Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age?
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...
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| Published in | The Journal of arthroplasty Vol. 38; no. 4; pp. 691 - 699 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.04.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0883-5403 1532-8406 1532-8406 |
| DOI | 10.1016/j.arth.2022.10.021 |
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| Abstract | 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. |
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| AbstractList | 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.BACKGROUNDCementless 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.METHODSThis 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.RESULTSThere 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.CONCLUSIONCementless 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. 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. |
| Author | Bryce, Leeann Cassidy, Roslyn S. Beverland, David E. Gibbons, John P. Napier, Richard J. Bloch, Benjamin V. |
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| Keywords | subsidence cementless total knee arthroplasty osteoporosis radiolucency uncemented |
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Which is better? publication-title: Int Orthop – volume: 20 start-page: 10 year: 2005 end-page: 11 ident: bib10 article-title: Choosing your implant: cementless, patella sparing and posterior cruciate ligament retaining publication-title: J Arthroplasty – volume: 25 start-page: 2825 year: 2017 end-page: 2834 ident: bib34 article-title: Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 34 start-page: 309 year: 2019 end-page: 314 ident: bib17 article-title: Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up publication-title: J Arthroplasty – volume: 97 start-page: 185 year: 2015 end-page: 191 ident: bib39 article-title: Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial publication-title: Bone Joint J – volume: 26 start-page: 933 year: 2019 end-page: 940 ident: bib32 article-title: Twenty-year survivorship of a cemented mobile bearing Total Knee Arthroplasty publication-title: Knee – volume: 19 start-page: 1 year: 2018 end-page: 9 ident: bib28 article-title: A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship publication-title: BMC Musculoskelet Disord – volume: 35 start-page: 127 year: 2020 end-page: 131 ident: bib49 article-title: The natural history of radiolucencies following uncemented total knee arthroplasty at 9 years publication-title: J Arthroplasty – volume: 404 start-page: 40 year: 2002 end-page: 50 ident: bib8 article-title: Long-term followup after mobile-bearing total knee replacement publication-title: Clin Orthop Relat Res – volume: 83 start-page: 36 year: 2012 end-page: 40 ident: bib38 article-title: Continued stabilization of trabecular metal tibial monoblock total knee arthroplasty components at 5 years measured with radiostereometric analysis publication-title: Acta Orthop – volume: 13 start-page: 419 year: 2006 end-page: 421 ident: bib11 article-title: Cementless total knee arthroplasty with Profix: a 8- to 10-year follow-up study publication-title: Knee – volume: 25 start-page: 1749 year: 2017 end-page: 1756 ident: bib20 article-title: No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 448 start-page: 129 year: 2006 end-page: 139 ident: bib37 article-title: Uncemented HA-coated implant is the optimum fixation for TKA in the young patient publication-title: Clin Orthop Relat Res – volume: 6 start-page: 265 year: 1991 end-page: 278 ident: bib36 article-title: Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthrosis and rheumatoid arthritis: randomized study using roentgen stereophotogrammetric analysis publication-title: J Arthroplasty – volume: 98 start-page: 867 year: 2016 end-page: 873 ident: bib2 article-title: Cementless total knee arthroplasty: current concepts review publication-title: Bone Joint J – volume: 464 start-page: 93 year: 2007 end-page: 98 ident: bib12 article-title: Young and heavy patients with a cementless TKA do as well as older and lightweight patients publication-title: Clin Orthop Relat Res – volume: 86 start-page: 824 year: 2004 end-page: 829 ident: bib9 article-title: Survival analysis of a cementless, cruciate-retaining total knee arthroplasty. 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| Title | Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? |
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