Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial

Abstract

Aims Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. Methods Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2 (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. Results At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001) Conclusion Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025–1032.

Total and partial knee arthroplasty implants that maintain native load transfer in the tibia

“…A 13-year randomized controlled trial of such a device found better patient outcomes and radiological findings compared to a conventional metal-backed design. 35 This improved performance may have been partially due to the more normal load transfer for the trabecular metal design. Our data can also be compared to computational models of load transfer in the tibia.…”

The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland

“…Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been proven as the [1] methods of choice in the treatment of end-stage hip or knee pathologies [2][3][4][5]. Improvement in biomaterials, surgical techniques and implant designs has been the reason for more indications for THA and TKA [1,3,4,[6][7][8][9].…”

Lattice implants that generate homeostatic and remodeling strains in bone

“…For example, in a randomized controlled trial, a tantalum trabecular metal tibial implant had improved radiological outcome compared to a solid tibial implant over a period of 15 years. 34 Another example is that the likelihood of a complex revision is reduced if the primary implant is a low modulus all polyethylene design compared to a conventional solid metal backed design. 35 Our method builds on these findings by allowing precise control of bone strain, using a manufacturing method that has already been deployed in over 1 million knee replacement implants.…”