Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Abstract

Background The routine use of stems in revision TKA improves survival rates by enhancing the stability of the prosthesis. The ideal method of stem fixation (cemented or uncemented) in two-stage reimplantation remains controversial. Questions/purposes The purpose of this study was to answer the following questions: (1) Are rerevision rates for aseptic loosening comparable between cemented stems and uncemented stems in two-stage reimplantation? (2) Is the reinfection rate comparable between antibiotic-impregnated cemented stems and uncemented stems for two-stage reimplantation? (3) Are there any differences in Knee Society radiographic scores between stem techniques? Methods A retrospective analysis was performed in all patients who underwent two-stage reimplantation between 1990 and 2010 at Anderson Orthopaedic Research Institute (AORI) and OrthoCarolina (OC). One hundred fourteen patients with 228 stems met the inclusion criteria. Of these 228 stems, 102 stems were cemented and 126 stems were uncemented. The indication for stem fixation was largely institution specific; AORI used cementless stems 92% (118) of the time, whereas OC used a cemented stem 92% (92) of the time. A 2-year minimum radiographic and clinical followup was required for inclusion into the study. Radiographic evaluations were performed using a modification of the Knee Society radiographic score. Results Rerevision rates for aseptic loosening were comparable with three cemented and three cementless stem constructs. The reinfection rate was also comparable between cemented and cementless stems (p = 0.86). Using post hoc analysis, 32% of cemented stems were radiographically classified as loose or closely observe (33 of 102) compared with 17% of the cementless stem group (21 of 126; p = 0.006). Patients with good bone quality had a

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

“…While they found similar survivorship, reinfection, and clinical outcomes at 52 months postoperatively, cemented stems were significantly more likely to have radiographic loosening (32 vs. 17%, p ¼ 0.0006). 42 The only meta-analysis addressing this question was performed by Wang et al When examining 17 observational studies, they found no superiority of either stem, with no significant difference in reoperation, aseptic loosening, and infection. 43 After a thorough evaluation of the best evidence in the literature, it is clear that no consensus can be made about cementing versus hybrid fixation of stems in rTKA.…”

Is There a Difference between Cemented and Uncemented Femoral Stem Extensions in Revision Knee Arthroplasty?

“…The results of this study of only the revision TKA femoral component are difficult to compare with other series of femoral components with C and UC stem fixation because of the variety of stem lengths used, severity of femoral metaphyseal defi-ciency, inclusion of both femoral and tibial stems in most studies, numbers of patients, and length of follow-up 1,2,[16][17][18][19][20][21] (►Table 3). Fehring et al reported no loosening or aseptic revisions in 54 C stem revisions and 17% aseptic revision or loosening in 47 UC stem at 5 years follow-up.…”

“…There have been studies advocating fully C femoral components with stems of variable length and UC fixation of the femoral stem extension of variable lengths, with cement fixation of the metaphyseal surface only (so-called hybrid fixation). [16][17][18][19][20][21] There are specific advantages and possible disadvantages with both techniques, thus a consensus has not been reached and there are no guidelines for specific use. The advantages of cemented fixation of the femoral stem include added fixation of the component in fresh metaphyseal and diaphyseal bone, flexibility in distorted bone geometries, and delivery of Note: These numbers do not add up to 50 and 34 knees respectively and % does not add up to 100% because some knees had no augments and some had more than one.…”

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

“…Stems are used to decrease strain at the bone-cement interface (distal femur or proximal tibia) by transferring the load to a larger area in order to provide additional mechanical stability for component fixation [71]. Stems can be cemented or cementless (press-fit) [72,73]. Table 2 shows a comparison of cemented and cementless stem techniques in rTKA with a minimum 24-month follow-up.…”