Effect of Stem Size and Fixation Method on Mechanical Failure After Revision Total Knee Arthroplasty

Fleischman, Andrew N.; Azboy, İbrahim; Fuery, Michael; Restrepo, Camilo; Shao, Hongyi; Parvızı, Javad

doi:10.1016/j.arth.2017.04.055

Cited by 43 publications

(42 citation statements)

References 27 publications

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“…Diaphyseal anchoring is possible through full cementation or in press-fit hybrid technique with pure undersurface cementation of the femoral and tibial component. The latter technique is increasingly being used, especially in young patients and in anticipation of future revision surgery [38]. Neither of these two options is available if cementless anchoring is required.…”

Section: Discussionmentioning

confidence: 99%

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

Fröschen

Gravius

Lau

et al. 2018

International Orthopaedics (SICOT)

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Purpose The contact allergens nickel, cobalt, and chromium are often discussed as possible triggers of allergic reactions to orthopedic implants. Additionally, acrylates and polymerization additives in bone cement (e.g., benzoyl peroxide (BPO)) have been implicated as triggers of eczema, wound healing disorders, and aseptic implant loosening. We report about six patients with aseptic loosening after total knee arthroplasty (TKA), who underwent revision surgery after testing positive for BPO hypersensitivity. Methods After clarification of possible other causes of implant failure, epicutaneous testing had been performed and the implants were replaced in a two-stage procedure with cementless, diaphyseal anchoring, hypoallergenic (TiNb-coated) revision endoprostheses.Results Epicutaneous testing revealed a BPO allergy in all six patients and an additional nickel allergy in three of the six patients. There was no histopathological or microbiological evidence for a periprosthetic infection. The clinical follow-up showed a low level of pain with good function, a stable knee joint, and proper implant position. The Knee Society Score (KSS) with its subscales Knee Score and Functional Score improved post-operatively from 43 to 70 points and from 47.5 to 68.3 points, respectively. Two implant-specific complications occurred: femoral stress shielding two years post-operatively with no further need for action and aseptic loosening of the tibial stem with the need of revision three years post-operatively. Conclusions The regression of complaints after replacement with cementless and nickel-free revision implants suggests allergic implant intolerance. Implantation of a cementless, hypoallergenic endoprosthesis might, therefore, be a surgical treatment strategy in patients with evidence of allergies.

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Section: Discussionmentioning

confidence: 99%

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

Fröschen

Gravius

Lau

et al. 2018

International Orthopaedics (SICOT)

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“…Fixation in the diaphyseal zone to unload the metaphyseal zone and protect the bone–implant interphase is carried out using intramedullary stems. 48 Cemented stems are used in case of local osteoporosis or incompatible geometry for stable cementless fixation. The filling they provide allows the construct to be shortened.…”

Section: Are Hinged Implants Still An Attractive Option In Tka Revision?mentioning

confidence: 99%

The role of rotating hinge implants in revision total knee arthroplasty

2019

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Hinged implants are the most constrained knee replacement prostheses. They are very useful in complex cases of total knee arthroplasty (TKA) revision. Hinged implants have evolved with rotating bearings and modularity that allows local joint reconstruction or segmental bone replacement. They are required when significant instability persists in cases with inadequate collateral ligaments and significant flexion laxity. They are now used when a large bone defect is reconstructed, or when bone fixation of the implant is questionable especially in the metaphyseal zone. The use of hinged implants in TKA revision is associated with high complication rates. Published outcomes differ based on the patients’ aetiology. The outcomes of rotating-hinged implants used in septic revisions or salvage situations are poorer than other types of revision and have a higher complication rate. The poor general health of these patients is often a limitation. Despite these relatively poor results, hinged implants continue to have a place in revision surgery to solve major instability or to obtain stable bone fixation of an implant when the metaphysis is filled with bone grafts or porous devices.Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180070

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“…Despite long-term use in rTKA, high quality evidence comparing cemented stems to hybrid stems is scarce, making it difficult to differentiate between the two ( 1 , 7 , 22 , 23 ). The consensus is that no significant differences exist between cemented and hybrid stems.…”

Section: Introductionmentioning

confidence: 99%

Comparing Revision Total Knee Arthroplasty Stems at a High-Volume Revision Center

et al. 2022

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IntroductionHybrid fixation and fully cemented fixation are commonly used in revision total knee arthroplasty (rTKA). These two techniques are typically done based on surgeon preference and one has not demonstrated superiority over the other. The purpose of this study was to examine if there was a difference in survivorship between the two different techniques.MethodsA retrospective cohort study of all consecutive patients undergoing rTKA (CPT 27487) from January 1, 2011 to January 1, 2018 at a single academic center was performed. Patients were divided into cemented and hybrid rTKA groups with comparison of patient demographic, clinical and radiological outcomes, reoperation, change in post-operative hemoglobin (HgB), and length of stay (LOS).ResultsA total of 133 rTKA for 122 patients were identified: 30.1% in the cemented and 69.9% in the hybrid groups. There was no significant difference in age (p = 0.491), sex (p = 0.250), laterality (p = 0.421), or body mass index (BMI) (p = 0.609) between the two groups. Mean LOS (hybrid 4.13 days, cemented 3.65 days; p = 0.356) and change in Hgb (hybrid 2.95 mg/dL, cemented 2.62mg/dL; p = 0.181) were not statistically different between the groups. Mean follow up for the hybrid (25.4 months, range 2–114 months) and cemented (24.6 months, range 3–75.5 months) rTKA was not statistically significant (p = 0.825). Overall survival rates were 80.9% in the hybrid and 84.6% in the cemented groups (p = 0.642).ConclusionsHybrid and fully cemented rTKA techniques have similar survival rates at a minimum followup of 2 years. Additionally, in our cohort, age, gender, and BMI were not associated with failure in either group. Furthermore, we did not observe differences in LOS or change in hemoglobin suggesting early postoperative complications may not differ between cemented and hybrid stemmed groups. Continued long-term research is required for defining the best rTKA technique.

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Effect of Stem Size and Fixation Method on Mechanical Failure After Revision Total Knee Arthroplasty

Cited by 43 publications

References 27 publications

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

The role of rotating hinge implants in revision total knee arthroplasty

Comparing Revision Total Knee Arthroplasty Stems at a High-Volume Revision Center

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