Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age?

• Published in: The Journal of arthroplasty Vol. 38; no. 4; pp. 691 - 699
• Main Authors: Gibbons, John P., Cassidy, Roslyn S., Bryce, Leeann, Napier, Richard J., Bloch, Benjamin V., Beverland, David E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - adverse effects; cementless total knee arthroplasty; Female; Humans; Knee Prosthesis - adverse effects; osteoporosis; Radiography; radiolucency; Reoperation; Retrospective Studies; subsidence; Tibia - surgery; Treatment Outcome; uncemented; subsidence; cementless total knee arthroplasty; osteoporosis; radiolucency; uncemented
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2022.10.021

Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.