Abstract
PurposeThe NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) has augmentable and non-augmentable tibial baseplate options. We have noted an anecdotal increase in the number of cases requiring early revision for aseptic loosening since adopting the non-augmentable option. The purpose of this study was to ascertain our rates of aseptic tibial loosening for the two implant types within five years of implantation and to investigate the causes for any difference observed.MethodsA database search was performed for all patients who underwent primary total knee arthroplasty (TKA) using the NexGen LPS between 2009 and 2015. Kaplan–Meier curves were plotted to assess for differences in revision rates between cohorts. We collected and compared data on gender, age, body mass index, component alignment and cement mantle quality as these were factors thought to affect the likelihood of aseptic loosening.ResultsTwo thousand one hundred seventy-two TKAs were included with five year follow-up. There were 759 augmentable knees of which 14 were revised and 1413 non-augmentable knees of which 48 were revised. The overall revision rate at five years was 1.84% in the augmentable cohort and 3.4% in the non-augmentable cohort. The revision rate for aseptic loosening was 0.26% in the augmentable group and 1.42% in the non-augmentable group (p = 0.0241).ConclusionsWe have identified increased rates of aseptic loosening in non-augmentable components. This highlights the effect that minor implant changes can have on outcomes. We recommend that clinicians remain alert to implant changes and publish their own results when important trends are observed.
Highlights
Total knee arthroplasty (TKA) remains the gold standard treatment for symptomatic arthritis of the knee and can significantly improve quality of life for the majority of patients; there are undoubtedly still problems related to this procedure which remain unresolved [1]
2172 TKAs were performed in the study period with 759 augmentable tibial components inserted between 05/01/2009 and 01/2011 and 1413 non-augmentable tibial components between 01/2011 and 31/03/2015
The purpose of this study was to ascertain differences in rates of aseptic loosening between augmentable and nonaugmentable NexGen TKA tibial baseplates used in our unit
Summary
Total knee arthroplasty (TKA) remains the gold standard treatment for symptomatic arthritis of the knee and can significantly improve quality of life for the majority of patients; there are undoubtedly still problems related to this procedure which remain unresolved [1]. The NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) was introduced to the market in 1997 and has been in use at our unit since 2007 for all primary TKA. This prosthesis has augmentable and non-augmentable options (Fig. 1); the augmentable option features 4 polyethylene lugs on the underside of the baseplate which can be removed to allow for attachment of augments and a polyethylene screw at the tip of the keel which can be replaced by a range of stems should these be required (Fig. 2).
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