Midterm Results of Cementless Total Knee Arthroplasty: A Retrospective Case Series.

Radosław Stempin,Wiesław Kaczmarek,Julian Dutka,Kacper Stempin

doi:10.2174/1874325001812010196

Radosław Stempin, Wiesław Kaczmarek + Show 2 more

Open Access

https://doi.org/10.2174/1874325001812010196

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Abstract

Background:There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA).Objective: The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA.Methods:From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken.Results:Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain.Conclusion:Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.

Highlights

Ever since the advent of cementless systems for Total Knee Arthroplasty (TKA), there has been discussion over when to choose this newer modality over conventional cemented fixation for TKA [1 - 4]
Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis
The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA

Summary

Introduction

Ever since the advent of cementless systems for Total Knee Arthroplasty (TKA), there has been discussion over when to choose this newer modality over conventional cemented fixation for TKA [1 - 4]. Cemented systems have created issues with cement-bone interface degradation and implant loosening, so the cementless TKA was designed to promote osseointegration and offer long-term fixation – especially in young and active patients [1, 5]. Other reported advantages of cementless TKA are that it is potentially time-saving during surgical implantation; it reduces ischemia time; and allows an easier, more bone-preserving, revision in the event of failure [7]. There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA)

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Conclusion