Abstract
Introduction
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.
Material methods
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.
Results
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.
Discussion
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.
Conclusion
MLS improves the alignment and fixation of cementless TKA. This is a safe solution when bone conditions are poor or modified by previous surgery.
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References
NIH Consensus Panel (2003) NIH Consensus Statement on total knee replacement. December 8–10. J Bone Joint Surg Am 86-A:1328
Mont MA, Pivec R, Issa K, Kapadia BH, Maheshwari A, Harwin SF (2014) Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis. J Knee Surg 27(5):369–376. https://doi.org/10.1055/s-0033-1361952
No authors listed. (2016) National Joint Replacement Registry. Australian Orthopaedic Association. Annual Report
No authors listed. National Joint Registry for England, Wales (2016), Northern Ireland and the Isle of Man. 13th annual report
Hungerford DS, Kenna RV, Krackow KA (1982) The porous-coated anatomic total knee. Orthop Clin North Am 13(1):103–122
Dodd CA, Hungerford DS, Krackow KA (1990) Total knee arthroplasty fixation. Comparison of the early results of paired cemented versus uncemented porous coated anatomic knee prostheses. Clin Orthop Relat Res 1990(260):66–70
Ebert FR, Krackow KA, Lennox DW, Hungerford DS (1992) Minimum 4-year follow-up of the PCA total knee arthroplasty in rheumatoid patients. J Arthroplast 7(1):101–108
Epinette JA, Manley MT (2007) Hydroxyapatite-coated total knee replacement: clinical experience at 10 to 15 years. J Bone Joint Surg Br. 89(1):34–38
Song SJ, Bae DK, Kim KI, Lee CH (2014) Conversion total knee arthroplasty after failed high tibial osteotomy. Arch Orthop Trauma Surg 134(1):73–77. https://doi.org/10.1007/s00402-013-1897-0
Meding JB, Wing JT, Ritter MA (2011) Does high tibial osteotomy affect the success or survival of a total knee replacement? Clin Orthop Relat Res 469(7):1991–1994
Karabatsos B, Mahomed NN, Maistrelli GL (2002) Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg 45(2):116–119
Lim JB, Loh B, Chong HC, Tan A (2016) History of previous knee surgery does not affect the clinical outcomes of primary total knee arthroplasty in an Asian population. Ann Transl Med 4(16):303
Amendola L, Fosco M, Cenni E, Tigani D (2010) Knee joint arthroplasty after tibial osteotomy. Int Orthop 34(2):289–295
Hernigou P, Duffiet P, Julian D, Guissou I, Poignard A, Flouzat-Lachaniette CH (2013) Outcome of total knee arthroplasty after high tibial osteotomy: does malalignment jeopardize the results when using a posterior-stabilized arthroplasty? HSS J 9(2):134–137
Gupta H, Dahiya V, Vasdev A, Rajgopal A (2013) Outcomes of total knee arthroplasty following high tibial osteotomy. Indian J Orthop 47(5):469–473
van Raaij TM, Bakker W, Reijman M, Verhaar JA (2007) The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 8:74
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): 90–93
Efe T, Heyse TJ, Boese C, Timmesfeld N, Fuchs-Winkelmann S, Schmitt J, Theisen C, Schofer MD (2010) TKA following high tibial osteotomy versus primary TKA-a matched pair analysis. BMC Musculoskelet Disord 11:207
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):2010
Piedade SR, Pinaroli A, Servien E, Neyret P (2013) TKA outcomes after prior bone and soft tissue knee surgery. Knee Surg Sports Traumatol Arthrosc 21(12):2737–2743
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
Caton JH, Prudhon JL, Aslanian T, Verdier R (2016) Patellar height assessment in total knee arthroplasty: a new method. Int Orthop 40(12):2527–2531 Epub 2016 Aug 9
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
Charnley J (1979) Numerical grading of clinical results. Low friction arthroplasty of the hip. Springer Verlag ed. Berlin1 979. P. 20–4
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):19–26
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
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
Bhimji S, Menegini RM (2012) Micromotion of cementless tibial baseplates under physiological loading conditions. J Arthroplasty 27(4):648–654
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:1665–1672
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
Petersen MM, Nielsen PT, Lebech A, Toksvig-Larsen S, Lund B (1999) Preoperative bone mineral density of the proximal tibia and migration of the tibial component after uncemented total knee arthroplasty. J Arthroplast 14(1):77–81
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 14:9–20
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 464:93–98
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. 2014
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):2204–2211
Cross MJ, Parish EN (2005) A hydroxyapatite-coated total knee replacement: prospective analysis of 1000 patients. J bone joint Surg [Br] 87-B:1073–1076
Voigt JD, Mosier M (2011) Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty. Acta Orthop 82(4):448–459
Baker PN, Khaw FM, Kirk LM, Esler NA, Gregg PJ (2007) A randomized controlled trial of cemented versus cementless press-fit condylar total knee replacement. J Bone Joint Surg Br 89(12):1608–1614
Ritter MA, Meneghini RM (2010) Twenty year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty 25(4):507–513. https://doi.org/10.1016/j.arth.2009.04.018
Cameron HU (1995) Clinical and radiologic effects of diaphyseal stem extension in non cemented total knee replacement. Can J Surg 38(1):45–50
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 8
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):199–203
Bagsby DT, Issa K, Smith LS, Elmallah RK, Mast LE, Harwin SF, Mont MA, Bhimani SJ, Malkani AL (2016) Cemented vs cementless total knee arthroplasty in morbidly obese patients. J Arthroplast 31(8):1727–1731. https://doi.org/10.1016/j.arth.2016.01.025
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Prudhon, JL., Verdier, R. & Caton, J.H. 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. International Orthopaedics (SICOT) 43, 1849–1857 (2019). https://doi.org/10.1007/s00264-018-4191-5
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DOI: https://doi.org/10.1007/s00264-018-4191-5