scholarly journals Incidence and Causes of Tibial Component Loosening Based on Level of Obesity in a Large Consecutive Cohort of Cemented Primary TKAs without Stem Extensions

2020 ◽  
Vol 3 ◽  
Author(s):  
Lilly Longawa ◽  
Leonard Buller ◽  
Mary Ziemba-Davis ◽  
R. Michael Meneghini
Keyword(s):  
Aseptic Loosening ◽  
Medical Records ◽  
Tibial Component ◽  
Low Viscosity ◽  
Primary Tkas ◽  
Total Knee ◽  
Potential Impact ◽  
Component Loosening ◽  
Component Revision

Background and Hypothesis: Aseptic loosening is one of the most common failure mechanisms of total knee arthroplasty (TKA) requiring revision.  The influence of obesity on tibial component aseptic loosening remains unknown. Some surgeons advocate the addition of a tibial stem extension to reduce the risk of loosening. The purpose of this study was to quantify the incidence and causes of revision for tibial component loosening in a large consecutive cohort of cemented primary TKAs without stem extensions based upon level of obesity.     Experimental Design or Project Methods: 534 consecutive cemented primary TKAs performed between 2016 and 2018 by one surgeon were retrospectively reviewed. Procedures were performed using consistent surgical, perioperative medical, and pain-control protocols. All tibial implants were tapered thin keeled designs without stem extensions and implanted with low viscosity cement. Medical records were examined and all-cause revisions of the index surgery were documented.     Results: After exclusions for confounds, 525 TKAs were analyzed. Mean age and BMI were 67.8 years and 33.9kg/m2 respectively and 72% were female. Mean follow-up was 19.1 (SD 10.5) months and 48% had minimum two-year follow-up. 41.3% of patients had a BMI greater than 35kg/m2 and 21.9% above 40kg/m2. There were 11 revisions in 10 patients, 1.9% out of all TKAs performed.  Five TKAs required both-component revision and three involved the femoral component only. No tibial component revisions were performed for aseptic loosening.    Conclusion and Potential Impact: None of the standard tibial implants with a keeled design without stem extensions failed in a patient population with greater than 40% obesity.  Despite some suggesting tibial stem extensions should be used in obese TKA patients, these findings suggest that tibial component failure in obese patients may be design specific and routinely utilizing stem extensions may not be warranted and could result in deleterious bone loss at revision if required for reasons other than aseptic loosening. 

scholarly journals Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

2021 ◽  
Vol 2 (11) ◽  
pp. 921-925
Author(s):  
Afton K. Limberg ◽  
Cody C. Wyles ◽  
Michael J. Taunton ◽  
Arlen D. Hanssen ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Total Knee Arthroplasties ◽  
Posterior Stabilized ◽  
Joint Registry ◽  
Primary Tkas ◽  
Superficial Wound ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
Primary Total Knee

Aims Varus-valgus constrained (VVC) devices are typically used in revision settings, often with stems to mitigate the risk of aseptic loosening. However, in at least one system, the VVC insert is compatible with the primary posterior-stabilized (PS) femoral component, which may be an option in complex primary situations. We sought to determine the implant survivorship, radiological and clinical outcomes, and complications when this VVC insert was coupled with a PS femur without stems in complex primary total knee arthroplasties (TKAs). Methods Through our institution’s total joint registry, we identified 113 primary TKAs (103 patients) performed between 2007 and 2017 in which a VVC insert was coupled with a standard cemented PS femur without stems. Mean age was 68 years (SD 10), mean BMI was 32 kg/m2 (SD 7), and 59 patients (50%) were male. Mean follow-up was four years (2 to 10). Results The five-year survivorship free from aseptic loosening was 100%. The five-year survivorship free from any revision was 99%, with the only revision performed for infection. The five-year survivorship free from reoperation was 93%. The most common reoperation was treatment for infection (n = 4; 4%), followed by manipulation under anaesthesia (MUA; n = 2; 2%). Survivorship free from any complication at five years was 90%, with superficial wound infection as the most frequent (n = 4; 4%). At most recent follow-up, two TKAs had non-progressive radiolucent lines about both the tibial and femoral components. Knee Society Scores improved from 53 preoperatively to 88 at latest follow-up (p < 0.001). Conclusion For complex primary TKA in occasional situations, coupling a VVC insert with a standard PS femur without stems proved reliable and durable at five years. Longer-term follow-up is required before recommending this technique more broadly. Cite this article: Bone Jt Open 2021;2(11):921–925.

scholarly journals Reoperations are few and confined to the most valgus phenotypes 4 years after unrestricted calipered kinematically aligned TKA

2021 ◽  
Author(s):  
Stephen M. Howell ◽  
Manpreet Gill ◽  
Trevor J. Shelton ◽  
Alexander J. Nedopil
Keyword(s):  
Mechanical Axis ◽  
Oxford Knee Score ◽  
Patellofemoral Instability ◽  
Level Of Evidence ◽  
Primary Tkas ◽  
Wide Range ◽  
Total Knee ◽  
Alignment Angle ◽  
Component Loosening

Abstract Purpose The present study determined the postoperative phenotypes after unrestricted calipered kinematically aligned (KA) total knee arthroplasty (TKA), whether any phenotypes were associated with reoperation, implant revision, and lower outcome scores at 4 years, and whether the proportion of TKAs within each phenotype was comparable to those of the nonarthritic contralateral limb. Methods From 1117 consecutive primary TKAs treated by one surgeon with unrestricted calipered KA, an observer identified all patients (N = 198) that otherwise had normal paired femora and tibiae on a long-leg CT scanogram. In both legs, the distal femur–mechanical axis angle (FMA), proximal tibia–mechanical axis angle (TMA), and the hip–knee–ankle angle (HKA) were measured. Each alignment angle was assigned to one of Hirschmann’s five FMA, five TMA, and seven HKA phenotype categories. Results Three TKAs (1.5%) underwent reoperation for anterior knee pain or patellofemoral instability in the subgroup of patients with the more valgus phenotypes. There were no implant revisions for component loosening, wear, or tibiofemoral instability. The median Forgotten Joint Score (FJS) was similar between phenotypes. The median Oxford Knee Score (OKS) was similar between the TMA and HKA phenotypes and greatest in the most varus FMA phenotype. The phenotype proportions after calipered KA TKA were comparable to the contralateral leg. Conclusion Unrestricted calipered KA’s restoration of the wide range of phenotypes did not result in implant revision or poor FJS and OKS scores at a mean follow-up of 4 years. The few reoperated patients had a more valgus setting of the prosthetic trochlea than recommended for mechanical alignment. Designing a femoral component specifically for KA that restores patellofemoral kinematics with all phenotypes, especially the more valgus ones, is a strategy for reducing reoperation risk. Level of evidence Therapeutic, Level III

scholarly journals Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Müjgan Yilmaz ◽  
Christina Enciso Holm ◽  
Thomas Lind ◽  
Gunnar Flivik ◽  
Anders Odgaard ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Bone Remodeling ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Segmental Motion ◽  
Implant Migration ◽  
Total Knee ◽  
Prospective Longitudinal

Abstract Background Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years. Methods This was a prospective longitudinal cohort study of 29 patients (number of female/male patients 17/12, mean age 65.2 years), received a hybrid Persona® TKA (Zimmer Biomet, Warsaw, IN, USA) consisting of a cemented tibial, an all-polyethylene patella, and uncemented trabecular metal femoral components. Follow up: preoperative, 1 week, and 3, 6, 12 and 24 months after surgery, and double examinations for RSA and DXA were performed at 12 months. RSA results were presented as maximal total point of motion (MTPM) and segmental motion (translation and rotation), and DXA results were presented as changes in BMD in different regions of interest (ROI). Results MTPM at 3, 6, 12, and 24 months was 0.65 mm, 0.84 mm, 0.92 mm, and 0.96 mm for the femoral component and 0.54 mm, 0.60 mm, 0.64 mm, and 0.68 mm, respectively, for the tibial component. The highest MTPM occurred within the first 3 months. Afterwards most of the curves flattened and stabilized. Between 12 and 24 months after surgery, 16% of femoral components had migrated by more than 0.10 mm and 15% of tibial components had migrated by more than 0.2 mm. Percentage change in BMD in each ROI for distal femur was as follows: ROI I 26.7%, ROI II 9.2% and ROI III 3.3%. BMD and at the proximal tibia: ROI I 8.2%, ROI II 8.6% and ROI III 7.0% after 2 years compared with 1 week postoperative results. There was no significant correlation between maximal percentwise change in BMD and MTPM after 2 years. Conclusion Migration patterns and changes in BMD related to femoral components after TKA in our study correspond well with previous studies; we observed marginally greater migration with the tibial component.

Is a full component revision necessary for isolated tibial loosening?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 123-128
Author(s):  
J. Ryan Martin ◽  
Michael B. Geary ◽  
Michael Ransone ◽  
David Macknet ◽  
Keith Fehring ◽  
...  
Keyword(s):  
Femoral Component ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Flexion Contracture ◽  
Management Options ◽  
Patient Demographics ◽  
Cause Of Failure ◽  
Component Loosening ◽  
Component Revision

Aims Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to “start again”. This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options. Methods Patients undergoing revision TKA for isolated aseptic tibial loosening between 2012 and 2017 were identified. Those with revision implants or revised for infection, instability, osteolysis, or femoral component loosening were excluded. A total of 164 patients were included; 88 had an isolated tibial revision and 76 had revision of both components despite only having a loose tibial component. The demographics and clinical and radiological outcomes were recorded. Results The patient demographics were statistically similar in the two cohorts. The median follow-up was 3.5 years (interquartile range (IQR) 1 to 12.5). Supplementary femoral metaphyseal fixation was required in five patients in the full revision cohort. There was a higher incidence of radiological tibial loosening in the full component revision cohort at the final follow-up (8 (10.5%) vs 5 (5.7%); p = 0.269). Three patients in the full component revision cohort developed instability while only one in the isolated tibial cohort did. Three patients in the full revision cohort developed a flexion contracture greater than 5° while none in the isolated tibial cohort did. Conclusion Isolated tibial revision for aseptic tibial loosening has statistically similar clinical and radiological outcomes at a median follow-up of 3.5 years, when compared with full component revision. Substantial bone loss can occur when removing a well-fixed femoral component necessitating a cone or sleeve. Femoral component revision for isolated tibial loosening can frequently be avoided provided adequate ligamentous stability can be obtained. Cite this article: Bone Joint J 2020;102-B(6 Supple A):123–128.

Early outcomes of a modern cemented total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 51-58
Author(s):  
JaeWon Yang ◽  
Nathanael D. Heckmann ◽  
Cindy R. Nahhas ◽  
Michael B. Salzano ◽  
Gregory P. Ruzich ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Primary Tkas ◽  
Total Knee ◽  
The Impact

Aims Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design. Methods All patients who received a primary, cemented TKA between 2012 and 2017 with a minimum two-year follow-up were included. The implant investigated features an asymmetrical tibial baseplate and shortened keel. Patient demographic details, Knee Society Scores (KSS), component alignment, and the presence of radiolucent lines at final follow-up were recorded. Kaplan-Meier analyses were performed to estimate survivorship. Results A total of 720 of 754 primary TKAs (95.5%) were included with a mean follow-up of 3.9 years (SD 1.3); 562 (78.1%) were cruciate-retaining and 158 (21.9%) were posterior-stabilized. A total of 11 (1.5%) required reoperation for periprosthetic joint infection and seven (1.0%) for aseptic tibial loosening (five cruciate-retaining, two posterior-stabilized). Loosening occurred at a mean of 3.3 years (0.9 to 6.5). There were no cases of loosening in the 33 patients who received a 14 mm × 30 mm tibial stem extension. All-cause survivorship was 96.6% at three years (95% confidence interval (CI) 95.3% to 98.0%) and 96.2% at five years (95% CI 94.8% to 97.7%). Survivorship with revision for aseptic loosening was 99.6% at three years (95% CI 99.1% to 100.0%) and 99.1% at five years (95% CI 98.4% to 99.9%). Tibial components were in significantly more varus in those with aseptic loosening (mean 3.4° (SD 3.7°) vs 1.3° (SD 2.0°); p = 0.015). There were no other differences in demographic, radiological, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p = 0.293 to 1.00). Mean KSS improved significantly from 57.3 (SD 9.5) preoperatively to 92.6 (SD 8.9) at the final follow-up (p < 0.001). Conclusion This is the largest series to date of this design of implant. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. Further observation is required to determine if there will be an abnormal rate of loosening at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(6 Supple A):51–58.

scholarly journals Increased Early Revision Rate with the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Elizabeth Cody ◽  
Michel Taylor ◽  
James Nunley ◽  
Selene Parekh ◽  
James DeOrio
Keyword(s):  
United States ◽  
Tibial Component ◽  
Revision Rate ◽  
The United States ◽  
Additional Patient ◽  
Foot And Ankle ◽  
Early Revision ◽  
One Year ◽  
Component Loosening

Category: Ankle Arthritis Introduction/Purpose: Modern total ankle arthroplasties (TAAs) have demonstrated improved survival rates at early- and mid-term follow-up, with revision rates ranging from 4 to 8% at five years. The INFINITY total ankle system (Wright Medical Technology, Arlington, TN) was first used in the United States in 2014. Its advantages include the ability to use patient-specific instrumentation and the option to choose between talar dome resurfacing and flat-cut talar components. While this implant is currently popular in the United States, clinical outcomes have not yet been reported. Our aim was to identify the rate of early revision among patients receiving the INFINITY prosthesis. Methods: Patients from two prospectively-collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary TAA with the INFINITY prosthesis and who were at least one year postoperative were included. All surgeries were performed by one of two orthopaedic foot and ankle surgeons with extensive experience in total ankle arthroplasty. The primary outcome was the need for revision surgery, which was defined as removal of one or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Anteroposterior and lateral radiographs at most recent follow-up were graded for lucency independently by two reviewers, both orthopaedic foot and ankle fellows, for individual peri-implant zones (Figure). Each zone was only considered “lucent” if recorded as such by both reviewers. Results: 160 patients underwent TAA with the INFINITY prosthesis between August 2014 and November 2016 with a mean 20 months of follow-up (range, 12-37). Six patients were lost to follow-up. Sixteen patients (10%) underwent revision a mean 1.2 years postoperatively. Revision was performed most commonly for tibial component loosening (seven patients, 4.4%) and deep infection (five patients, 3.1%). Of cases with tibial loosening, progressive lucency and/or subsidence was obvious radiographically in four patients; one patient had equivocal radiographs but loosening was suggested on single-photon emission computed tomography; and two patients revised for persistent pain had loosening confirmed intraoperatively. Of the 108 patients with retained components and at least one year of radiographic follow-up, eight (7.4%) had global lucency around the tibial component at most recent follow-up. Conclusion: Our initial review of patients undergoing TAA with the INFINITY prosthesis demonstrates an elevated early revision rate due to tibial component loosening. The reasons for this finding remain unclear, but could possibly include inadequate bony purchase of the implant’s three prongs, particularly in patients with large preoperative deformities or with imperfect component alignment. We plan to further investigate the possible reasons for this finding in the future by assessing additional patient factors, including age, sex, arthritis type, tobacco use, pre- and postoperative coronal and sagittal alignment, and presence of ipsilateral hindfoot fusion.

DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

2013 ◽  
Vol 16 (02) ◽  
pp. 1350007
Author(s):  
P. Motwani ◽  
A. Jariwala ◽  
N. Valentine
Keyword(s):  
Total Knee Replacement ◽  
Tibial Component ◽  
Sagittal Plane ◽  
Computer Navigation ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

Imaging of symptomatic total knee arthroplasty with cone beam computed tomography

2018 ◽  
Vol 59 (12) ◽  
pp. 1500-1507 ◽  
Author(s):  
Antti Jaroma ◽  
Juha-Sampo Suomalainen ◽  
Lea Niemitukia ◽  
Tarja Soininvaara ◽  
Jari Salo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cone Beam Computed Tomography ◽  
Tibial Component ◽  
Cone Beam ◽  
Component Rotation ◽  
Symptomatic Knee ◽  
Total Knee ◽  
Component Loosening

Background Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging. Purpose To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics. Material and Methods CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified. Results The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12–0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74–0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35–0.87) and 0.92 (95% CI = 0.80–0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate. Conclusion Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.

Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

2019 ◽  
Vol 101-B (11) ◽  
pp. 1356-1361 ◽  
Author(s):  
Brian P. Chalmers ◽  
Kapil G. Mehrotra ◽  
Rafael J. Sierra ◽  
Mark W. Pagnano ◽  
Michael J. Taunton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Cox Regression Analysis ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

scholarly journals Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 39
Author(s):  
Jean-Louis Prudhon ◽  
Jacques H. Caton ◽  
Thierry Aslanian
Keyword(s):  
Survival Rate ◽  
Femoral Component ◽  
First Year ◽  
Low Friction ◽  
Low Viscosity ◽  
Kaplan Meier ◽  
Cemented Stem ◽  
Component Revision ◽  
Cement Restrictor

Introduction: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the “second-generation cementing technique.” The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. Material and methods: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan–Meier method. Results: Mean follow-up was 6.55 ± 2.6 (range 1–11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. Discussion: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. Conclusion: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

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