Cementless knee arthroplasty: a review of recent performance

Asokan, Ajay; Plastow, Ricci; Kayani, Babar; Radhakrishnan, Ganan T; Magan, Ahmed; Haddad, Fares S.

doi:10.1302/2633-1462.21.bjo-2020-0172.r1

Cited by 23 publications

(15 citation statements)

References 79 publications

(30 reference statements)

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“…Failure rates are two-fold higher for young patients 17 , who present a 35% revision risk in the 40-year follow-up upon cemented hip arthroplasties 18 . Implant technologies using uncemented fixations are thus significantly increasing worldwide 19 , particularly for younger and active patients whose lifestyle places heavy demands on implants 20 . Cementless fixations aim to maximize implant survival and outperform the mid- and long-term high deterioration risk of cemented implants 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

“…Cementless fixations aim to maximize implant survival and outperform the mid- and long-term high deterioration risk of cemented implants 21 , 22 . Nevertheless, the risk of bone loss is higher due to stress-shielding using uncemented fixations, given the reduced mechanical stimuli delivered to peri-implant bone structures upon implant insertion 6 , 20 , 21 . Unstable bone–implant fixations triggered by stress-shielding can induce aseptic loosening, an adverse bone remodeling response that exceeds 50% of the revision indications 6 , 9 , 10 , 23 .…”

Section: Introductionmentioning

confidence: 99%

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Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants

et al. 2021

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Replacement orthopedic surgeries are among the most common surgeries worldwide, but clinically used passive implants cannot prevent failure rates and inherent revision arthroplasties. Optimized non-instrumented implants, resorting to preclinically tested bioactive coatings, improve initial osseointegration but lack long-term personalized actuation on the bone–implant interface. Novel bioelectronic devices comprising biophysical stimulators and sensing systems are thus emerging, aiming for long-term control of peri-implant bone growth through biointerface monitoring. These acting-sensing dual systems require high frequency (HF) operations able to stimulate osteoinduction/osteoconduction, including matrix maturation and mineralization. A sensing-compatible capacitive stimulator of thin interdigitated electrodes and delivering an electrical 60 kHz HF stimulation, 30 min/day, is here shown to promote osteoconduction in pre-osteoblasts and osteoinduction in human adipose-derived mesenchymal stem cells (hASCs). HF stimulation through this capacitive interdigitated system had significant effects on osteoblasts’ collagen-I synthesis, matrix, and mineral deposition. A proteomic analysis of microvesicles released from electrically-stimulated osteoblasts revealed regulation of osteodifferentiation and mineralization-related proteins (e.g. Tgfb3, Ttyh3, Itih1, Aldh1a1). Proteomics data are available via ProteomeXchange with the identifier PXD028551. Further, under HF stimulation, hASCs exhibited higher osteogenic commitment and enhanced hydroxyapatite deposition. These promising osteoinductive/conductive capacitive stimulators will integrate novel bioelectronic implants able to monitor the bone–implant interface and deliver personalized stimulation to peri-implant tissues.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants

et al. 2021

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“…POD has long been acknowledged as a significant complication in surgery patients. With the aging of the population and the increase of joint diseases, the demand for joint replacement surgery is also increasing [ 16 ]. Studies have shown that the incidence of POD after major surgery is 20% to 50% in people over the age of 60 [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study

Chen

Liu

et al. 2021

BioMed Research International

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Objective. To explore the related risk factors of postoperative delirium (POD) after hip or knee arthroplasty in elderly orthopedic patients and the predictive value of related risk factors. Material and Methods. In total, 309 patients (≥60 years) who received knee and hip arthroplasty between January 2017 and May 2020 were consecutively selected into the POD and nonpostoperative delirium (NPOD) groups. Group bias was eliminated through propensity score matching. Univariate and multivariable logistic analysis was used to determine the risk factors for POD. The nomogram was made by R. Results. 58 patients were included in each group after propensity score matching; multivariable analysis demonstrated that LDH ( OR = 4.364 , P = 0.017 ), CHE ( OR = 4.640 , P = 0.004 ), Cystatin C ( OR = 5.283 , P = 0.006 ), arrhythmia ( OR = 5.253 , P = 0.002 ), and operation duration ( OR = 1.017 , P = 0.050 ) were independent risk factors of POD. LDH, CHE, Cystatin C, and arrhythmia were used to construct a nomogram to predict the POD. The nomogram was well calibrated and had moderate discriminative ability ( AUC = 0.821 , 95% CI: 0.760~0.883). Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions. Our study revealed that arrhythmia, operation duration, the increase of lactate dehydrogenase and Cystatin C, and the decrease of cholinesterase were reliable factors for predicting postoperative delirium after elderly hip and knee arthroplasty. Meanwhile, the nomogram we developed can assist the clinician to filtrate potential patients with postoperative delirium.

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“… 5 A recent review evaluating the functional outcomes and implant survivorship with new generations of cementless TKAs has shown encouraging results for this type of fixation in primary TKA. 6 The authors also highlighted the importance of high-quality reporting of functional outcome and implant survivorship in the long term. To our knowledge, there are no other RSA studies with rTKAs, and therefore no data to act as reference when investigating the future effects of these patterns of migration.…”

Section: Introductionmentioning

confidence: 99%

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

Mills

Wymenga

Hellemondt

et al. 2022

The Bone & Joint Journal

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Aims Both the femoral and tibial component are usually cemented at revision total knee arthroplasty (rTKA), while stems can be added with either cemented or press-fit (hybrid) fixation. The aim of this study was to compare the long-term stability of rTKA with cemented and press-fitted stems, using radiostereometric analysis (RSA). Methods This is a follow-up of a randomized controlled trial, initially involving 32 patients, of whom 19 (nine cemented, ten hybrid) were available for follow-up ten years postoperatively, when further RSA measurements were made. Micromotion of the femoral and tibial components was assessed using model-based RSA software (RSAcore). The clinical outcome was evaluated using the Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (pain and satisfaction). Results The median total femoral translation and rotation at ten years were 0.39 mm (interquartile range (IQR) 0.20 to 0.54) and 0.59° (IQR 0.46° to 0.73°) for the cemented group and 0.70 mm (IQR 0.15 to 0.77) and 0.78° (IQR 0.47° to 1.43°) for the hybrid group. For the tibial components this was 0.38 mm (IQR 0.33 to 0.85) and 0.98° (IQR 0.38° to 1.34°) for the cemented group and 0.42 mm (IQR 0.30 to 0.52) and 0.72° (IQR 0.62° to 0.82°) for the hybrid group. None of these values were significantly different between the two groups and there were no significant differences between the clinical scores in the two groups at this time. There was only one re-revision, in the hybrid group, for infection and not for aseptic loosening. Conclusion These results show good long-term fixation with no difference in micromotion and clinical outcome between fully cemented and hybrid fixation in rTKA, which builds on earlier short- to mid-term results. The patients all had type I or II osseous defects, which may in part explain the good results. Cite this article: Bone Joint J 2022;104-B(7):875–883.

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Cementless knee arthroplasty: a review of recent performance

Cited by 23 publications

References 79 publications

Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants

Capacitive interdigitated system of high osteoinductive/conductive performance for personalized acting-sensing implants

Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

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