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

Kemker, Bernard P.; Sowers, Christopher B.; Seedat, Raees; Satpathy, Jibanananda; Patel, Nirav K.; Lombardo, Daniel J.; Golladay, Gregory J.

doi:10.3389/fsurg.2022.716510

Cited by 3 publications

(11 citation statements)

References 26 publications

(39 reference statements)

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“…Follow-up ranged from 2 to 114 months with an average follow-up of 25 months, and the researchers found no significant difference in outcomes between cemented and hybrid stems. 15 Similar results were reported in a meta-analysis by Wang et al that explored outcomes from 17 studies. 7 While some literature exists demonstrating superior anatomic alignment with offset stem use compared with straight stems, there has been no data supporting differences in patient outcomes between fixation methods.…”

supporting

confidence: 80%

Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty

et al. 2023

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Introduction Intramedullary stems are often required in patients undergoing revision total knee arthroplasty (rTKA) to achieve stable fixation. Significant bone loss may require the addition of a metal cone to maximize fixation and osteointegration. The purpose of this study was to investigate clinical outcomes in rTKA using different fixation techniques. Methods We conducted a single-institution retrospective review of all patients who received a tibial and femoral stem during rTKA between August 2011 and July 2021. Patients were separated into three cohorts based on fixation construct: press-fit stem with an offset coupler (OS), fully cemented straight (CS) stem, and press-fit straight (PFS) stem. A sub analysis of patients who received tibial cone augmentation was also conducted. Results A total of 358 patients who underwent rTKA were included in this study, of which 102 (28.5%) had a minimum two-year follow-up and 25 (7.0%) had a minimum five-year follow-up. In the primary analysis, 194 patients were included in the OS cohort, 72 in the CS cohort, and 92 in the PFS cohort. When stem type alone was considered, there was no significant difference in re-revision rate (p=0.431) between cohorts. Sub analysis of patients who received augmentation with a tibial cone demonstrated that OS implants led to significantly higher rates of re-revision compared to the other two stem types (OS: 18.2% vs CS: 2.1% vs PFS: 11.1%; p=0.037). Conclusion The findings of the present analysis demonstrate that fully cemented stems and cones in rTKA may provide more reliable long-term outcomes compared to press-fit stems with offset couplers.

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supporting

confidence: 80%

Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty

et al. 2023

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“…On the contrary, studies by Gomez et al, Gililland et al and Jacquet et al studied all aseptic causes of primary TKA failure [ 19 – 21 ]. The rest of the studies included all indications of revision TKAs including loosening, infection, instability, osteolysis or polywear, stiffness, malposition, arthrofibrosis and patellar subluxation [ 16 , 22 – 25 ]. Majority of the studies included in this systematic review were from the United States of America (USA).…”

Section: Resultsmentioning

confidence: 99%

“…Of note, there were no studies from Asian countries. Majority of the studies reported the implants that they opted for apart from four of the studies that did not specify [ 16 , 20 , 23 , 25 ]. Most studies explicitly detailed their post-operative care for their patients.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of hybrid vs. cemented stems – which method is more optimal for revision total knee arthroplasty?

Thever,

James Loh,

Raghavan

et al. 2024

BMC Musculoskelet Disord

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Introduction The number of primary and revision Total Knee Arthroplasty (TKA) cases are expected to increase in future. There are various advantages and disadvantage to employing either of the two main types of stem fixation methods – cemented or hybrid technique. This review aimed to study the most optimal fixation method for revision TKAs by comparing radiological outcomes and re-revision rates. Methods A systematic review and meta-analysis was performed using PubMed and Cochrane Library from 2010 to identify studies explicitly comparing outcomes between cemented against hybrid fixation revision TKA techniques, with a minimum follow up of at least 24 months. A total of 8 studies was included in this review. Egger’s test and visual inspection of the funnel plot did not reveal publication bias. Results There was no statistically significant difference in radiological failure and loosening (OR 0.79, CI 0.37–1.66, I2 = 29%, p = 0.22), all causes of re-revision (OR 1.03, CI 0.73–1.44, I2 = 0%, p = 0.56) and aseptic revision (OR 0.74, CI 0.27–2.02, I2 = 0%, p = 0.41) between cemented and hybrid techniques. Functional and pain outcomes compared between the two fixation techniques were largely similar across the studies included in this meta-analysis. Conclusion Despite a trend favouring hybrid stems in revision TKA, current evidence revealed that radiological outcomes and re-revision rates are largely similar between cemented and hybrid fixation techniques.

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“…In fact, higher failure rates have been reported in rTKA cases without the use of intramedullary stems, where failure rates increased from 8% with stem usage to as high as 66% without stems at 5-year followup [51,52]. However, the choice of the most appropriate fixation technique remains a challenging decision [32].…”

Section: Discussionmentioning

confidence: 99%

Cemented versus Cementless Stem Fixation in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Darwich,

Jovanovic,

Dally

et al. 2023

Antibiotics

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The number of revision knee arthroplasties (rTKA) is growing significantly as is the use of intramedullary stems for optimized stability. The choice of the most appropriate stem fixation method is still controversial. The purpose of this meta-analysis is to compare cemented versus cementless stem fixation in rTKA. Publications with patients undergoing rTKA with a follow-up > 24 months were systemically reviewed. Extracted parameters included total revision and failure rates for any reason, incidence of aseptic loosening, periprosthetic infection, and radiolucent lines, as well as the clinical outcome. A statistical regression analysis was then performed on all extracted clinical and radiological outcome data. A total of 35 publications met the inclusion criteria and were included and analyzed. Overall, 14/35 publications compared cementless versus cemented stem fixation, whereas 21/35 publications investigated only one stem fixation method. There were no significant differences in revision (p = 0.2613) or failure rates (p = 0.3559) and no differences in the incidence of aseptic loosening (p = 0.3999) or periprosthetic infection (p = 0.1010). The incidence of radiolucent lines was significantly higher in patients with cemented stems (26.2% versus 18.6%, p < 0.0001). However, no differences in clinical outcomes were observed. No superiority of a specific stem fixation method in rTKA was found. Rates of revision or failure for any reason as well as incidence of aseptic loosening and periprosthetic infection in cemented versus cementless stem fixation showed no significant difference. A higher incidence of radiolucent lines was observed in cemented stem fixation; however, no effect was observed on the clinical outcome.

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

Cited by 3 publications

References 26 publications

Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty

Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty

A systematic review and meta-analysis of hybrid vs. cemented stems – which method is more optimal for revision total knee arthroplasty?

Cemented versus Cementless Stem Fixation in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

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