Long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15 years of follow-up

Song, Sang Jun; Lee, Jong Whan; Bae, Dae Kyung; Park, Cheol Hee

doi:10.1007/s00167-021-06463-5

Cited by 3 publications

(6 citation statements)

References 27 publications

(49 reference statements)

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“…Second, a hybrid cementation was performed which could lead to potentially worse radiological results. However, recent studies found similar results between hybrid and full cementation TKA at long-term follow-up [4,35]. Furthermore, all tibial components were cemented, and loosening was always observed on the tibial component in the present study.…”

Section: Discussionsupporting

confidence: 78%

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Sappey‐Marinier

Shatrov

Batailler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA. Methods A retrospective monocentric single surgeon case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta ® , Switzerland). Patient speciic cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the inal follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan-Meier model. Signiicance was set at p < 0.05. Results Mean follow-up was 42.9 months ± 3.6 (range 37.6-46.7) and 53.3 months ± 4.1 (range 45.5-59.8) for rKA and MA groups. Postoperatively, no signiicant diferences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip-Knee-Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a signiicant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint. Conclusion An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA. Level of evidence Retrospective case-control study, Level IV.

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Section: Discussionsupporting

confidence: 78%

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Sappey‐Marinier

Shatrov

Batailler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Secondary exchange arthroplasty was performed following a diagnosis of aseptic failure based on clinical symptoms (including pain and swelling) and conventional radiographic criteria, defined as a progressive radiolucent line of ≥ 2‐mm width at the bone‐cement or bone‐implant interface, a significant change in component positions including subsidence, or a visible fracture of the surrounding cement [24]. A radiolucent line was defined as a radiolucent zone at the bone–cement or bone–implant surface parallel to the implant surface [29]. The location of the significantly progressive radiolucent lines was evaluated with reference to the zones suggested by the Knee Society radiographic evaluation method [29].…”

Section: Methodsmentioning

confidence: 99%

“…A radiolucent line was defined as a radiolucent zone at the bone–cement or bone–implant surface parallel to the implant surface [29]. The location of the significantly progressive radiolucent lines was evaluated with reference to the zones suggested by the Knee Society radiographic evaluation method [29].…”

Section: Methodsmentioning

confidence: 99%

“…A radiolucent line was deined as a radiolucent zone at the bone-cement or bone-implant surface parallel to the implant surface [29]. The location of the signiicantly progressive radiolucent lines was evaluated with reference to the zones suggested by the Knee Society radiographic evaluation method [29]. Thorough assessments were conducted to detect PJI when the secondary exchange was necessary, including analyses of laboratory inlammatory markers and preoperative joint luid and careful intraoperative assessment including pathologic evaluation of the frozen tissue.…”

Section: Secondary Exchange Arthroplasty and Aseptic Failurementioning

confidence: 99%

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Aseptic survival of the 1.5‐stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert

Song,

Hwang,

Baek

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). Methods Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1 month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was deined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors afecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°). Results The spacer in-situ time was 3.7 years (0.2-6.4). The clinical results improved hip-knee-ankle signiicantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0 years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a signiicant factor afecting survival (odds ratio = 5.491; p = 0.011). ConclusionThe aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty.

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“…Total knee arthroplasty (TKA) is a useful treatment for patients with end-stage knee joint arthritis, and its long-term survivorship is reported to reach ≥90% 1,2 . However, despite its successful clinical outcomes, some patients experience complications and need to undergo revision surgery.…”

mentioning

confidence: 99%

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

Lee,

Kim,

Park

et al. 2023

Journal of Bone and Joint Surgery

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Background: The causes of primary total knee arthroplasty (TKA) failure can be divided into septic and aseptic etiologies. It is unclear whether the etiology affects the infection rate after revision TKA. This systematic review was conducted to evaluate whether there is a difference in infection rates between septic and aseptic revision TKA. We hypothesized that infection rates would be higher after septic revision TKA. Methods: The PubMed and Embase databases and the Cochrane Library were searched to find studies evaluating infection rates following septic and aseptic revision TKA. We included studies that compared the postoperative infection rates of a group that received revision TKA for aseptic failure and a group that received 1- or 2-stage revision TKA for septic failure. Studies on re-revision TKA and on revision surgery after partial knee arthroplasty were excluded, as were studies of debridement, antibiotics, and implant retention (DAIR). Results: Twelve studies were included in this systematic review. In studies in which 1- or 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (odds ratio [OR], 6.83; 95% confidence interval [CI], 1.54 to 30.33; p = 0.01). Similarly, in studies in which 2-stage revision TKA was performed for septic failure, septic revision TKA had a significantly higher infection rate than aseptic revision TKA (OR, 4.14; 95% CI, 2.33 to 7.36; p < 0.00001). In the comparison of revision TKA for aseptic loosening and septic revision TKA, septic revision TKA had a higher infection rate than aseptic revision TKA (OR, 4.45; 95% CI, 2.28 to 8.70; p < 0.0001). Conclusions: Overall, septic revision TKA had a higher infection rate than aseptic revision TKA. Even when 2-stage revision TKA was performed for septic failure, the infection rate was higher after septic revision TKA than after aseptic revision. Surgeons should explain the relatively high infection rates to patients undergoing revision TKA for septic failure of their primary joint replacement. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15 years of follow-up

Cited by 3 publications

References 27 publications

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

Aseptic survival of the 1.5‐stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert

Risk of Infection After Septic and Aseptic Revision Total Knee Arthroplasty

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