Cementless vs Cemented Tibial Fixation in Primary Total Knee Arthroplasty

Behery, Omar A.; Kearns, Seán; Rabinowitz, Justin M.; Levine, Brett R.

doi:10.1016/j.arth.2016.12.023

Cited by 25 publications

(20 citation statements)

References 31 publications

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“…2015); 7 revised or radiographically loose components in a series of 51 subjects (Behery et al. 2017); 1 revision for subsidence out of 50 cases (Fricka et al. 2015); and statistically significantly higher overall migration compared with the TM Monoblock component, but no difference between groups in change in migration from 1 to 2 years in 53 subjects (Andersen et al.…”

Section: Discussionmentioning

confidence: 99%

Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties

et al. 2019

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Background and purpose — Thresholds of implant migration for predicting long-term successful fixation of tibial components in total knee arthroplasty have not separated cemented and uncemented fixation. We compared implant migration of cemented and uncemented components at 1 year and as the change in migration from 1 to 2 years. Patients and methods — Implant migration of 360 tibial components measured using radiostereometric analysis was compared at 1 year and as the change in migration from 1 to 2 years in 222 cemented components (3 implant designs) and 138 uncemented components (5 implant designs). Results — 1-year maximum total point motion was lower for the cemented tibial components compared with the uncemented components (median = 0.31 mm [0.03–2.98] versus 0.63 mm [0.11–5.19] respectively, p < 0.001, mixed model). The change in migration from 1 to 2 years, however, was equivalent for cemented and uncemented components (mean [SD] 0.06 mm [0.19] and 0.07 mm [0.27] mm respectively, p = 0.6, mixed model). Interpretation — These findings suggest that current thresholds of acceptable migration at 1 year may be better optimized by considering cemented and uncemented tibial components separately as higher early migration of uncemented components was not associated with decreased stability from 1 to 2 years.

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Section: Discussionmentioning

confidence: 99%

Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties

et al. 2019

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“…17,31,35 However, some instances of early aseptic loosening in cementless tibial components persist. 36 In the interest of investigating aseptic loosening in cementless tibial trays, several previous studies have been undertaken to assess the mechanical stability of an implanted tibial tray through bench testing and finite element analysis. [21][22][23][37][38][39][40][41][42][43][44][45] Many of these studies have used simplified loading models to assess tibial tray stability, while a few more recent studies have included more complex loading scenarios.…”

Section: Discussionmentioning

confidence: 99%

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

et al. 2019

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Highly porous ingrowth surfaces have been introduced into tibial tray fixation to improve long-term survivorship in cementless total knee arthroplasty. This study was designed to evaluate the effect of porous ingrowth surface on primary stability in the implanted cementless tibial component. Three tibial tray designs possessing sintered bead or roughened porous coating ingrowth surfaces were implanted into a foam tibia model with primary stability assessed via digital image correlation during stair descent and condylar liftoff loading. Follow-up testing was conducted by implanting matched-pair cadaveric tibias with otherwise identical trays with two iterations of ingrowth surface design. Trays were loaded and micromotion evaluated in a condylar liftoff model. The sintered bead tibial tray exhibited slightly lower micromotion than the roughened porous coating in stair descent loading. However, no significant difference in primary stability was observed in condylar liftoff loading in either foam or cadaveric specimens. Cementless tibial trays featuring two different iterations of porous ingrowth surfaces demonstrated both good stability in cadaveric specimens with less than 80 microns of micromotion and 1 mm of subsidence under cyclic loading. While improved ingrowth surfaces may lead to improved biological fixation and long-term osteointegration, this study was unable to identify a difference in primary stability associated with subsequent ingrown surface design iteration.

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“…2016 ), or clinical series (Behery et al. 2016 ). Given that the tibia remains the component most at risk for failure (Voigt and Mosier 2011 ), hybrid fixation was introduced as a pragmatic alternative to employ the advantages of 2 differing fixation philosophies (Kraay et al.…”

Section: Discussionmentioning

confidence: 99%

The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

et al. 2018

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Background and purposeRecent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation.MethodsRegistry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation preferring surgeons, designated routinely hybrid (RH), and those treated by high-volume cemented fixation preferring surgeons, designated routinely cemented (RC).ResultsAt 13 years, the cumulative percentage revision of the RC cohort was 4.8% (CI 4.1–5.7) compared with 5.5% (CI 3.5–8.7) for the RH cohort. The revision risk for each cohort was the same for all causes (HR =1.0 (CI (0.84–1.20)), non-infective causes, and for infection. This finding was irrespective of patient age or sex, patella resurfacing, and with non-cross-linked polyethylene (NXLPE). The RH cohort who received cross-linked polyethylene (XLPE) had a lower revision risk than the RC cohort with XLPE (HR =0.57 (0.37–0.88), p = 0.01).InterpretationThe risk of revision for the patients of surgeons who prefer cemented fixation in minimally stabilized TKR is the same as for the patients of surgeons who prefer hybrid fixation, except when used with XLPE, where hybrid fixation has a lower revision risk.

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Cementless vs Cemented Tibial Fixation in Primary Total Knee Arthroplasty

Cited by 25 publications

References 31 publications

Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties

Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

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