Primary cementless total knee arthroplasty with or without stem extension: a matched comparative study of ninety eight standard stems versus ninety eight long stems after more than ten years of follow-up
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Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS.
We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions. The two cohorts were statistically compared. Revision for tibial loosening was used as the endpoint in the survivorship analysis.
We recorded two cases of tibial loosening and three cases of bipolar loosening in the SK group (0% MLS vs 5% SK). No tibial loosening occurred in the MLS group (statistically significant). No tibial periprosthetic or intra-operative fractures occurred in either group. The survivorship at eight years of follow-up was 95.6% in the SS cohort vs 100% in the MLS cohort using revision for tibial loosening as the endpoint.
This study was not randomized. Its strength was that it took into account the comparative midterm outcomes of a matched cohort of patients implanted with two types of cementless components in the same bone conditions. We did not record any tibial loosening in the MLS group. Using long stems has been criticized but we did not observe any adverse reactions and no intra-operative tibial fracture occurred.
MLS improves the alignment and fixation of cementless TKA. This is a safe solution when bone conditions are poor or modified by previous surgery.
KeywordsCementless total knee arthroplasty Long stem Standard keel Survivorship at eight years Poor bone conditions
- 1.NIH Consensus Panel (2003) NIH Consensus Statement on total knee replacement. December 8–10. J Bone Joint Surg Am 86-A:1328Google Scholar
- 3.No authors listed. (2016) National Joint Replacement Registry. Australian Orthopaedic Association. Annual ReportGoogle Scholar
- 4.No authors listed. National Joint Registry for England, Wales (2016), Northern Ireland and the Isle of Man. 13th annual reportGoogle Scholar
- 5.Hungerford DS, Kenna RV, Krackow KA (1982) The porous-coated anatomic total knee. Orthop Clin North Am 13(1):103–122Google Scholar
- 17.Robertsson O, W-Dahl A (2015) The risk of revision after TKA is affected by previous HTO or UKA. Clin Orthop Relat Res 473(1): 90–93Google Scholar
- 19.Niinimäki T, Eskelinen A, Ohtonen P, Puhto AP, Mann BS, Leppilahti J (2010) Total knee arthroplasty after high tibial osteotomy: a registry-based case-control study of 1,036 knees. BMC Musculoskelet Disord 11(207):2010Google Scholar
- 21.Gaillard R, Cerciello S, Lustig S, Servien E, Neyret P (2017) Risk factors for tibial implant malpositioning in total knee arthroplasty – consecutive series of one thousand, four hundred and seventeen cases. Int Orthop41(4):749–756. doi: https://doi.org/10.1007/s00264-016-3307-z
- 23.Prudhon JL, Caton JH, Aslanian T, Verdier R (2017) How is patella height modified after total knee arthroplasty? Int Orthop. https://doi.org/10.1007/s00264-017-3539-6
- 24.Charnley J (1979) Numerical grading of clinical results. Low friction arthroplasty of the hip. Springer Verlag ed. Berlin1 979. P. 20–4Google Scholar
- 25.Kim T, Suzuki M, Ohtsuki C, Masuda K, Tamai H, Watanabe E, Osaka A, Moriya H. (2003) Enhancement of bone growth in titanium fiber mesh by surface modification with hydrogen peroxide solution containing tantalum chloride. J Biomed Mater Res B Appl Biomater 64(1):19–26Google Scholar
- 26.Graves S, Davidson D, Tomkins A (2010) Australian Orthopaedic Association. National Joint Registry. Annual report, 2010. http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2010.pdf
- 27.Ellams D, Forsyth O, Mistry A (2010) National Joint Registry for England and Wales: 7th annual-report, 2010. http://www.njrcentre.org.uk/NjrCentre/Portals/0/NJR%207th%20Annual%20Report%202010
- 29.Nelissen RG, Valstar ER, Rozing PM (1998) The effect of hydroxyapatite on the micromotion of total knee prostheses. A prospective, randomized, double-blind study, J Bone Joint Surg [Am]. 80-A:1665–1672Google Scholar
- 30.Ferreira A, Aslanian T, Dalin T, Picaud J (2017) Ceramic bearings with bilayer coating in cementless total hip arthroplasty. A safe solution. A retrospective study of one hundred and twenty-six cases with more than ten years’ follow-up. Int Orthop 41(5):893–899. https://doi.org/10.1007/s00264-016-3271-7 CrossRefGoogle Scholar
- 32.Nilsson KG, Kärrholm J, Carlsson L, Dalén T (1999) Hydroxyapatite coating versus cemented fixation of the tibial component in total knee arthroplasty: prospective randomized comparison of hydroxyapatite-coated and cemented tibial components with 5-year follow-up using radiostereometry. J Arthroplast 14:9–20CrossRefGoogle Scholar
- 33.Whiteside LA, Viganò R (2007) Young and heavy patients with a cementless TKA do as well as older and lightweight patients. Clin Orthop Relat Res 464:93–98Google Scholar
- 34.Kim YH, Park JW, Lim HM, Park ES (2014) Cementless and cemented total knee arthroplasty in patients younger than fifty-five years. Which is better? Int Orthop. 2014Google Scholar
- 35.Beaupre LA, al-Yamani M, Huckell JR, Johnston DW (2007) Hydroxyapatite-coated tibial implants compared with cemented tibial fixation in primary total knee arthroplasty. A randomized trial of outcomes at five years. J Bone Joint Surg Am 89(10):2204–2211Google Scholar
- 40.Cameron HU (1995) Clinical and radiologic effects of diaphyseal stem extension in non cemented total knee replacement. Can J Surg 38(1):45–50Google Scholar
- 41.Barlow BT, Oi KK, Lee YY, Joseph AD, Alexiades MM (2016) Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016 Jul 8Google Scholar
- 42.Mittal A, Bhosale PB, Suryawanshi AV, Purohit S. (2013) One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures. J Orthop Surg 21(2):199–203Google Scholar