Prophylactic Tibial Stem Fixation in the Obese: Comparative Early Results in Primary Total Knee Arthroplasty

Steere, Joshua T.; Sobieraj, Michael C.; DeFrancesco, Christopher J.; Israelite, Craig L.; Nelson, Charles L.; Kamath, and Atul F.

doi:10.5792/ksrr.18.022

Cited by 23 publications

(14 citation statements)

References 16 publications

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“…Most morbidly obese have lower activity levels, and the overall mechanical stress might not be as big as earlier anticipated ( 37 ). Some studies have suggested the use of short-stemmed tibial components to help mitigate the risk of aseptic loosening ( 38 , 39 ). Garceau et al investigated this further and found significantly less tibial loosening when using short-stemmed tibial components in morbidly obese ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Tilburg

Andersen

2022

EFORT Open Reviews

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Purpose Due to substantial increase in obesity, the demand for total knee arthroplasty (TKA) in obese and morbidly obese patients is higher than ever. This review aims to investigate mid- to long-term complications, revision rates, and outcome for morbidly obese, compared with non-obese after TKA. Methods A systematic search was conducted in May 2021. Included studies reported revision rates for morbidly obese and non-obese with a mean follow-up of at least 2 years. Reported knee society score (KSS) has been used to compare the functional outcome. PRISMA protocol was followed, and PROSPERO registered (ID: CRD42021254119). Results From 12 studies that met the inclusion criteria, a total of 1031 cases of morbidly obese and 9797 cases of non-obese controls were included. The risk ratio for revision was 1.48 for the morbidly obese, compared with non-obese (95% CI: 0.98 to 2.24; P = 0.06). Regarding aseptic and septic revision, the risk ratio was 1.44 (95% CI: 0.64 to 3.25; P = 0.37) and 2.22 (95% CI: 0.89 to 5.57; P = 0.09), respectively. The morbidly obese scored lower in Objective Knee Society Score (OKSS) and Functional Knee Society Score (FKSS) both preoperatively and postoperatively, compared with the non-obese; however, the two groups improved equally in function scores OKSS (P= 0.967) and FKSS (P = 0.834). Overall risk ratio for complications was 1.56 (95% CI: 0.98 to 2.48; P = 0.06). Conclusions The gained benefit in functional outcome surpasses the increase in risk of revision and complications for the morbidly obese in TKA surgery.

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Section: Discussionmentioning

confidence: 99%

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Tilburg

Andersen

2022

EFORT Open Reviews

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“…These patients usually recorded lower functional score. Steere et al 22 recommended addition of stem to the tibial tray in obese patients who undergo TKA. They attributed early failure in obese patients with standard tray to small-sized tibial trays used in this group of patients that concentrate more stresses on proximal tibia.…”

Section: Discussionmentioning

confidence: 99%

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Samy

Azzam

2020

J Knee Surg

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Over many decades, total knee replacement (TKR) becomes the ideal treatment option for advanced arthritis. Many designs were introduced to increase the stability of the tibial tray, hence the longevity of the prosthesis. This retrospective study was performed on 168 patients who received NexGen cemented primary total knee either with standard tibial tray (group A) or tibial tray with an intramedullary stem (group B) between May 2008 and May 2017. We reviewed all preoperative and postoperative clinical and radiological data retrospectively. In addition, a prospective clinical and radiological reassessment was done. Our aim was to answer the following questions: (1) Is there any difference between both groups in regard to clinical and radiological results? (2) Is there any difference in the revision rate? (3) Is there a role of using stemmed tibial tray in primary TKR? Better results were recorded in obese and severely obese patients having stemmed cemented tibial tray and so for patients with marked and severe preoperative varus angle. Our recommendations are to use cemented tibial tray with a stem in complicated primary surgery without fear of adverse effects on short and intermediate terms of follow-up.

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“…1 ). For patients with obesity and a femoral shaft with a laterally bowed deformity, a diaphyseal-engaging press-fit stem is usually helpful to offload the excessive shearing stress on the tibia and further improve longevity ( 22 , 23 , 24 ). High-constrained prostheses are appropriate to avoid early failure in neuromuscular diseases caused by poliomyelitis.…”

Section: Specific Factors Affecting Decision-making Regarding Prosthe...mentioning

confidence: 99%

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

Zhang

2022

EFORT Open Reviews

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The number of primary and revision total knee arthroplasties (rTKAs) continues to increase annually. To date, most of the literature has focused on the surgical technique and outcome of revision prostheses. Thanks to the contributions of surgeons, engineers, and researchers, the design of prostheses has reached a prominent milestone. However, very limited discussion regarding the design, rationale and constitution of prostheses has been documented at present. An electronic search of four online databases (Embase, MEDLINE, PubMed, and Google Scholar) was conducted to identify eligible resources. Forty-four review articles were acquired by searching the terms ‘prosthesis selection’, ‘prosthesis option’, and ‘prosthesis determination’ in rTKA. Sixty-eight research articles investigating the factors affecting prosthesis options in rTKA were screened and integrated with the authors’ perspective to reach a final recommendation. This article first discusses the pathological, individual, and other factors affecting prosthesis options in rTKA and further illustrates the classification, geometry, biomechanics, and constitution of the revision system from the authors’ perspective. An evidence-based recommendation in the form of a matching algorithm was formulated. This review offers special value for decision-making regarding prosthesis options in rTKA. Particularly, it presents specific recommendations regarding unclear practical issues, such as the optimal level of constraint, individualized design, length, and fixation of extension stem, as well as the pros and cons of modularity.

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Prophylactic Tibial Stem Fixation in the Obese: Comparative Early Results in Primary Total Knee Arthroplasty

Cited by 23 publications

References 16 publications

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

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