Long-term survival of fully cemented stem in re-revision total knee arthroplasty performed on femur with diaphyseal deformation due to implant loosening

Abstract

The study aims to analyze long-term clinical and radiographic results, and survival of re-revision total knee arthroplasty (TKA) using fully cemented stems performed on femurs with diaphyseal deformation. Thirty-seven re-revision TKAs using fully cemented stems performed in femoral diaphyseal deformations, characterized as diaphyseal canal enlargement and cortex deformation due to aseptic loosening of previously implanted stems, between 2003 and 2015 were retrospectively reviewed. The mean follow-up period was 10.0years. Clinically, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Radiographically, mechanical axis (MA) and component positions were measured. Complications and survival rates were also analyzed. Clinically, the WOMAC significantly improved at final follow-up (61.2 vs 47.2, p < 0.001), but not the ROM (95.5 vs 102.5, p = 0.206). Radiographically, the MA and component positions were appropriate, with no changes in component positions from immediately post-operative to final follow-up, but with MA change from varus 2.9° to 3.7° (p = 0.020). Two cases (5.4%) with history of previous infections developed periprosthetic joint infection (PJI). Debridement with polyethylene insert exchange following antibiotic suppression were performed in those cases because of concern for difficult implant-cement removal. The fiveand tenyear survival rates were 100% and 93.2%, respectively. Fully cemented stems are viable in providing long-term satisfactory survival after re-revision TKA in patients with femoral diaphyseal deformation. However, it should be used carefully for those with previous infections.