Stemmed femoral implants show lower failure rates in revision total knee arthroplasty

Nelson, Charles L.; Vanushkina, Maria; Irgıt, Kaan; Strohecker, Kent; Bowen, Thomas R.

doi:10.1016/j.knee.2015.02.013

Cited by 14 publications

(8 citation statements)

References 31 publications

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“…In a report published by Nelson et al, they determine that a femoral stem, even when used in the setting of more severe preoperative bone loss, had less failure rates at 4 years in comparison to when femoral stems were not used. 8 Similar findings have been noted with the use of tibial implants, as seen in a study by Lachiewicz and Soileau, where after reviewing 58 tibial component revisions using a cemented stem extension, they reported no revisions for loosening at a mean follow-up of 5 years. 9 One of the earliest concerns utilizing tibial stems without full cementation, however, is that there could be a significant loosening rate.…”

Section: Historysupporting

confidence: 76%

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

2019

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Successful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, there remains two options to assist with fixation, either fully cementing the entire implant or using a “hybrid” system, which combines an uncemented press-fit diaphyseal stem with cement in both the metaphysis and metaphysis–diaphysis junction of the keel. In this review, we discuss the history of these two techniques, evaluate the theoretical benefits and pitfalls, and assess the best evidence supporting each in the literature. To conclude, we will examine future directions and questions needed to better elucidate the best treatment options in a variety of revision scenarios.

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Section: Historysupporting

confidence: 76%

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

2019

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“…In situations, either primary or revision, where the collateral ligaments are incompetent, there is gross flexion-extension gap imbalance, or there is severe or relevant bone loss affecting the insertion site of the collateral ligaments, then a CCK would not provide adequate stability and a hinge component should be used instead [ 19 , 20 ]. In this case report, CCK components with fully cemented short stem extensions were used for both tibial and femoral components to increase the contact area of the bone-cement interface, which has been shown to reduce the rate of loosening and increase the longevity of the implant [ [21] , [22] , [23] ], although their necessity has been debated in literature [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…For both the knees presented in this report, there were posteromedial small residual uncontained bone defects that were approximately 3 mm in depth. Given the size of defects and their contained nature, we elected to use a screw and cement rebar technique, which have been shown to have 30% less loosening of the prosthesis than cement alone in tibial defects [ 23 , 25 ]. The use of screws is intended to distribute the load away from the joint line and the cement-bone interface and has been proven to be a reliable, reproducible, inexpensive technique when addressing these defects [ 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Given the size of defects and their contained nature, we elected to use a screw and cement rebar technique, which have been shown to have 30% less loosening of the prosthesis than cement alone in tibial defects [ 23 , 25 ]. The use of screws is intended to distribute the load away from the joint line and the cement-bone interface and has been proven to be a reliable, reproducible, inexpensive technique when addressing these defects [ 23 , 25 ]. In cases where there are large uncontained defects, however, modular metal augments, metaphyseal sleeves, or trabecular metal cones should be considered as an alternative [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique

Taylor

Carpenter²,

Runner

2021

Arthroplasty Today

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Blount disease is an acquired, asymmetrical disorder of proximal tibial growth that results in a complex three-dimensional proximal tibial deformity, with tibial varus being the dominating feature. Although the exact pathophysiology is unknown, Blount disease is separated into 2 clinical variants, infantile and adolescent, based on the onset of symptoms occurring before or after the age of 10 years. If recognized and treated early, affected patients generally have a favorable prognosis; however, if neglected, it can lead to progressive malalignment and premature osteoarthritis. We present a patient with bilateral neglected Blount disease who underwent successful bilateral total knee arthroplasty performed in a staged fashion using a gap balancing technique with constrained condylar knee implants.

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“…In this study, we present medium-term outcomes of a hybrid fixation technique in semi-constrained implants with a cementless metaphyseal tibial fixation and short-cemented femoral fixation with excellent survivorship of 97.6% at median 6.7 years. In the absence of stems, failure rates have been reported as high as 66% at 5 years compared with 8% with modular stems [19,20]. Fully cemented stems are generally shorter in length engaging the metaphysis with favorable bone for cement interdigitation, while press-fit stems require more length to engage the cortical bone of the diaphysis.…”

Section: Discussionmentioning

confidence: 99%

High Survivorship of Short-Cemented Femoral Stems in Condylar Revision Total Knee Arthroplasty Without Significant Metaphyseal Bone Loss: Minimum 5-Year Follow-Up

Matar

Bloch

James

2021

The Journal of Arthroplasty

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Background: We aimed to evaluate the outcomes of hybrid fixation technique in condylar revision total knee arthroplasty (rTKA) using cementless metaphyseal tibial sleeves and short-cemented femoral stems with a rotating platform articulation. Methods: Retrospective consecutive study of all condylar rTKAs with a cemented femoral stem between 2009 and 2016 was conducted. Patients were identified using a local prospective database and linkable data obtained from the National Joint Registry for rTKA. Demographic, clinical, and surgical data were collected from patients' electronic health records. The primary outcome measure was mechanical failure and implant survivorship using a nationally collected data, complications, re-operations, and "any-cause revision" were also recorded. Results: There were 72 consecutive patients (72 knees) with minimum 5-year follow-up: 33 (45.8%) females and 39 (54.2%) males with a median age of 70 years (range 47-88). The indication for revision surgery was aseptic loosening (n ¼ 34, 47.2%), instability (n ¼ 17, 23.6%), infection (n ¼ 14, 19.5%) with 10 patients having 2-stage approach and 4 patients with single-stage approach, stiffness (n ¼ 4, 5.6%), and malalignment (n ¼ 3, 4.1%). At mean follow-up of 6.87 years (median 6.7; range 5-11.8), only 2 patients required revision for infection. Using "any-cause implant revision" as an end point, implant survivorship for this construct was 97.2% at median 6.7 years. To date, none of the femoral stems have been revised for mechanical failure. Conclusion:In rTKA with good femoral condylar bone stock, we have shown excellent survivorship with a short-cemented femoral stem, in conjunction with a mobile-bearing and a tibial sleeve. This has the advantage of reducing the length of the revision construct of this complex surgery.

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Stemmed femoral implants show lower failure rates in revision total knee arthroplasty

Cited by 14 publications

References 31 publications

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique

High Survivorship of Short-Cemented Femoral Stems in Condylar Revision Total Knee Arthroplasty Without Significant Metaphyseal Bone Loss: Minimum 5-Year Follow-Up

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