A hydroxyapatite-coated total knee replacement

Cross, Marita; Parish, E. N.

doi:10.1302/0301-620x.87b8.15772

Cited by 73 publications

(35 citation statements)

References 22 publications

(25 reference statements)

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“…Functional results and survivorship of HA-coated implants are comparable to cemented implants. [33][34][35][36] In a study of 81 patients randomized to HA-coated or cemented implants, Beaupre et al 33 showed no differences in function, radiographic findings, or complications at 5 years postoperatively. Similarly, Cossetto and Gouda 31 reported a survivorship of 98.85% and bony ingrowth in all but one of their cementless tibial implants with HA overcoating.…”

Section: New Perspectivesmentioning

confidence: 99%

Cementless Fixation in High Performance Knee Design

Milchteim¹,

Unger²

2011

Techniques in Knee Surgery

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Although cemented fixation in total knee arthroplasty remains the gold standard, new interest in cementless fixation has returned. Earlier implant designs for use in cementless fixation have been associated with high failure rates but newer implants have achieved similar results to their cemented counterparts. This is in part due to advances in the technique and the introduction of new porous materials and design modifications. Cementless techniques can achieve better bony fixation, have less potential for backside wear, and may result in better bone stock. We report excellent results on 177 trabecular metal (TM) (porous tantalum) monoblock tibial components using a minimal invasive technique. Although our experience with cementless TM tibia and fiber metal femur has been excellent, the high failure rate of the TM monoblock patella led us to abandon the implant in favor of an all-polyethylene component. Therefore, excellent results are possible with cementless tibial and femoral fixation but the ideal method for patellar fixation remains to be determined.

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Section: New Perspectivesmentioning

confidence: 99%

Cementless Fixation in High Performance Knee Design

Milchteim¹,

Unger²

2011

Techniques in Knee Surgery

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“…10 Currently, Ͼ95% survivorship can be expected with both cemented and cementless primary TKA at long-term follow-up. 1,14,18,19,24,41,51 Therefore, although these early results are encouraging, longer-term follow-up is necessary to validate the efficacy of this prosthesis.…”

Section: D 3ementioning

confidence: 99%

Porous Tantalum in Reconstructive Surgery of the Knee – A Review

Levine¹,

Sporer²,

Valle³

et al. 2010

J Knee Surg

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Porous tantalum represents an alternative metal for primary and revision total knee arthroplasty (TKA) with several unique properties. Tantalum is a transition metal, which in its bulk form has shown excellent biocompatibility and is safe to use in vivo as evidenced by its current application in pacemaker electrodes, cranioplasty plates, and as radiopaque markers. Current designs for orthopedic implants maintain a high volumetric porosity (70%-80%), low modulus of elasticity (3 MPa), and high frictional characteristics, making this metal conducive to biologic fi xation. The low modulus of elasticity of such components allows for more physiologic load transfer and relative preservation of bone stock. Its more bio-active nature and ingrowth properties have led to its use in primary as well as revision knee components with good early clinical results reported. In revision arthroplasty, it has been used as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fi brous ingrowth properties and allows for substantial soft-tissue attachment with the potential for use in cases such as mega-prostheses and patella salvage. Although porous tantalum is in its early stages of evolution, the initial clinical data and basic science studies support its use as an alternative to traditional orthopedic implant materials.[J Knee Surg. 2007;20: 185-194.]

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“…[17][18][19][20] Despite these early problems, innovations in biomaterials and implant design have led to improved osseointegration and implant fixation, which could potentially improve cementless TKA long-term survivorship. 14,16,21,22 With newer implant designs, the optimal fixation for TKA components remains debatable, and therefore, the purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented TKAs. The specific aims were to evaluate (1) all-cause survivorship, (2)…”

mentioning

confidence: 99%

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis

et al. 2019

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The purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented total knee arthroplasties (TKAs). Specifically, we evaluated (1) all-cause survivorship, (2) aseptic survivorship, and (3) functional outcomes (Knee Society Scores [KSS], Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores, and ranges of motion [ROMs]). A literature search was performed for studies that evaluated cementless versus cemented TKAs published between 2000 and 2017. Selected studies included three randomized controlled trials, three retrospective observational studies, and one prospective observational study that met the following criteria: (1) primary TKAs, (2) compared cementless and cemented TKAs, (3) implant survivorship that described the causes of failure, and (4) at least one functional outcome. To compare the two cohorts, pooled odds ratios (OR) and 95% confidence intervals (95% CI) were used to calculate tibial and femoral implant survivorship, and pooled mean differences (MD) and 95% CI calculated the functional scores and ROMs. Based on pooled data from the few number of studies, cementless TKAs had a better all-cause survivorship (OR = 0.37; 95% CI, 0.15–0.92) and tended to have a better aseptic survivorship (OR = 0.44; 95% CI, 0.17–1.14). However, this is likely due to the 83.3% weight of the single cementless study potentially influencing the analysis. There were no differences in terms of KSS knee (MD = 1.03; 95% CI, −1.13–3.20) or function scores (MD = 5.36; 95% CI, –3.75–14.51), Oxford knee scores (MD = 0.36; 95% CI, –3.84–4.56), or WOMAC scores (MD = 0.62; 95% CI, –0.87–2.11). Moreover, there was no difference in ROMs (MD = 1.47; 95% CI, –0.11–3.05). Cementless TKA had a better all-cause survivorship when compared with cemented fixation, and similar functional outcomes were demonstrated. However, these findings are based on only a few number of studies (n = 7). Therefore, additional prospective, randomized control trials need to be performed to best compare cementless versus cemented outcomes.

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A hydroxyapatite-coated total knee replacement

Cited by 73 publications

References 22 publications

Cementless Fixation in High Performance Knee Design

Cementless Fixation in High Performance Knee Design

Porous Tantalum in Reconstructive Surgery of the Knee – A Review

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis

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