Abstract
BackgroundThere have been no studies comparing patient-reported outcome measures including end-of-stem tip pain and patient satisfaction based on the use of cementing techniques in revision total knee arthroplasty (TKA). The purpose of this study was to compare end-of-stem tip pain and PROMs with hybrid and modified hybrid cementing techniques in revision TKAs.MethodSixty-two cases of revision TKA performed by a single surgeon were divided into two groups based on the cementing technique with a minimum follow-up of 2 years. Two types of cementing technique for femoral and tibial stems were used as follows: (1) a hybrid cementing technique (33 cases), in which cement was applied immediately distal to the modular junction of the stem and the component while the distal stem was press-fitted into the diaphysis without using cement; and (2) a modified hybrid cementing technique (29 cases), in which cement was applied to the tip of femoral and tibial stems. The thigh and shin were assessed for the end-of-stem tip pain. Patient satisfaction was evaluated based on the satisfaction items of New Knee Society Score.ResultsModified hybrid cementing significantly lowered the percentage of patients manifesting shin pain (3.4% vs. 24.2%, p = 0.029). Patients treated with the modified hybrid cementing technique showed a higher satisfaction rate (p = 0.003). Multivariate logistic regression analysis showed an increase in the odds of satisfaction 32.686-fold (p = 0.004) in patients without pain at the end-of-stem tip in the shin and 9.261-fold (p = 0.027) in patients treated with the modified hybrid cementing technique.ConclusionThe modified hybrid cementing technique for fixation of long-stem in revision TKAs reduced the end-of-stem tip pain in the shin, leading to significantly higher satisfaction compared with the hybrid cementing technique after revision TKA.Level of evidenceLevel III
Highlights
There have been no studies comparing patient-reported outcome measures including end-of-stem tip pain and patient satisfaction based on the use of cementing techniques in revision total knee arthroplasty (TKA)
The modified hybrid cementing technique for fixation of long-stem in revision TKAs reduced the endof-stem tip pain in the shin, leading to significantly higher satisfaction compared with the hybrid cementing technique after revision TKA
Diaphyseal fixation with a long stem is associated with pain at the end-of-stem tip, which might be related to patient dissatisfaction after revision TKA [8, 9]
Summary
There have been no studies comparing patient-reported outcome measures including end-of-stem tip pain and patient satisfaction based on the use of cementing techniques in revision total knee arthroplasty (TKA). The purpose of this study was to compare end-of-stem tip pain and PROMs with hybrid and modified hybrid cementing techniques in revision TKAs. Revision total knee arthroplasty (TKA) is more difficult than primary TKA due to severe bone defects and insufficient soft tissue [1, 2]. In the total cement technique, cement is applied to the whole stem in addition to the component [4, 6, 7] Both methods are associated with their own advantages and disadvantages [4, 6, 7]. We have encountered end-of-stem tip pain when using the hybrid cementing technique with long stem for diaphyseal fixation.
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