Abstract
Background and purpose — Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients?Patients and methods — 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1–5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs).Results — The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse.Interpretation — The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.
Highlights
Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years
The revision rates for posterior stabilized (PS) implants have been found to be higher compared with CR implants (Comfort et al 2014, Vertullo et al 2017), perhaps due to the higher constraint of the PS articulation leading to larger forces at the implant–bone interface (Catani et al 2004)
Most radiostereometric analysis (RSA) studies have focused on the magnitude of migration during the early postoperative years
Summary
Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Patients and methods — 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Interpretation — The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA. Posterior stabilized implants (PS) have consistently been shown to lead to greater flexion compared with cruciate retaining (CR) implants (Jacobs et al 2005, Bercik et al 2013, Li et al 2014, Jiang et al 2016). The revision rates for PS implants have been found to be higher compared with CR implants (Comfort et al 2014, Vertullo et al 2017), perhaps due to the higher constraint of the PS articulation leading to larger forces at the implant–bone interface (Catani et al 2004)
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