Stemmed revision arthroplasty for aseptic loosening of total knee replacement

Bertin, K. C.; Freeman, M. A. R.; Samuelson, K. M.; Ratcliffe, SS; Todd, R. C.

doi:10.1302/0301-620x.67b2.3980534

Cited by 108 publications

(41 citation statements)

References 8 publications

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“…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%

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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: 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%

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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“…There are currently no direct comparative studies assessing the effects of revision reason on functional outcome and satisfaction, with studies combining results from aseptic revisions without substratifying those performed for aseptic loosening against other reasons. In one of the few studies to examine revisions performed for aseptic loosening, Bertin et al [4] found 91% of 53 patients who had revisions reported relief of pain and 80% could walk for more than 30 minutes. A study of revisions performed for stiffness showed low postoperative Knee Society scores and only modest improvements in scores at a mean of 43 months after surgery (postoperative Knee Society pain score, 46.9 (improvement, 31.9); postoperative Knee Society function score, 58.4 (improvement, 18.4)) [22].…”

Section: Discussionmentioning

confidence: 99%

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

Baker

Cowling

Kurtz

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear. Questions/purposes We determined differences in patientreported outcomes and rates of satisfaction between primary and revision TKAs, and determine whether the reason for revision influences patient-reported outcomes after revision TKA. Methods We retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) for 24,190 patients (23,393 TKAs; 797 aseptic revision TKAs). We compared patient-reported outcomes using the Oxford Knee Score (OKS), EuroQol (EQ-5D), and patient satisfaction between primary TKA and revision TKA, and for subsets of the revision TKA cohort. The followup data were collected between 6 and 12 months (7 months average) postoperatively. Results Improvements in the OKS (10) and EQ-5D (0.231) were smaller after revision when compared with primary TKA (OKS, 15; EQ-5D, 0.303). Patients who had revision TKA were less satisfied (66% versus 83%). Revisions for aseptic loosening or lysis were associated with the best patient outcomes (OKS improvement = 11; EQ-5D improvement = 0.232; satisfaction = 72%). Revisions for stiffness had the worst results (OKS improvement = 6; EQ-5D improvement = 0.176; satisfaction = 47%). Conclusions The early improvements in knee function and general health after revision TKA are only 69% to 76% of those observed for primary TKA. Levels of patient-reported knee function, general health, and satisfaction after revision are varied and related to the reason for revision. Even the best revision group does not approach the levels of function and satisfaction observed after primary TKA at a mean of 7 months postoperatively.

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“…[1][2][3][4][5][6][7][8][9][10] The reason is that stem extensions have improved survivorship time and clinical outcomes of revision surgery for TKRs. [1][2][3][4]11 Revision TKR surgery is a difficult procedure that requires the use of stem extensions to allow for endosteal referencing, bypassing of bone defects, and reduction of interface stresses of damaged bone in the distal femur or proximal tibia. 12 Although some investigators believe that cemented fixation of stems is the best choice to achieve optimal clinical outcome and mechanical stability for revision TKR surgery, 7,13,14 other researchers have shown that cementless stems can have mechanical superiority or equivalence relative to cemented devices.…”

Section: Introductionmentioning

confidence: 99%

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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Few biomechanical studies exist on femoral cementless press-fit stems for revision total knee replacement (TKR) surgeries. The aim of this study was to compare the mechanical quality of the femur–stem interface for a series of commercially available press-fit stems, because this interface may be a ‘weak link’ which could fail earlier than the femur–TKR bond itself. Also, the femur–stem interface may become particularly critical if distal femur bone degeneration, which may necessitate or follow revision TKR, ever weakens the femur–TKR bond itself. The authors implanted five synthetic femurs each with a Sigma Short Stem (SSS), Sigma Long Stem (SLS), Genesis II Short Stem (GSS), or Genesis II Long Stem (GLS). Axial stiffness, lateral stiffness, ‘offset load’ torsional stiffness, and ‘offset load’ torsional strength were measured with a mechanical testing system using displacement control. Axial (range = 1047–1461 N/mm, p = 0.106), lateral (range = 415–462 N/mm, p = 0.297), and torsional (range = 115–139 N/mm, p > 0.055) stiffnesses were not different between groups. The SSS had higher torsional strength (863 N) than the other stems (range = 167–197 N, p < 0.001). Torsional failure occurred by femoral ‘spin’ around the stem’s long axis. There was poor linear correlation between the femur–stem interface area versus axial stiffness (R = 0.38) and torsional stiffness (R = 0.38), and there was a moderate linear correlation versus torsional strength (R = 0.55). Yet, there was a high inverse linear correlation between interfacial surface area versus lateral stiffness (R = 0.79), although this did not result in a statistical difference between stem groups (p = 0.297). These press-fit stems provide equivalent stability, except that the SSS has greater torsional strength.

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Stemmed revision arthroplasty for aseptic loosening of total knee replacement

Cited by 108 publications

References 8 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?

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

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