Technique For Total Knee Arthroplasty Research Articles

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.

Combining load sensor and robotic technologies for ligament balance in total knee arthroplasty

Good ligament balance in total knee arthroplasty (TKA) is thought to improve clinical results, but is highly surgeon-dependent when performed without technological assistance. We therefore describe a TKA technique using the Mako robotic arm (Stryker, Kalamazoo, Michigan, USA) as sole means of balancing ligament tension by bone recuts associated to control by the VERASENSE load sensor (Orthosensor, Inc, Dania Beach, Florida, USA). In this preliminary series of 29 patients, 27 (93%) showed a well-balanced knee in extension at end of procedure, and 23 (79%) showed a well-balanced knee in flexion and extension, without any periarticular soft-tissue release. The load sensor analyzes ligament balance after the initial bone cuts, and guides possible further femoral or tibial recuts. This technique enables quantifiable alignment and control of ligament tension. Collecting objective intraoperative data should improve knowledge in placing TKA prostheses.

Sensor-Assisted Total Knee Arthroplasty: A Narrative Review.

Wireless intraoperative load sensors have been used to improve the quality of soft-tissue balancing during total knee arthroplasty(TKA). Recent studies using the sensors have demonstrated reductions in gap imbalance, as well as early improvement of patient-reported clinical outcomes and low rates of arthrofibrosis. However, well-designed prospective studies are needed to determine whether the application of the sensor technology for TKA will have clinical benefits and improve the survival of prosthesis. Knowledge of the load-sensing technology (advantages and disadvantages, potential pitfalls, and future prediction) is crucial to apply this new TKA technique successfully. Herein, we conduct a narrative review of previous studies on this technique.

Unicondylar knee arthroplasty versus total knee arthroplasty in adults with isolated medial osteoarthritis: A matched study protocol.

Background:The choice between unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA) is likely to have long-term implications for patient-reported health outcomes. However, high-quality studies that compare the outcomes of TKA and UKA and their effects are still lacking in the literature. Thus, the aim of the present study was to compare the UKA and TKA techniques with regard to functional outcomes and perioperative complications in patients who had isolated medial osteoarthritis.Methods:This was a retrospective, single-center, matched-controlled study performed with approval of our hospital (Kunshan hospital of Traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine), with the ethics number KZY2020–37. To reduce the effect of selection bias and potential confounding in this observational study, a 1:1 matching algorithm was applied. The groups were split by sex, age to within 6 years, and body mass index within 5 kg/m2. Thus, we retrospectively reviewed the records of 240 consecutively enrolled patients who underwent UKA and 240 patients who underwent TKA from January 2013 to June 2015 from the database of our institution. Written informed consent was obtained from all subjects participating in the trial. Clinical outcomes included range of motion, Short Form 12 score, new Knee Society Score, Western Ontario and McMaster Universities Arthritis Index, and the complications. The outcome measures were evaluated by a physiotherapist and were assessed preoperatively and postoperatively at 6 months and 2 years. The mean follow-up time was 3 years.Conclusion:We hypothesized that there was no significant difference between the 2 groups in terms of postoperative outcomes.Trial registration:Our study was registered in Research Registry (researchregistry5828).

Radiographical post-operative flexion gap balance was improved using a modified gap-balancing technique in navigation-assisted total knee arthroplasty

BackgroundAdequate lower extremity alignment and knee joint stability are important factors in total knee arthroplasty (TKA) for achieving good prognosis after surgery. There is still controversy surrounding the best technique for TKA. Although several reports have compared the measured resection technique with the gap-balancing technique, little is known about the flexion gap difference after cruciate-retaining (CR) TKA. This study aimed to compare radiographic images of post-operative flexion gap balance after CR TKA using the navigation-assisted measured resection (NAMR) technique and the navigation-assisted modified gap-balancing (NAMGB) technique. MethodsA total of 70 patients with knee osteoarthritis underwent CR TKAs (28 NAMR procedures, 42 NAMGB procedures). Flexion gap balance was compared by measuring the lift-off angle (LOA), which was the angle between the tibial cutting line and the posterior condylar axis, on axial radiographs of the distal femur at 3 months post-operatively. Furthermore, post-operative hip-knee-ankle (HKA) angles, range of motion (ROM), and Knee Society Score (KSS) were compared between the two groups. ResultsThe mean post-operative LOA in the NAMGB group was significantly lower than that in the NAMR group (1.2 ± 1.7° varus versus 2.3 ± 2.7° varus; p < 0.05). No difference in post-operative HKA angle, ROM, or KSS was observed. ConclusionsBased on post-operative axial radiographs of the distal femur, post-operative flexion balance was better in the NAMGB group after CT TKAs. We believe that the NAMGB technique provides better soft-tissue balancing than NAMR TKA.

Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: a randomized controlled trial.

The Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune® Knee System: the measured resection or gap balancing technique. A prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post-surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36). Using weight-bearing coronal radiographs, the hip-knee-ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient. There were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post-surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups. Both measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post-surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune® Knee System. I.

Gap balancing versus measured resection in primary total knee arthroplasty

Background:Recently, controversy still exists regarding the clinical effects of measured resection or gap-balancing technique in total knee arthroplasty (TKA). The objective of this retrospective study was to compare the clinical outcomes of conventional measured resection technique and computer-assisted gap-balancing technique in TKA.Methods:Strengthening the Reporting of Observational studies in Epidemiology checklist. Patients underwent primary TKA by a single surgeon between 2014 and 2016 were reviewed. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included surgical time, intraoperative complications, patient satisfaction, Oxford Knee Score, range of motion, postoperative complications, and revision.Results:This study had limited inclusion and exclusion criteria and a well-controlled intervention.Conclusion:We were able to directly compare the outcomes of measured resection versus gap-balancing techniques and might reveal a better technique in TKA.Trial registration:This study protocol was registered in Research Registry (researchregistry5441).

Flexion First Balancer: description of new technique in TKA to reproduce joint line and pre-disease mechanical alignment

A considerable proportion of patients (19%) are dissatisfied after total knee arthroplasty (TKA). Possible factors contributing to this dissatisfaction are decreased posterior condylar offset (PCO) with subsequent joint line elevation, leading to mid-flexion instability. Secondly, the pre-disease mechanical alignment is changed into a neutral alignment. The Flexion First Balancer was developed to avoid these problems. This technique aims to maintain MCL isometry by restoring medial PCO and medial joint line to its pre-disease level. Also, to reconstruct the pre-disease mechanical alignment by adjusting the distal femoral angle. In this study we provide a detailed technical overview of the Flexion First Balancer technique.

Increasing range of motion in total knee replacement using novel patellar resection technique

Background: Total knee arthroplasty (TKA) is a surgical procedure designed to alleviate pain and improve function in patients suffering from osteoarthritis. Range of motion is one of the most important factors for patient satisfaction after total knee replacement. The purpose of this study was to assess the effectiveness of a new TKA technique involving patellar resection to enable increased flexion of the knee joint.Methods: Eighty-four patients suffering from osteoarthritis with an indication for conducting TKA underwent the novel procedure. Pre-operative and post-operative flexion measurements were assessed.Results: Mean age of patients participating in this study was 62 years. Males and females were 63% and 37 % of total population respectively. The mean pre-operative and post-operative flexion measurements were 97.39±3.33 º and 131.35±4.27 respectively. The mean in flexion measurements was improved by 33.95±5.30 º (p&lt;0.05). The joint was kinematically stable during full flexion, mid-flexion, and extension.Conclusions: The novel patellar resection technique can be beneficial for the patients. They can able to follow their native lifestyle and perform their daily activities without any hindrance. The mean increase in the range of flexion was 33.95±5.30 º (ranged 30-35 º, p&lt;0.05). This technique allowed patients to have a greater range of flexion as compared to standard and high flexion designs.

No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty.

Accurate implant position in total knee arthroplasty (TKA) can potentially lead to better long-term functional outcomes and implant survival. Recent studies on whether better clinical results could be obtained from computer-navigated or conventional TKA were inconclusive. In addition, recent reviews only included short-term follow-up studies without performing quantitative mid- to long-term follow-up analysis. Thus, the purpose of the present study was to perform a meta-analysis comparing mid- to long-term clinical outcomes (such as knee scoring and functional results) and radiological outcomes (such as normal alignment of the limb axis or component) between computer-navigated TKA and conventional TKA to determine which method of TKA could obtain better clinical and radiological results. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases were searched for relevant articles published through August 2018 that compared outcomes of computer-navigated TKA and conventional TKA. Data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. Clinical and radiological outcomes of both techniques were evaluated using various outcome measures. Seven randomized controlled trials were included. Based on Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, pain, and range of motion, there were no significant differences in clinical outcomes between the two techniques. Based on outliers from the normal axis, outliers of femoral components in the coronal plane, and outliers of tibial components in the coronal plane, radiologic outcomes showed no significant differences between the two techniques either. The present study revealed that there were no significant differences in clinical or radiological outcomes between computer-navigated TKA and conventional TKA. It remains unclear which TKA technique yields better results in terms of mid- to long-term clinical and radiological outcomes. I.

Comparison of iASSIST Navigation System with Conventional Techniques in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Radiographic and Clinical Outcomes.

The iASSIST navigation system is a handheld accelerometer‐based navigation system that has been applied in clinical practice in recent five years. This meta‐analysis aimed to compare the radiographic and clinical outcomes of iASSIST navigation with conventional surgical techniques for patients undergoing total knee arthroplasty (TKA) and to compare the surgery time between an iASSIST group and a conventional treatment group. This systematic review and meta‐analysis included all comparative prospective and retrospective studies published in Pubmed, Embase, the Cochrane Central Register of Controlled Trials, the Web of Science and the CNKI databases over the past 20 years. Inclusion criteria were studies that compared the iASSIST navigation system with conventional TKA. The primary outcomes were mechanical axis (MA) and outliers, which means postoperative MA varus or valgus of more than 3°. Secondary outcomes were coronal femoral angle (CFA) and coronal tibial angle (CTA). Knee Society Score (KSS) was used to evaluate functional outcome. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Eight studies involving 558 knees were included in this meta‐analysis. Of these, 275 patients used the iASSIST navigation system and 283 used conventional surgical techniques. A total of 5 studies were considered high quality and the other 3 were considered to be of moderate quality. The occurrence of malalignment of >3° in the iASSIST group was 13.3%, compared with 29.04% in the conventional group. Postoperative MA of the iASSIST group was significantly better than that of the conventional group (I 2 = 19%, OR = −0.92, 95% CI = −1.09 to −0.75, P < 0.00001). The iASSIST navigation system provided significantly increased accuracy in the coronal femoral angle (I 2 = 79%, OR = −0.88, 95% CI = −1.21 to −0.54, P < 0.00001) and the coronal tibial angle (I 2 = 34%, OR = 0.39, 95% CI = −0.48 to −0.30, P < 0.00001) compared with conventional techniques. However, the duration of surgery using the iASSIST procedure was longer and there was no significant difference in the short‐term KSS in the iASSIST group compared with the conventional group. We found that when pooling the data of included studies, the number of outliers was fewer in the iASSIST group, and compared with conventional TKA techniques, the iASSIST system significantly improved the accuracy of lower limb alignment but the duration of surgery was prolonged in addition to there being no apparent advantage in terms of short‐term functional score.

Hemostatic techniques to reduce blood transfusion after primary TKA: a meta-analysis and systematic review.

To investigate the efficacy of non-tranexamic acid (TXA) on reducing blood loss and requirements of allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA). The PubMed, EMBASE, and the Cochrane Library databases were researched since incipiency to June 2018. Only randomized controlled trials (RCTs) involved with non-TXA hemostatic techniques in TKA met the inclusion criteria. A total of 36 RCTs, including 1511 patients, were recruited for analysis. The results of subgroup analysis revealed that hemostatic techniques, which could substantially decrease the rate of ABT, were cell salvage with the transfusion trigger of 9mg/dl, fibrin sealant with a dosage of 10ml, and postoperative flexion position. The available evidence in this meta-analysis suggests that postoperative flexion position, fibrin sealant, and cell salvage can substantially decrease the rate of ABT in TKA. Further studies, including more hemostatic methods and high-quality research, are expected.

A potential need for surgeon consensus: Cementation techniques for total knee arthroplasty in orthopedic implant manufacturers' guidelines lack consistency.

Given recent concerns regarding the influence of different cements and implants on the rate of aseptic failures in total knee arthroplasty (TKA), we wondered if cementation technique could play a role. The primary aim of this review was to collect and compare the surgeon education materials from eight orthopedic implant manufacturers to evaluate the manufacturers' recommended cementation technique in TKA and identify if there was any consistency in these readily available guides as to the best practices of cementation of their implants. We reviewed contemporary surgeon education guidelines for all TKA systems available from eight manufacturers. Variables included: cement type, batches prepared, surface preparation prior to application, cleaning and/or drying the bone surface, mixing the cement, the waiting phase after the cement has been mixed prior to application, pressurizing the cement, location of cement application, and the curing time. Data were recorded and organized for qualitative comparisons. We identified a total of 43 guides covering 38 implants from eight different manufacturers. There were 41 surgical technique guides and two general brochures regarding cementation techniques available from the manufacturers. Even within the manufacturers' own guidelines for the different implants, there was a wide variety of differing guidelines on many aspects of the cementation technique. There is clearly no consensus for a preferred cementation technique both within and among manufacturers' surgeon education materials regarding tibial baseplate cementation during TKA. Efforts may be needed to identify a best-practice cementation technique in an effort to reduce the number of TKA failures associated with aseptic loosening.

The “linked soft tissue guided technique”: a novel method for cutting the tibia while performing a kinematic femoral alignment in total knee arthroplasty

Kinematic total knee arthroplasty (TKA) has gained much attention in recent years. While most surgeons agree on how to adjust the femoral component, cutting the tibia and restoring it to its pre-arthritic state while maintaining the native laxity of the soft tissue envelope remains an unsolved issue. In this study we present a novel, easy and reproducible technique for cutting the tibia when performing a kinematic TKA. A novel technique for kinematic TKA (“linked soft tissue guided technique”) was developed for planning and executing the tibia cut, without the use of patient specific instrumentations nor navigation. Patient reported outcomes 6 months post op suggested a learning curve of approximately 20 patients. In 26 patients who had undergone a previous mechanical knee arthroplasty, a comparison was made between the two knees in regards to pain and function. Our preliminary results show an advantage for the novel technique regarding patient satisfaction. In conclusion, the “linked soft tissue guided technique” is a simple, comfortable, and a reproducible technique, and may aid surgeons in their transition to kinematic alignment arthroplasties.

Cementing technique for primary knee arthroplasty: a scoping review

Background and purpose — The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).Patients and methods — A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria.Results — The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration.Interpretation — There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.

Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances.

The objective of this study was to calculate bone resection thicknesses and resulting gap sizes, simulating a measured resection mechanical alignment (MA) technique for total knee arthroplasty (TKA). MA bone resections were simulated on 1000 consecutive lower limb CT scans from patients undergoing TKA. Femoral rotation was aligned with either the surgical trans-epicondylar axis (TEA) or with 3° of external rotation to the posterior condyles (PC). Imbalances in the extension space, flexion space, medial compartment and lateral compartment were calculated. Extension space imbalances (≥ 3mm) occurred in 25% of varus and 54% of valgus knees and severe imbalances (≥ 5mm) were present in up to 8% of varus and 19% of valgus knees. Higher flexion space imbalance rates were created with TEA versus PC (p < 0.001). Using TEA, only 49% of varus and 18% of valgus knees had < 3mm of imbalance throughout the extension and flexion spaces, and medial and lateral compartments. A systematic use of the simulated measured resection MA technique for TKA leads to many cases with imbalance. Some imbalances may not be correctable surgically and may result in TKA instability. Modified versions of the MA technique or other alignment methods that better reproduce knee anatomies should be explored. 2.

A randomized, controlled trial of comparison of a continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) using 0.2% ropivacaine for postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA)

Background and Aims:Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine.Material and Methods:Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any.Results:The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance.Conclusion:CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.

Anesthesia and analgesia for total knee arthroplasty.

The demand for total knee arthroplasty (TKA) is rising worldwide. Controversy persists in the literature regarding the benefits of general versus neuraxial anesthesia and which anesthetic is associated with the best outcomes. Likewise, the abundance of analgesic options for post-TKA pain have led to debate regarding the safest, most effective regimens. In this paper, we evaluated a selection of recent publications regarding anesthetic and analgesic choices for TKA. High-quality studies and meta-analyses linking anesthetic agents and analgesic modalities to clinically important outcomes were chosen wherever possible. We included a range of clinical and population-based research, incorporating established and emerging techniques. Although not uniform, clinical and population-based data favor neuraxial anesthesia, and suggest less morbidity compared to general anesthesia. There is good evidence to support an opioid-minimizing, multimodal approach to post-TKA analgesia, featuring peripheral nerve blocks and/or peri-articular injection. The recently described IPACK (interspace between the popliteal artery and posterior capsule of the knee) block may address posterior knee pain after TKA. Ultrasound-guided regional analgesia techniques are cost and clinically effective. Liposomal bupivacaine represents an expanding topic of research in TKA-analgesia, but currently, data do not support routine use. Evidence to guide the creation of pathways of care for TKA abounds, but must be tailored to local practice to maximize chances of success. Recent data supports the use of neuraxial anesthesia and regional analgesia techniques for TKA. Recommendations for clinical practice and future research to improve the state of the art are provided.

Current concepts for aligning knee implants: patient-specific or systematic?

Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee.Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA.The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined.The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation.While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021

Full Cementation in Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis with an Average 7-Year Follow-up.

PurposeTo evaluate clinical and radiological outcome of the full cementation technique in revision total knee arthroplasty (TKA) using a constrained condylar knee (CCK) prosthesis.Materials and MethodsBetween January 2008 and March 2012, 18 cases (16 patients) of fully cemented revision TKA were performed using a CCK prosthesis. Fifteen cases of aseptic loosening (13 patients) and 3 cases of infection were included. There were 2 males and 14 females with a mean age of 76.7 years at the time of surgery, and the average follow-up was 81 months. Clinically, the pain score, function score and Hospital for Special Surgery (HSS) score were evaluated. Radiologically, loosening, radiolucent lines and migration of implant were evaluated.ResultsPreoperatively, the pain score, function score and HSS score were 50.3, 24.4 and 61.8 points, respectively. At the latest follow-up, the scores were improved to 84.8, 63.6 and 85.6 points, respectively (p<0.05). Loosening or migration of implant was not observed in any cases. Radiolucent lines were observed in 5 cases underneath the tibial component without progression during the follow-up.ConclusionsThe full cementation technique in revision TKA using a CCK showed excellent clinical results. Although radiolucent lines were observed in 27.8% underneath the tibial component, there was no progression to loosening or instability.