Hybrid Total Knee Arthroplasty Research Articles

Mode of Fixation and Survivorship in Primary Total Knee Arthroplasty in the American Joint Replacement Registry

BackgroundA recent rapid increase in cementless total knee arthroplasty (TKA) has been noted in the American Joint Replacement Registry (AJRR). The purpose of our study was to compare TKA survivorship based on the mode of fixation reported to the AJRR in the Medicare population. MethodsPrimary TKAs from Medicare patients submitted to AJRR from 2012 to 2022 were analyzed. The Medicare and AJRR databases were merged. Cox regression stratified by sex compared revision outcomes (all-cause, infection, mechanical loosening, and fracture) for cemented, cementless, and hybrid fixation, controlling for age and the Charlson comorbidity index (CCI). ResultsA total of 634,470 primary TKAs were analyzed. Cementless TKAs were younger (71.8 versus 73.1 years, P < .001) than cemented TKAs and more frequently utilized in men (8.2 versus 5.8% women, P < .001). Regional differences were noted, with cementless fixation more common in the Northeast (10.5%) and South (9.2%) compared to the West (4.4%) and Midwest (4.3%) (P < .001). No significant differences were identified in all-cause revision rates in men or women ≥ 65 for cemented, cementless, or hybrid TKA after adjusting for age and CCI. Significantly lower revision for fracture was identified for cemented compared to cementless and hybrid fixation in women ≥ 65 after adjusting for age and CCI (P = .0169). ConclusionsNo survivorship advantage for all-cause revision was noted based on the mode of fixation in men or women ≥ 65 after adjusting for age and CCI. A significantly lower revision rate for fractures was noted in women ≥ 65 utilizing cemented fixation. Cementless fixation in primary TKA should be used with caution in elderly women.

A Systematic Review and Network Meta-Analysis of the Outcomes of Patients With Total Knee Arthroplasty Using Cemented, Uncemented, or Hybrid Techniques.

In this study, we aim to explore the differences among the three types of fixation methods for the components of the knee joint in patients who underwent total knee arthroplasty (TKA). These methods are cemented, uncemented, and hybrid fixation. Cemented fixation means that a special type of grout is used to attach the components to the bone.Uncemented fixation means that the components are designed to fit tightly into the bone and allow new bone growth to secure them. Hybrid fixation means that a combination of cemented and uncemented fixation is used for different components.We searched four online databases to find studies relevant to our research question. We use the R program (R Foundation for Statistical Computing, Vienna, Austria) for network meta-analysis (NMA) to analyze the data from the studies. We calculate the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between methods. We use these measures for continuous outcomes, meaning they can have any value. For dichotomous outcomes, meaning they can only have two values, we use the risk ratio (RR) and the 95% CI, which are statistical measures of the relative risk and the uncertainty between methods. We assess the quality of randomized controlled trials, which are studies that randomly assign participants to different methods, using the Cochrane Risk of Bias Assessment Tool 1, a tool that evaluates the potential biases in the studies. We include 21 studies, and our analysis shows that cemented TKA reveals a statistically significant decrease in pain with hybrid TKA (MD = -2.82). That said, we find no significant differences between uncemented and cemented or hybrid (MD = -0.80 and -2.02, respectively). The results show that there is no significant difference between uncemented TKA and cemented TKA or hybrid technique (RR = 0.87, 95% CI 0.35-2.14; RR = 0.73, 95% CI 0.22-2.39, respectively). Also, we find no significant difference between cemented TKA and hybrid TKA (RR = 0.84, 95% CI 0.24-2.93).Cemented TKA is associated with a lower risk of deep vein thrombosis (DVT) incidence rate. Moreover, it shows a significant decrease in pain compared to hybrid TKA. Future research is needed to compare among the three interventions.

The influence of radiologic bone transparency after hybrid total knee arthroplasty on clinical outcomes: Minimum 6-year follow up of 214 cases

BackgroundThis study aimed to investigate how bone transparency affects loosening of the cementless femoral component by serially analyzing radiologic images in hybrid total knee arthroplasty (TKA). MethodsA total of 214 cases of TKA performed using the hybrid technique that were followed up for at least 6 years were retrospectively investigated. Bone transparency around the femoral component during the follow up period was evaluated. All TKA cases were divided into two groups and compared: those with radiologic bone transparency (bone transparency group, n = 51) and those without radiologic bone transparency (no bone transparency group, n = 163). ResultsThe incidence of revision TKA in all patients was 6.1%, and obesity, preoperative and postoperative mechanical alignment did not affect surgical outcomes. All bone transparency cases were asymptomatic, and only 8/51 cases (15.7%) of bone transparency spontaneously resolved. Between the bone transparency and no bone transparency groups, there was no difference found in the preoperative and postoperative radiologic parameters and clinical outcomes. During the follow up period, there were four (1.9%) cases with a definite radiolucent line in the femoral component, all of which belonged to the bone transparency group. ConclusionsThe bone transparency around the femoral component that appears on radiography after hybrid TKA could be an early sign of aseptic loosening; therefore, follow up serial radiography is essential.

No effect of fixation type on early and late mortality after total knee arthroplasty: a Dutch arthroplasty register study.

Postoperative mortality is commonly reported as outcome measurement after total knee arthroplasty (TKA). Mortality might be influenced by multiple factors including cementation of the prosthesis. Until now, the influence of cementation on early and late mortality after TKA is unknown. The aim of the present study was to determine the effect of fixation on early and late mortality after primary TKA. All patients in the Dutch Arthroplasty Register (LROI) with a primary TKA for osteoarthritis were eligible for inclusion. Data collected from 2007 to 2014 with follow-up until January 2020 were used. Survival analysis was performed by using Kaplan-Meier and Cox survival analysis to determine the mortality rate according to fixation. Adjustments were made for age at time of surgery, gender,American Society of Anaesthesiologistsclass, and year of surgery. In total 108,687 TKA were included for analysis, which comprised 95,857 cemented, 6,140 cementless and 6,690 hybrid TKA. The early and late mortality rate in cemented TKA was statistically not different compared to cementless or hybrid TKA at 30days, 31-90days, 91days-1year and 1-5years. The hazard ratio at 30days was 1.05 (CI 0.49-2.25) for hybrid fixation, and 1.46 (CI 0.74-2.90) for cementless fixation compared to cemented fixation. The 1-5 yearshazard ratio was 1.06 (CI 0.96-1.17) and 0.97 (CI 0.87-1.08), respectively. Based on register data, method of fixation does not influence early mortality after primary TKA. This suggests that there is no preferred fixation technique for primary TKA based on the mortality rates. IV.

Are The Applications of Tranexamic Acid in Reverse Hybrid Total Knee Arthroplasty (TKA) The Same as Those in Fully Cemented TKA?: A Randomized Controlled Trial.

Traditional fully cemented prosthesis for total knee arthroplasty (TKA) has many disadvantages. Current studies have shown that the effects of mixed fixation TKA are the same as or even better than those of fully cemented TKA. We aimed to compare the total blood loss (TBL) in the two fixation types of TKA and the hemostatic effects of different doses of tranexamic acid (TXA) for reverse hybrid TKA. From September 2018 to November 2020, 233 patients with knee osteoarthritis undergoing unilateral TKA were randomly divided into four groups: groups 1 and 2: fully cemented TKA + intra-articular injection (IAI) of either 1g TXA (n = 54) or 2g TXA (n = 60); groups 3 and 4: reverse hybrid TKA + IAI of either 1g TXA (n = 56) or 2g TXA (n = 63). All patients were administered intravenous drip of TXA (20mg/kg) as the basic drug. Perioperative and follow-up data of all patients were compared. The TBL in groups 1, 2, and 3 was higher than that in group 4 (P < 0.0001). The TBL in group 1 was significantly less than that in group 3 (P < 0.05). Although there was no significant difference in blood transfusion demand among the four groups (P > 0.05), the number of anemic patients who did not meet the standard of blood transfusion in group 4 decreased significantly (P < 0.0001). There was no significant difference in pain, function or thrombotic complications among all patients. The TBL in reverse hybrid TKA is larger than in fully cemented TKA. For reverse hybrid TKA, the hemostatic effect of TXA with 2g of IAI was significantly better than with 1g. Although this method does not reduce the need for blood transfusion, it can significantly reduce the incidence of postoperative anemia.

Less polyethylene wear in monobloc compared to modular ultra-high-molecular-weight-polyethylene inlays in hybrid total knee arthroplasty: A 5-year randomized radiostereometry study

BackgroundA modular polyethylene (PE) inlay in total knee arthroplasty (TKA) may wear on both sides. PE particles may induce osteolysis, which can lead to implant loosening. The aim of this study was to determine if PE wear in monobloc TKA differs from that ofmodular TKA at 60-month follow-up. Patients and methodsIn a prospective, patient-blinded trial, 50 patients were randomized to hybrid TKA surgery with either acementless high-porosity trabecular-metal tibial component with a monobloc UHMWPE inlay (MONO-TM) or a cementless low-porosity screw-augmented titanium fiber-mesh tibial component with a modular UHMWPE inlay (MODULAR-FM). Radiostereometry was used to measure PE wear and tibial component migration. ResultsAt 60-monthfollow-up, mean PE wear of the medial compartment was 0.24 mm and 0.61 mm and mean PE wear of the lateral compartment was 0.31 mm and 0.82 mm for the MONO-TM and the MODULAR-FM groups, respectively (p < 0.01). The PE wear-rate was 0.05 mm (95% CI 0.03–0.08) in the MONO-TM group and 0.14 mm (95% CI 0.12–0.17) in the MODULAR-FM group (p < 0.01). Total translation at 60 months was mean 0.30 mm (95% CI 0.10–0.51) less (p < 0.01) for MONO-TM compared with MODULAR-FM tibial components. The majority of tibial components were stable (<0.2 mm MTPM) from 12 to 24-month and 24 to 60-month follow-up. ConclusionAt mid-term follow-up, monobloc PE inlay wear was approximately 40% of that of the modular PE inlay wear, which suggest that back-side wear of modular PE inlays is a significant contributor of PE wear in hybrid TKA.

Long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15years of follow-up.

To compare long-term clinical and radiographic results and survival rates between hybrid and cemented total knee arthroplasties (TKAs) performed on paired knees. Seventy-two patients with hybrid and cemented TKAs performed on paired knees with NexGen® cruciate-retaining prostheses were retrospectively reviewed after a minimum 15years of follow-up. Mean follow-up period was 17.5years. Preoperative alignment deformity and range of motion (ROM) were not different between groups. The Knee Society score, Western Ontario and McMaster Universities Osteoarthritis Index, and ROM were evaluated. Radiographically, change in joint space width, component loosening, and osteolysis were evaluated. Implant survival rate was analyzed. There were no significant differences in clinical results between hybrid and cemented TKAs performed on paired knees of 72 patients at the last follow-up. No significant difference was observed in the change in joint space width between the two groups at the last follow-up (medial = 0.3mm vs. 0.4mm; lateral = 0.1mm vs. 0.2mm). One hybrid TKA showed tibial component loosening, for which revision was performed. There was femoral osteolysis in one hybrid and one cemented TKA, and tibial osteolysis in eight hybrid TKAs and seven cemented TKAs (n.s., respectively). The 20-year survival rate was 97.7% for hybrid TKAs and 100% for cemented TKAs (n.s.). The long-term outcomes were similar between hybrid and cemented TKAs performed on paired knees at a minimum 15years of follow-up. The method of femoral component fixation did not have a significant effect on long-term TKA success. III.

Characteristics of hidden blood loss following hybrid total knee arthroplasty

BackgroundHidden blood loss (HBL) unrecognized by the usual practice of assessing intraoperative loss and postoperative drainage comprises a considerable proportion of total blood loss (TBL) during primary total knee arthroplasty (TKA). However, HBL has not been adequately investigated in hybrid TKA (uncemented femur, cemented tibia). The purpose of this study was to clarify the amount and influential factors of HBL in hybrid TKA. MethodsA consecutive series of 151 knees in 137 patients with knee osteoarthritis who underwent hybrid TKA were retrospectively evaluated. We examined the correlations between HBL and various factors of concern for their effects on TBL, including age, sex, body weight (BW), body height, body mass index, operation time, tourniquet time, and visible blood loss (VBL) in three periods (intraoperative: VBL1; until 3 h postoperatively: VBL2; from 3 h to 1 day postoperatively: VBL3). ResultsMedian (interquartile range) HBL and TBL were 528 (388, 711) mL and 725 (582, 926) mL, respectively. HBL relative to TBL (H/T) was 73%. There were weak correlations between HBL and BW (r = 0.249, p = 0.002) and between HBL and VBL3 (r = −0.261, p = 0.001). Multivariate analyses confirmed a positive correlation between HBL and BW (β = 0.296, p < 0.001) and a negative correlation between HBL and VBL3 (β = −0.270, p < 0.001). ConclusionsHybrid TKA showed comparable values of HBL and H/T to those reported for cemented TKA. Therefore, management strategies for HBL in hybrid TKA can follow the same protocols used for cemented TKA. High BW and low VBL3 may be predictors of postoperative HBL in hybrid TKA.

Association between fixation type and revision risk in total knee arthroplasty patients aged 65 years and older: a cohort study of 265,877 patients from the Nordic Arthroplasty Register Association 2000–2016

Background and purpose — The population of the Nordic countries is aging and the number of elderly patients undergoing total knee arthroplasty (TKA) is also expected to increase. Reliable fixation methods are essential to avoid revisions. We compared the survival of different TKA fixation concepts with cemented fixation as the gold standard. Patients and methods — We used data from the Nordic Arthroplasty Register Association (NARA) database of 265,877 unconstrained TKAs performed for patients aged ≥ 65 years with primary knee osteoarthritis between 2000 and 2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and the Cox multiple-regression model were used to compare the revision risk of the fixation methods. Results — Cemented fixation was used in 243,166 cases, uncemented in 8,000, hybrid (uncemented femur with cemented tibia) in 14,248, and inverse hybrid (cemented femur with uncemented tibia) fixation in 463 cases. The 10-year KM survivorship (95% CI) of cemented TKAs was 96% (96 − 97), uncemented 94% (94 − 95), hybrid 96% (96 − 96), and inverse hybrid 96% (94 − 99), respectively. Uncemented TKA was associated with increased risk of revision compared with the cemented TKA; the adjusted hazard ratio was 1.3 (95% CI 1.1 − 1.4). Interpretation — Cemented, hybrid, and inverse hybrid TKAs showed 10-year survival rates exceeding 95%. Uncemented fixation was associated with an increased risk of revision in comparison with cemented fixation. As both hybrid and inverse hybrid fixation were used in only a limited number of TKAs, indicating possibility of selection bias in their favor, cemented TKA still remains the gold standard, as it works reliably in the hands of many.

Comparison of infection in cemented, cementless and hybrid primary total knee arthroplasty: a network meta-analysis and systematic review of randomized clinical trials.

Prosthetic joint infection (PJI) is a serious complication of joint replacement surgeries. Surgeons often take extra measures to reduce the risk of PJI. Whilst many studies have compared between cemented, cementless and hybrid fixation (femoral cementless, tibial cemented), most focus on survivorship, clinical and function outcome scores as primary endpoints. This meta-analysis aims to study the association between fixation methods and risk of PJI in primary total knee arthroplasty (TKA). A systematic review and network meta-analysis of randomized controlled trials (RCT) were performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data from studies assessing prevalence of PJI in each fixation type were extracted and analysed. Twelve RCT comprising a total of 1573 knees were included. Six RCT compared between cemented (n = 486 knees) and cementless (n = 440 knees) fixation, while six RCT compared between hybrid (n = 324 knees) and cementless (n = 323 knees) fixation. Network meta-analysis did not reveal any fixation type that significantly increased the infection rate in TKA. Rate of all infection was lowest in cemented TKA as compared to cementless (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.35-2.28) and hybrid (OR 0.63, 95%CI 0.13-2.99) TKA. Rate of PJI requiring revision surgery was lowest in cementless TKA as compared to cemented (OR 0.89, 95%CI 0.30-2.41) and hybrid (OR 0.57, 95%CI 0.09-2.71) TKA. Rate of PJI not requiring revision surgery was lowest in cemented TKA as compared to hybrid (OR 0.56, 95%CI 0.06-6.10) and cementless (OR 0.55, 95% 0.14-5.63). Unlike total hip arthroplasties, fixation method is not a predisposing risk factor for infections in TKA. However, this meta-analysis may not have sufficient statistical power to show a significant difference between fixation types. It is recommended that prophylactic precautions against other known risk factors for infection should still be clinically practiced. Level I, meta-analysis of randomized controlled trials.

Better clinical outcomes and overall higher survival with hybrid versus cemented primary total knee arthroplasty: a minimum 15years follow-up.

To compare the clinical outcomes and survival at long-term between hybrid and cemented primary total knee arthroplasty (TKA). A better clinical outcome and survival following a follow-up as long as 15years with the use of hybrid fixation as compared with cemented fixation was hypothesized. Case-control study of 126 patients with a mean age of 62.4years who underwent hybrid TKA matched with 126 patients underwent cemented TKA. Clinical outcome was assessed by the Knee Society scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Radiological assessment was made by the Knee Society method. The mean follow-up was 15.7 (range 15-17)years. At the final follow-up, clinical scores were significantly better in the hybrid group, although the differences were not clinically relevant. Revisions for all reasons were performed in five knees in the hybrid group and 15 knees in the cemented group (p = 0.033). In the hybrid group, there was one aseptic femoral loosening and no aseptic tibial loosening. In the cemented group, the main reasons for aseptic revisions were polyethylene wear (six knees) and tibial loosening (four knees). Cemented fixation was a significant risk factor for aseptic revision (hazard ratio 2.3; 95% CI 1.3-3.7%; p = 0.004). Survival at 15years for aseptic reasons was 96.5% (95% CI 93.4-98.7%) in hybrid groups and 90.3% (95% CI 88.7-93.9%) in cemented group (p = 0.020). After a minimum follow-up of 15years, hybrid fixation of primary TKA for osteoarthritis provide significantly higher clinical benefits compared with cemented fixation, but the differences were not clinically relevant. Hybrid fixation provides longer overall survival, although the femoral component survival was similar between groups. III.

Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up

BackgroundThe type of total knee arthroplasty (TKA) fixation (cemented or uncemented) is still subject to debate. The aim of this study is to assess the survival rate, clinical outcomes, and radiological results of TKA according to the fixation type. MethodsA total of 130 patients were randomly assigned to either the cement group (cemented femoral and tibial implants) or the hybrid group (cemented tibial implant, uncemented femoral implant). The inclusion criteria were patients between 50 and 90 years old who underwent primary TKA for osteoarthritis between 2004 and 2005 without a history of open knee surgery. Revisions and complications were reported, as well as clinical scores and radiological signs of loosening. ResultsOne hundred eighteen patients had complete data at 10 years of minimum follow-up (59 in each group). The mean age was 72 years old. The mean follow-up was 13 years. The survival rate was 98% at 13 years in both groups (1 aseptic loosening at 2 years in the cement group, 1 septic loosening in the hybrid group). The complication rate in the cement group was 8.5% (n = 5) vs 12.1% (n = 7) in the hybrid group (P = .8). The clinical results were not significantly different. In the cement group, 25% of patients (n = 15) had radiolucent lines at 10 years. In the hybrid group, 33% of patients had bone transparencies, not evolving or symptomatic. ConclusionAt a minimum follow-up of 10 years, there were no significant differences between cemented TKA and hybrid TKA for the survivorship, the complication rate, the clinical scores, or the radiological signs of loosening. Level of EvidenceI.

The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age: a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016

Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years.Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason.Results — The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4–93.8), uncemented 91.2% (CI 90.1–92.2), hybrid 93.0% (Cl 92.2–93.8), and inverse hybrid 96.0% (CI 94.1–98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years’ follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4–0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1–1.7]) and > 6 years’ (HR 1.3 [1.0–1.7]) follow-up compared to the reference.Interpretation — Both cemented and hybrid TKAs had 10-year survival rates exceeding 92–>93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.

Hybrid fixation versus full-cemented or full-cementless fixation in total knee arthroplasty: Systematic review and meta-analysis of comparative studies

ObjectiveHybrid fixation is one alternative to full-cemented fixation in total knee arthroplasty (TKA) with theoretical advantages. Hybrid fixation may offer the advantages of cementless femoral fixation, while also avoiding the problem of tibial loosening in full-cementless TKA. The purpose of the study is to determine whether hybrid TKA may perform comparably to or better than full-cemented and full-cementless TKA. MethodsWe searched the MEDLINE, EMBASE and Cochrane Library databases through September 2018 for randomized controlled trials and observational studies comparing outcomes of hybrid versus full-cemented or full-cementless fixation techniques. Outcomes of interest included aseptic loosening, overall reoperation rate, infection, radiolucent lines and operating time. Data were pooled with the Mantel–Haenszel random effects model. ResultsWe included 14 studies with follow-up ranging from 2.7 to 9.6 years in our quantitative analysis, of which 7 studies compared hybrid fixation with full-cemented TKA and another 7 compared hybrid fixation with full-cementless TKA. Combined data revealed that the hybrid fixation group had a similar rate of aseptic loosening compared with cemented (P = 0.19) and cementless (P = 0.49) groups. There was no difference with respect to other outcomes, including overall reoperation rate, infection, radiolucent lines and operating time between groups. ConclusionHybrid, cementless and cemented TKAs have comparable mid-term results as it pertains to aseptic loosening, overall reoperation, infection, radiolucent lines and operating time. Further comparative studies are needed to investigate these potential effects over the long-term.

Obesity Does Not Affect Outcomes in Hybrid Versus Cemented Total Knee Arthroplasty in Asians

BackgroundThis study aims to evaluate patient reported and functional outcomes following hybrid versus cemented total knee arthroplasty (TKA) in patients, stratified by body mass index (BMI). MethodsRegistry data of patients undergoing primary TKA between January 2004 and January 2013 were collected. Baseline interviews were conducted preoperatively to assess sociodemographic characteristics, BMI, and knee arthritis severity, using the Knee Society Score which consists of the Knee Society Knee Score and the Knee Society Function Score (KSFS) and Oxford Knee Score (OKS). These scores were collected prospectively, preoperatively, and postoperatively up to 2 years. Two-year outcomes and 5-year revision rates were then compared between (1) hybrid and cemented TKA groups and (2) BMI subclasses within the hybrid and cemented TKA groups. ResultsPatients who underwent cemented TKA had marginally better flexion range, KSFS, and OKS at 2 years postoperatively. In the overweight category, flexion range, KSFS, and OKS were marginally lower for hybrid TKAs. There were no differences in outcomes between the 2 groups in Class I and II obesity. Within the cemented TKA group, there were no differences in the outcomes between BMI subclasses. There were significant differences in the KSFS (0.023) and OKS (0.030) between the BMI subclasses within the hybrid TKA group, with patients in Class II obesity faring the worst. There was no statistically significant difference in the revision rates. ConclusionWe conclude that obesity does not affect outcomes in hybrid versus cemented TKA.

Femoral Component Survival in Hybrid Total Knee Arthroplasty.

Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.].

Better survival of hybrid total knee arthroplasty compared to cemented arthroplasty

Background and purpose — There have been few comparative studies on total knee replacement (TKR) with cemented tibia and uncemented femur (hybrid TKR). Previous studies have not shown any difference in revision rate between cemented and hybrid fixation, but these studies had few hybrid prostheses. We have evaluated the outcome of hybrid TKR based on data from the Norwegian Arthroplasty Register (NAR).Patients and methods — We compared 4,585 hybrid TKRs to 20,095 cemented TKRs with risk of revision for any cause as the primary endpoint. We included primary TKRs without patella resurfacing that were reported to the NAR during the years 1999–2012. To minimize the possible confounding effect of prosthesis brands, only brands that were used both as hybrids and cemented in more than 200 cases were included. Kaplan-Meier survival analysis and Cox regression analysis were done with adjustment for age, sex, and preoperative diagnosis. To include death as a competing risk, cumulative incidence function estimates were calculated.Results — Estimated survival at 11 years was 94.3% (95% CI: 93.9–94.7) in the cemented TKR group and 96.3% (CI: 95.3–97.3) in the hybrid TKR group. The adjusted Cox regression analysis showed a lower risk of revision in the hybrid group (relative risk = 0.58, CI: 0.48–0.72, p < 0.001). The hybrid group included 3 brands of prostheses: LCS classic, LCS complete, and Profix. Profix hybrid TKR had lower risk of revision than cemented TKR, but the LCS classic and LCS complete did not. Kaplan-Meier estimated survival at 11 years was 96.8% (CI: 95.6–98.0) in the hybrid Profix group and 95.2% (CI: 94.6–95.8) in the cemented Profix group. Mean operating time was 17 min longer in the cemented group.Interpretation — Survivorship of the hybrid TKR at 11 years was better than that for cemented TKR, or the same, depending on the brand of prosthesis. Hybrid fixation appears to be a safe and time-efficient alternative to cemented fixation in total knee replacement surgery.

Effect of a single injection of tranexamic acid on blood loss after primary hybrid TKA

BackgroundControl of perioperative blood loss is important in total knee arthroplasty (TKA), especially cementless or hybrid TKA. There is increasing interest in the use of tranexamic acid (TXA) for this purpose, however, studies to date have mainly evaluated the effects of various TXA administration regimens on patients who have undergone cemented TKA. We sought to determine (1) whether administration of TXA reduces blood loss after hybrid TKA, and (2) whether an autologous blood reinfusion system is necessary in TKA patients who are treated with TXA. MethodsNinety-five patients (100 knees) who underwent hybrid primary TKA (cemented tibia, uncemented femur) were included in this study. The initial 50 knees were treated without TXA and the following 50 were treated with TXA. Intravenous TXA (1000mg) was administered shortly before deflation of the tourniquet. All continuous variables were expressed as median values. ResultsTotal volumes of blood lost at postoperative 1day were 590mL and 150mL and autotransfusion of collected blood was performed in 88% and 16% of patients in the without and with TXA groups, respectively. A median volume of 400mL of collected blood was returned to the patients in the without TXA group, and 0mL to the patients in the with TXA group. The calculated volumes of blood lost were 761mL and 683mL (p=0.2250), respectively. ConclusionsOne intravenous injection of 1000mg TXA may help to control postoperative blood loss and reduce the need for postoperative autologous blood reinfusion after hybrid TKA. Level of evidenceLevel II.

Hybrid total knee arthroplasty: 10- to 16-year follow-up.

A cementless femoral component may allow for a smaller surgical incision when a minimally invasive approach is used during primary total knee arthroplasty. Fixation by cement is the gold standard for total knee arthroplasty. The results of cementless total knee arthroplasty are mixed. Cementless femoral components have done well. Although some tibial components have performed well at long-term follow-up, others have been plagued by high rates of loosening and revision. The question remains whether the results of hybrid total knee arthroplasty, consisting of an uncemented femoral component and a cemented tibial component, will equal those of total knee replacement fixed with cement at long-term follow-up. The authors reviewed 148 hybrid total knee arthroplasties performed by a single surgeon between 1993 and 1995. At a mean follow-up of 14 years (range, 10-16) 5 knees (4%) had undergone revision of both the femoral and tibial components. Only 1 knee required revision for aseptic loosening. Two knees were revised for sepsis; 1 knee had been revised for fracture and 1 for instability. No additional femoral or tibial components were loose by radiographic criteria. Mild focal femoral osteolysis was identified in 3 knees (2%), and minor tibial osteolysis was present in 2 knees (1%). The rate of survivorship with revision for aseptic loosening as the end point was 99% (95% confidence interval, 0.97-100) at 16 years for both the femoral and tibial components. In this series, hybrid total knee arthroplasty showed excellent fixation at 16 years.

Clinical Results of Hybrid Total Knee Arthroplasty

Clinical Results of Hybrid Total Knee Arthroplasty