Tibial Fixation Without Screws in Cementless Knee Arthroplasty

Holloway, Ian; Lusty, P.J.; Walter, William L.; Walter, William K.; Zicat, B.

doi:10.1016/j.arth.2008.09.023

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…In comparison, fewer clinical studies reported on the radiographic performance of the PFC Sigma and LCS Complete Duofix trays. The incidence of radiolucencies for the porous coated version of the PFC Sigma has been between 28% and 60%,45, 46 whereas the incidence for the HA coated LCS Complete Duofix tray was reported to be between 2% and 6% 48–50. The addition of the four peripheral pegs, inserted into better quality cancellous bone, appears better able to resist the varus moment, reducing the micromotions at the resected surface (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Influence of loading and activity on the primary stability of cementless tibial trays

Taylor¹,

Barrett²,

Deffenbaugh³

2012

Journal Orthopaedic Research

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Several potential advantages exist for cementless tibial fixation including preservation of bone stock and increased longevity of fixation. However, clinical results have been variable, with reports of extensive radiolucent lines, rapid early migration, and aseptic loosening. The primary stability of an implant depends on the micromotion of the bone-implant interface, which depends on the kinematics and kinetics of the replaced joint. Finite element analysis was used to examine the micromotion for different activities (walking, stair ascent, stair descent, stand-to-sit, and deep knee bend) for three commercially available tibial tray designs. Similar trends were observed for all three designs across the range of activities. Stair ascent and descent generated the highest micromotions, closely followed by level gait. Across these activities, the mean peak (maximum) micromotions measured across the entire resected surface ranged from 64 to 78 (186-239) mm for PFC Sigma,[61][62][63][64][65][66][67][68][69][70][71][72]) mm for LCS Complete Duofix, and 92-106 (229-264) mm for LCS Complete. The peak micromotions did not necessarily occur at the peak loads. For instance, the peak micromotions for level walking occurred when there were low axial forces, but moderate varus-valgus moments. This highlights the need to examine the whole gait cycle to properly determine the initial stability of tibial tray designs. By exploring a range of activities and interrogating the entire resected surface, it is possible to differentiate between the relative performance of different implant designs. ß

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Section: Discussionmentioning

confidence: 99%

“…The clinical performance of the LCS Complete,17, 18, 20, 21, 40–44 PFC Sigma,3, 11, 45–47 and LCS Complete Duofix cementless tibial trays48–50 have been widely reported. The incidence of radiolucent lines was reported to vary significantly from 0% to >90% of patients for the LCS Complete design.…”

Section: Discussionmentioning

confidence: 99%

Influence of loading and activity on the primary stability of cementless tibial trays

Taylor¹,

Barrett²,

Deffenbaugh³

2012

Journal Orthopaedic Research

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“…69 The concept of using screws to provide more predictable initial stability led to many early designs incorporating screws into tibial baseplates. 61,70 However, reports 3,71 show osteolysis associated with the use of screws and discuss the theoretical risks of debris formation, channels for osteolysis, and neurovascular damage. Many surgeons now recognise that stems, keels and pegs provide sufficient initial fixation, and the use of baseplates with screws is less popular.…”

Section: Cementless Tkamentioning

confidence: 99%

Cementless total knee arthroplasty

Dalury

2016

The Bone & Joint Journal

121

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As the number of younger and more active patients treated with total knee arthroplasty (TKA) continues to increase, consideration of better fixation as a means of improving implant longevity is required. Cemented TKA remains the reference standard with the largest body of evidence and the longest follow-up to support its use. However, cementless TKA, may offer the opportunity of a more bone-sparing procedure with long lasting biological fixation to the bone. We undertook a review of the literature examining advances of cementless TKA and the reported results. Cite this article: Bone Joint J 2016;98-B:867-73.

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“…After catastrophic failure of earlier cementless designs, screw-based fixation has been replaced by pegged tibial designs, eliminating screw-holes and providing an increased surface area for implant fixation, while simultaneously removing potential points where osteolysis can occur due to polyethylene debris entering cancellous bone surfaces [16,17].…”

Section: Figurementioning

confidence: 99%

Cementless Highly Porous Titanium Tibial Base Plate in Total Knee Arthroplasty – Midterm Outcomes.

2021

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Introduction & Aims TKA in more active and young patients has prompted the interest in more durable and biological methods of Osteo-integration with cementless components. With the emergence of improved biomaterials like porous titanium and the success, search for a cementless TKA with long-term durability and survivorship may have ended. This is a retrospective study of 492 consecutive TKAs using Cementless tibial fixation, reporting on the early 4 years clinical and radiological outcomes. Method We studied 492 TKAs performed consecutively by a single surgeon between 1stJan. 2010 and 31stDec. 2015 using a cementless, fixed bearing tibial tray (porous–Regenerex, Vanguard, Zimmer-Biomet) and a cementless femoral component (Vanguard) with no exclusion criteria. Clinical and radiological follow-up was done on these patients and in addition a comprehensive joint registry review was performed on the whole cohort (Level II evidence). Results The average Knee Society Score at final follow-up was 89.33, average pre-op being 42.06. Average post-op WOMAC score was 43.45 and average pre-op was 77.78. On radiological examination, no patients had osteolysis around tibial base plate. In our series 9 patients were revised, out of which only 4 patients had the tibial tray and femoral component revised and 5 patients had patella resurfacing or liner exchange. Overall survivorship of the cementless tibial component is excellent with a survivorship of 99.4% at 5.9 years based on a comprehensive AOANJRR data. Conclusions Cementless tibial fixation using a porous titanium construct can provide stable bone ingrowth fixation on the tibial side with excellent and predictable early 4 to 5 year clinical and radiological outcomes.

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Tibial Fixation Without Screws in Cementless Knee Arthroplasty

Cited by 12 publications

References 9 publications

Influence of loading and activity on the primary stability of cementless tibial trays

Influence of loading and activity on the primary stability of cementless tibial trays

Cementless total knee arthroplasty

Cementless Highly Porous Titanium Tibial Base Plate in Total Knee Arthroplasty – Midterm Outcomes.

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