Comparable Stability of Cemented vs Press-Fit Placed Stems in Revision Total Knee Arthroplasty With Mild to Moderate Bone Loss: 6.5-Year Results From a Randomized Controlled Trial With Radiostereometric Analysis

详细信息    查看全文

• 作者：Nienke M. Kosse ; PhD^a ; ; Gijs G. van Hellemondt ; MD^b ; Ate B. Wymenga ; MD ; PhD^b ; Petra J.C. Heesterbeek ; PhD^a
• 关键词：revision total knee arthroplasty ; RSA (radiostereometric analysis) ; stems ; hybrid fixation ; cemented fixation
• 刊名：The Journal of Arthroplasty
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：32
• 期：1
• 页码：197-201
• 全文大小：1205 K
• 卷排序：32

文摘

Short-term stability after revision total knee arthroplasty (TKA) with either fully cemented or hybrid-placed implants is comparable. Interestingly, implant micromotion >1 mm/degree occurred with both techniques which might increase the risk of loosening in the midterm or long-term. Therefore, the present study investigated midterm stability and clinical results of fully cemented vs hybrid-placed revision TKA, with mild to moderate bone loss, using radiostereometric analysis (RSA).MethodsThis study involves the prolonged follow-up of a previous randomized controlled trial. RSA images taken at baseline, 6 weeks, 3 and 6 months, and 1, 2 and 6.5 years of follow-up were analyzed. Stability of the femoral and tibial implants was evaluated using total translation and rotation, based on the micromotion determined with model-based RSA.ResultsOf the 30 patients who completed the 2-year follow-up in the original randomized controlled trial, 23 (12 cement, 11 hybrid) were available for follow-up at 6.5-year (range 5.4-7.3). There were no differences in median total translation and rotation of the femoral and tibial components between the 2 groups, and none of the clinical scores differed between the groups. Interestingly, in the group with cemented stems, 5 tibia implants showed >1 mm/degree micromotion compared to none in the hybrid group.ConclusionThere was no difference in median micromotion and clinical outcome between fully cemented and hybrid-placed revision TKA 6.5 years postoperatively. Two femur components showed progressive migration over time whereas tibia components migrate especially in the first year followed by a stable situation. Whether this will lead to loosening and re-revisions remains to be investigated.