Revision total knee arthroplasty with use of modular components with stems inserted without cement.

Haas, Steven B.; Insall, John N.; Montgomery, William; Windsor, Russell E.

doi:10.2106/00004623-199511000-00009

Cited by 266 publications

(130 citation statements)

References 15 publications

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“…Our aseptic rerevision rate is similar to several studies reporting 2% to 16% aseptic failure rates after cemented or cementless stem revision TKA for any diagnosis [6,14,17,31,32,38,41]. One study reported no component revisions for aseptic loosening in 40 monoblock, fully cemented long-stemmed revisions at an average followup of 58.2 months [25].…”

Section: Discussionsupporting

confidence: 85%

“…Previous studies have shown 32% to 61% of fully cemented stems and 10% to 74% of hybrid cementless stems have adjacent radiolucencies [4,7,13,14,17,26,32]. Although the majority of these studies used the Knee Society radiographic scoring system to evaluate radiolucencies, they categorized radiolucencies based on progression.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies report 2% to 26% prevalence of radiolucent lines along cemented and uncemented tibial stems; radiolucencies were more common along the tibial rather than femoral implants [4,14,17,28,31,32]. At least one other study has also shown a higher radiographic failure rate in tibial stems as compared with femoral stems [32].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, cementless, diaphyseal-engaging stems with cement along the undersurface of the femoral/tibial components, along the metaphyseal portion (stem/coupler interface) of the implant, and the metaphysis, in a so-called ''hybrid'' technique, are a fixation alternative that have also shown excellent 5-and 10-year survivorship in aseptic revision TKA [14,17,26,27,31,41]. Both cemented and hybrid cementless stem fixation techniques are currently being used during reimplantation for periprosthetic knee sepsis.…”

Section: Introductionmentioning

confidence: 99%

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Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Edwards

Fehring

Hamilton

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The routine use of stems in revision TKA improves survival rates by enhancing the stability of the prosthesis. The ideal method of stem fixation (cemented or uncemented) in two-stage reimplantation remains controversial. Questions/purposes The purpose of this study was to answer the following questions: (1) Are rerevision rates for aseptic loosening comparable between cemented stems and uncemented stems in two-stage reimplantation? (2) Is the reinfection rate comparable between antibiotic-impregnated cemented stems and uncemented stems for two-stage reimplantation? (3) Are there any differences in Knee Society radiographic scores between stem techniques? Methods A retrospective analysis was performed in all patients who underwent two-stage reimplantation between 1990 and 2010 at Anderson Orthopaedic Research Institute (AORI) and OrthoCarolina (OC). One hundred fourteen patients with 228 stems met the inclusion criteria. Of these 228 stems, 102 stems were cemented and 126 stems were uncemented. The indication for stem fixation was largely institution specific; AORI used cementless stems 92% (118) of the time, whereas OC used a cemented stem 92% (92) of the time. A 2-year minimum radiographic and clinical followup was required for inclusion into the study. Radiographic evaluations were performed using a modification of the Knee Society radiographic score. Results Rerevision rates for aseptic loosening were comparable with three cemented and three cementless stem constructs. The reinfection rate was also comparable between cemented and cementless stems (p = 0.86). Using post hoc analysis, 32% of cemented stems were radiographically classified as loose or closely observe (33 of 102) compared with 17% of the cementless stem group (21 of 126; p = 0.006). Patients with good bone quality had a

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Edwards

Fehring

Hamilton

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Major tibial and femoral bone defects, classified as Anderson Orthopaedic Research Institute (AORI) [10] Types 2B and 3, have been reconstructed using impaction bone grafting with or without mesh augmentation [22,25,38,40,44], structural or bulk allografts [7,11,14,16,17,28,31,39], modular metal augmentations of prostheses [15,32], and tumor-type megaprostheses [2]. Studies using structural allografts have reported numerous complications and minimum 5-year survivorship of 67% to 96% [1,6,7,14,17], whereas reconstructions with tumor-type megaprostheses have shown a 5-year survivorship of 68% [33].…”

Section: Introductionmentioning

confidence: 99%

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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Background Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. Questions/purposes We wished to determine the midterm (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. Methods We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system.

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A 57-Year-Old Man With Osteoarthritis of the Knee

Lonner

2003

JAMA

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Revision total knee arthroplasty with use of modular components with stems inserted without cement.

Cited by 266 publications

References 15 publications

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

A 57-Year-Old Man With Osteoarthritis of the Knee

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