.1; range 32-48), knee flexion 127.3° (SD 11.1°; range 105°-144°) and EQ-5D 77.4 (SD 9.3; range 60-100). The OKS (p < 0.0001), EQ-5D (p = 0.024) and active knee flexion ROM (p < 0.0001) all significantly improved from pre-surgery to 1-year post-surgery, with no further significant changes in these scores between any post-operative time period up until 10 years. 32% (7/22) of tibial and 45% (10/22) of femoral components showed progressive radiolucencies between 2 and 5-year and 10-year follow-up. CONCLUSIONS This is the largest cohort of patients having undergone BCKA (with the Journey-Deuce prosthesis) with longest follow-up described in the literature. At 10 years, patients presented with significantly improved clinical outcomes, comparable to other surgical arthroplasty options. No major component revision was performed. Progressive radiolucencies were noted in 32% of tibial and 45% of femoral components without corresponding clinical signs of loosening. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Randeep S Aujla
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia. .,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia.
| | - Jennifer Woodhouse
- HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, WA, 6009, Australia
| | - Jay R Ebert
- HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, WA, 6009, Australia.,School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA, 6009, Australia.,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia
| | - Michael Finsterwald
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia
| | - Christopher W Jones
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia
| | - Piers Yates
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, WA, 6009, Australia.,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia
| | - Peter D'Alessandro
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, WA, 6009, Australia.,Orthopaedic Research Foundation of Western Australia, Alma St, Fremantle, Perth, WA, Australia
| | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, WA, 6009, Australia
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Zanchini F, Piscopo A, Cipolloni V, Fusini F, Cacciapuoti S, Piscopo D, Pripp C, Nasto LA, Pola E. Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients. World J Orthop 2022; 13:454-464. [PMID: 35633750 PMCID: PMC9124994 DOI: 10.5312/wjo.v13.i5.454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial. Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques. Recently, several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures. AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85. METHODS Data from 11 consecutive patients (10 females, 1 male) presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded. We collected standard demographic data, comorbidities and patient reported outcomes including Visual Analogical Scale (VAS), Oxford Knee Score (OKS) and Barthel's Index. Post-operative joint range of motion (ROM) and standard radiographic data were also collected. RESULTS At a mean follow-up of 23.2 mo, all of the implants were well-positioned and osteointegrated. Furthermore, all the patients were alive and walking either independently or with walking aids. There was a marked improvement in pain (VAS 4.5 postop vs 1.9 at the last follow-up), OKS score (29.5 postop vs 36.81 at the last follow-up), ROM (96.2° postop vs 102° at the last follow-up) and restoration of pre-injury ambulatory status (average Barthel Index 77.3). The radiographic evaluations showed good restoration of the articular geometry. No deaths and no complications were recorded. CONCLUSION In conclusion, we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice. This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis. It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
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Affiliation(s)
- Fabio Zanchini
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Antonio Piscopo
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli IRCCS University Hospital, Catholic University of Rome, Rome 00168, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì 12084, Italy
| | - Stefano Cacciapuoti
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Davide Piscopo
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Charlotte Pripp
- Service de Geriatrie et réaaptation HUG, Hôpital de Bellerive Chem, Genève 1205, Switzerland
| | - Luigi Aurelio Nasto
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Enrico Pola
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
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Wang Z, Chen X, Zhou Y, Shao H, Huang Y, Deng W. Hybrid fixation versus full-cemented or full-cementless fixation in total knee arthroplasty: Systematic review and meta-analysis of comparative studies. J Orthop Sci 2020; 25:1047-1054. [PMID: 31928850 DOI: 10.1016/j.jos.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/02/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Hybrid fixation is one alternative to full-cemented fixation in total knee arthroplasty (TKA) with theoretical advantages. Hybrid fixation may offer the advantages of cementless femoral fixation, while also avoiding the problem of tibial loosening in full-cementless TKA. The purpose of the study is to determine whether hybrid TKA may perform comparably to or better than full-cemented and full-cementless TKA. METHODS We searched the MEDLINE, EMBASE and Cochrane Library databases through September 2018 for randomized controlled trials and observational studies comparing outcomes of hybrid versus full-cemented or full-cementless fixation techniques. Outcomes of interest included aseptic loosening, overall reoperation rate, infection, radiolucent lines and operating time. Data were pooled with the Mantel-Haenszel random effects model. RESULTS We included 14 studies with follow-up ranging from 2.7 to 9.6 years in our quantitative analysis, of which 7 studies compared hybrid fixation with full-cemented TKA and another 7 compared hybrid fixation with full-cementless TKA. Combined data revealed that the hybrid fixation group had a similar rate of aseptic loosening compared with cemented (P = 0.19) and cementless (P = 0.49) groups. There was no difference with respect to other outcomes, including overall reoperation rate, infection, radiolucent lines and operating time between groups. CONCLUSION Hybrid, cementless and cemented TKAs have comparable mid-term results as it pertains to aseptic loosening, overall reoperation, infection, radiolucent lines and operating time. Further comparative studies are needed to investigate these potential effects over the long-term.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
| | - Xi Chen
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China.
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, People's Republic of China
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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: 45] [Impact Index Per Article: 7.5] [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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Kuriyama S, Hyakuna K, Inoue S, Kawai Y, Tamaki Y, Ito H, Matsuda S. Bone-femoral component interface gap after sagittal mechanical axis alignment is filled with new bone after cementless total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1478-1484. [PMID: 28194499 DOI: 10.1007/s00167-017-4452-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study retrospectively evaluated the fate of mismatch between an uncemented femoral component and each femoral cut surface (i.e., wedge-shaped gap) relative to sagittal mechanical alignment in total knee arthroplasty (TKA). METHODS Primary TKA was performed on 99 consecutive knees. The femoral components were aligned to the sagittal mechanical axis with CT-based navigation. All patients were assessed with postoperative true lateral radiographs. Bone-side surfaces of the uncemented femoral component were divided into five zones: anterior flange, anterior chamfer, posterior chamfer, posterior part, and distal part, which were defined as zones 1 to 5, respectively. Bone filling of wedge-shaped gaps in each zone was evaluated after 1 year. RESULTS Femoral anterior notching did not occur. However, wedge-shaped gaps were observed in at least one zone in 23 of 99 knees (23%), most frequently in zone 5 (18%). There were 9 and 7 gaps in zones 1 and 2, respectively. The femoral component showed malpositioning of approximately 3° of flexion in cases with wedge-shaped gaps in zones 2 and/or 5. After one year, 67% (6/9) of zone 1, 100% (7/7) of zone 2, and 94% (17/18) of zone 5 wedge-shaped gaps were filled in with new bone. CONCLUSIONS Femoral alignment relative to sagittal mechanical axis caused wedge-shaped gaps due to unstable anterior bone cutting through hard bone, but the small gaps were not clinically significant and filled in within one year. Sagittal setting of the femoral component should aim for the anatomical axis rather than the mechanical axis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Katsufumi Hyakuna
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Satoshi Inoue
- Department of Orthopaedic Surgery, Nakae Hospital, Wakayama, Japan
| | - Yasutsugu Kawai
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Berahmani S, Janssen D, Wolfson D, Rivard K, de Waal Malefijt M, Verdonschot N. The effect of surface morphology on the primary fixation strength of uncemented femoral knee prosthesis: a cadaveric study. J Arthroplasty 2015; 30:300-7. [PMID: 25449588 DOI: 10.1016/j.arth.2014.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/30/2014] [Accepted: 09/22/2014] [Indexed: 02/01/2023] Open
Abstract
We investigated the effect of surface morphology on the mechanical performance of uncemented femoral knee prosthesis. Eighteen implants were implanted on nine paired femurs and then pushed-off (left legs: a novel surface morphology; right legs: Porocoat as baseline). Bone mineral density (BMD) and anteroposterior dimension were not significantly different between groups. The insertion force was not significantly different, however, the loosening force was significantly higher in the novel group (P=0.007). BMD had a direct relationship with the insertion and loosening force (P<0.001). The effect of surface morphology on implant alignment was very small. We conclude that the surface properties create a higher frictional resistance, thereby providing a better inherent stability of implants featuring the novel surface morphology.
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Affiliation(s)
- Sanaz Berahmani
- Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Kori Rivard
- DePuy Synthes Joint Reconstruction, Warsaw, Indiana
| | | | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands; Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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Hybrid total knee arthroplasty revisited: midterm followup of hybrid versus cemented fixation in total knee arthroplasty. BIOMED RESEARCH INTERNATIONAL 2013; 2013:854871. [PMID: 24224179 PMCID: PMC3800574 DOI: 10.1155/2013/854871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/27/2013] [Indexed: 11/18/2022]
Abstract
The optimal method of fixation in total knee arthroplasty is still debated. Hybrid total knee arthroplasty (TKA), with cemented tibial and cementless femoral components, is a proposed method of fixation to improve outcomes. Although several studies have shown favorable outcomes, there is still lack of consensus in the literature. We hypothesized that hybrid TKA yields similar clinical, radiographic, and survivorship results compared to fully cemented TKA. The clinical and radiographic outcomes of 304 cruciate retaining TKAs with minimum two-year followup, including 193 hybrid (mean followup of 4.1 years) and fully cemented TKAs (mean followup of 3.2 years) were evaluated. Knee society scores were similar between the two groups. The total number of femoral radiolucencies was also similar between the two groups, while a greater number of femoral Zone 4 radiolucencies were seen in the cemented group (9% versus 1.6%, P = 0.005). The hybrid group demonstrated a 99.2% survival rate of the femoral component out to seven years for aseptic loosening. No significant difference in survivorship was seen between the groups for all cause or aseptic failure at seven years. We conclude that hybrid fixation leads to similar intermediate-term outcomes as fully cemented components and remains a viable option in total knee arthroplasty.
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Choi YJ, Lee KW, Kim CH, Ahn HS, Hwang JK, Kang JH, Han HD, Cho WJ, Park JS. Long-term Results of Hybrid Total Knee Arthroplasty: Minimum 10-years Follow-up. Knee Surg Relat Res 2012; 24:79-84. [PMID: 22708107 PMCID: PMC3374003 DOI: 10.5792/ksrr.2012.24.2.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/15/2011] [Accepted: 10/30/2011] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the survival rate and long term clinical outcomes of hybrid total knee arthroplasty (TKA). Materials and Methods We retrospectively analyzed 113 hybrid TKAs (NexGen) in 86 patients that were followed for more than 10 years. Kaplan-Meier survival curves were generated using revision as an end point. Knee Society Score (KSS) and range of motion were evaluated for clinical assessment and plane radiographs were used to evaluate implant problems. Results At 11.2 years (range, 10 to 12.2 years) of follow-up on average, 7 knees required revision. The reason for revision was aseptic loosening in 4 knees (1 in femoral and tibial component and 3 in tibial component only) and infection in 3 knees. The survival rate was 93.8% at 12 years for all knees, and 96.5% when septic loosening was excluded. The KSS improved from 29.3 to 91.5 in the Cruciate-Retaining type (CR) and from 21.5 to 90.3 in the posterior stabilizing type (PS) at latest follow-up. The average range of motion was improved from 120.6° to 133.8° in the CR type and 119.5° to 135.5° in the PS type. Conclusions Hybrid TKA provides good survival rates and clinical results comparable to cemented TKA.
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Affiliation(s)
- Young Joon Choi
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Demey G, Servien E, Lustig S, Aït Si Selmi T, Neyret P. Cemented versus uncemented femoral components in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:1053-9. [PMID: 21161174 DOI: 10.1007/s00167-010-1347-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to analyse the influence of femoral cement on clinical and radiological results after total knee arthroplasty. METHODS Preoperatively 130 patients were randomly assigned to treatment in either the Cement Group or the Hybrid Group. The International Knee Society scores, femoral radiolucent lines and bone transparencies were compared. RESULTS There were no significant differences concerning postoperative knee and function scores. We observed a significant difference in radiolucent lines (Cement Group, 24%; Hybrid Group, 2%; P < 0.001) as well as bone transparencies (Cement Group, 21%; Hybrid Group, 62%; P < 0.001). All radiolucent lines measured less than 2 mm in width. CONCLUSION Cementing the femoral component of a total knee arthroplasty does not appear to influence the clinical results. A longer follow-up period is required to determine the influence of radiological findings on final outcome.
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Affiliation(s)
- Guillaume Demey
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France.
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Cemented versus uncemented fixation of the femoral component of the NexGen CR total knee replacement in patients younger than 60 years: a prospective randomised controlled RSA study. Knee 2009; 16:200-6. [PMID: 19097910 DOI: 10.1016/j.knee.2008.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 11/02/2008] [Accepted: 11/06/2008] [Indexed: 02/08/2023]
Abstract
The optimal mode of femoral fixation in total knee arthroplasty (TKA) remains controversial, especially for the young patient. In a prospective randomised study we compared the magnitude and pattern of the fixation of cemented versus uncemented femoral components during 2 years in patients younger than 60 years. Forty-one knees in 41 patients were randomised to receive a NexGen (Zimmer, Warsaw, USA) cruciate-retaining TKA with either a cemented or an uncemented non HA-coated femoral component. The patients were examined by radiostereometric analysis (RSA), as well as clinical and radiological evaluation. The magnitude and pattern of migration as measured by RSA did not differ significantly between the cemented and uncemented fixation during the 2-year follow-up, nor were there any differences between the groups in clinical parameters. These findings suggest that an uncemented and non HA-coated femoral component may behave equally as well as a cemented one in the long-term.
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Lombardi AV, Berasi CC, Berend KR. Evolution of tibial fixation in total knee arthroplasty. J Arthroplasty 2007; 22:25-9. [PMID: 17570273 DOI: 10.1016/j.arth.2007.02.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 02/07/2007] [Indexed: 02/01/2023] Open
Abstract
Cementless total knee arthroplasty (TKA) implants were designed as an alternative to cemented implants. They were touted to provide long-term fixation without the fear of cement debris particle generation and cement degradation resulting in late prosthetic loosening and failure. They were envisioned as a superior solution for TKA in younger patients. However, critical studies revealed a unique set of complications, which included poor fixation as evidenced by frequent occurrence of radiolucent lines, aseptic loosening, osteolysis, and patellar polyethylene dissociation from metal-backed cementless patellar components. At the same time, cemented prostheses continue to yield excellent results. To address some of the issues with cementless implants, porous metal devices have been produced. Although in vitro and early in vivo clinical studies show promising results, these devices must be measured against cemented fixation, which continues to be the "gold standard" in TKA.
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