The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

Abstract

Background and purposeRecent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation.MethodsRegistry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation preferring surgeons, designated routinely hybrid (RH), and those treated by high-volume cemented fixation preferring surgeons, designated routinely cemented (RC).ResultsAt 13 years, the cumulative percentage revision of the RC cohort was 4.8% (CI 4.1–5.7) compared with 5.5% (CI 3.5–8.7) for the RH cohort. The revision risk for each cohort was the same for all causes (HR =1.0 (CI (0.84–1.20)), non-infective causes, and for infection. This finding was irrespective of patient age or sex, patella resurfacing, and with non-cross-linked polyethylene (NXLPE). The RH cohort who received cross-linked polyethylene (XLPE) had a lower revision risk than the RC cohort with XLPE (HR =0.57 (0.37–0.88), p = 0.01).InterpretationThe risk of revision for the patients of surgeons who prefer cemented fixation in minimally stabilized TKR is the same as for the patients of surgeons who prefer hybrid fixation, except when used with XLPE, where hybrid fixation has a lower revision risk.

Experimental model of peri-prosthetic infection of the knee caused by Staphylococcus aureus using biomaterials representative of modern TKA

“…Semi-quantitative methods were subsequently used to infer implant stability and bacterial persistence in this non-constrained model (Søe et al, 2013). Notably, implant stability and long-term success of TKA is dependent on component fixation that can either be cemented (constrained) or cementless (non-constrained) (Dalury, 2016; Vertullo et al, 2018). Antibiotic-laden bone cement was introduced in the 1970s for infection prophylaxis in arthroplasty, with gentamicin one of the most commonly incorporated antibiotics (Hinarejos et al, 2015).…”

“…In modern TKA, hybrid fixation techniques involving a cementless femoral component and a cemented tibial component is often used (Vertullo et al, 2018). Titanium alloys are one of the most commonly used metals in non-bearing surfaces of orthopaedic implants, whilst ultra-highly cross-linked polyethyelene (UHXLPE) is used for articulating surfaces (Bravin and Dietz, 2018).…”

The effect of patient and prosthesis factors on revision rates after total knee replacement using a multi-registry meta-analytic approach

“…Cement may protect against early migration and revision for loosening ( 45 ). Cement fixation for TKA has been termed the “gold standard” and has consistently been reported to be superior to cementless fixation ( 18 , 37 , 46 ). However, there has been support for the contrary viewpoint ( 17 ).…”

“…Patient factors that influence TKA survivorship include age ( 5 , 7 ), sex ( 8 ), obesity ( 9 , 10 ), and comorbidity ( 11 , 12 ). Key prosthesis factors are prosthesis constraint ( 13 , 14 ), bearing mobility ( 15 , 16 ), fixation method ( 17 , 18 ), patellar resurfacing ( 19 , 20 ), and polyethylene type ( 21 , 22 ).…”

Experimental study of the effects of hypoxia simulator on osteointegration of titanium prosthesis in osteoporotic rats

“…Implant stability and the long-term success of total knee arthroplasty depend on component fixation that can either be cemented or cementless [ 1 , 2 ]. Prosthesis stability depends not only on good initial mechanical stability, but also on late osseointegration, whether in normal or osteoporotic bone.…”