Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Abstract

Over many decades, total knee replacement (TKR) becomes the ideal treatment option for advanced arthritis. Many designs were introduced to increase the stability of the tibial tray, hence the longevity of the prosthesis. This retrospective study was performed on 168 patients who received NexGen cemented primary total knee either with standard tibial tray (group A) or tibial tray with an intramedullary stem (group B) between May 2008 and May 2017. We reviewed all preoperative and postoperative clinical and radiological data retrospectively. In addition, a prospective clinical and radiological reassessment was done. Our aim was to answer the following questions: (1) Is there any difference between both groups in regard to clinical and radiological results? (2) Is there any difference in the revision rate? (3) Is there a role of using stemmed tibial tray in primary TKR? Better results were recorded in obese and severely obese patients having stemmed cemented tibial tray and so for patients with marked and severe preoperative varus angle. Our recommendations are to use cemented tibial tray with a stem in complicated primary surgery without fear of adverse effects on short and intermediate terms of follow-up.

Stemmed Versus Nonstemmed Tibia in Primary Total Knee Arthroplasty: A Similar Pattern of Aseptic Tibial Loosening in Obese Patients with Moderate Varus. 5-Year Outcomes of a Randomized Controlled Trial

“…These conclusions supported the outcome of our study by using the standard tibial TKAs in obese patients with limited varus deformity; however, the previous studies did not define a cut-off for the varus degree before using stemmed TKAs. 36 In this study, standard nonstemmed TKAs were used in obese patients, with BMI < 40 kg/m 2 and varus deformity <15 degrees, yielding comparable results to long-stemmed tibial design and providing results that may favor the use of standard tibial implants in a similar group of patients to avoid stem-related complications and improve the costeffectiveness. However, the degree of preoperative varus deformity above 10 degrees was associated with less favorable outcomes in both groups but no increase in radiographic evidence of loosening.…”