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

Abstract

PurposeTo 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 15 years with the use of hybrid fixation as compared with cemented fixation was hypothesized. MethodsCase–control study of 126 patients with a mean age of 62.4 years 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. ResultsThe 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 15 years 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). ConclusionAfter a minimum follow‐up of 15 years, 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. Level of evidenceIII.

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

“…A recent long-term follow-up study reported that KS, FS, and WOMAC in hybrid TKAs were signiicantly better than those in cemented TKAs at last follow-up (mean followperiod: 15.7 years in both hybrid and cemented TKAs), and pain might be the main reason for these diferences [4]. However, the mean diferences in Knee Society scores or WOMAC between groups were lower than the minimal clinically important diferences [17,18].…”

“…Theoretically, hybrid TKA would take advantages of the reliable and durable cementless ixation of the femoral component and eliminate the risk of tibial component loosening by cemented ixation. Many previous studies have reported satisfactory long-term results, including implant survival, of hybrid TKAs with modern prostheses [3][4][5].…”

“…The cementless method has been introduced for long-term durable biologic ixation and has an absence of cement particles, but TKAs using only cementless ixation have historically shown tibial component loosening [2]. Thus, a site-speciic strategy was suggested as an alternative ixation method, designated as hybrid ixation [4]. Theoretically, hybrid TKA would take advantages of the reliable and durable cementless ixation of the femoral component and eliminate the risk of tibial component loosening by cemented ixation.…”

“…It has not been determined whether hybrid TKA is superior to cemented TKA at long-term follow-up. One recent study reported better clinical outcomes and overall higher implant survival in hybrid TKA compared with cemented TKA [4], but another recent study reported similar survival, complication rate, and clinical results between the two types of TKAs [2]. Although these studies were well designed, factors afecting long-term outcomes, such as bone quality and patient lifestyle, were not thoroughly controlled between hybrid and cemented TKAs [6,7].…”

Similar patient-reported outcomes for hybrid and cemented stem fixation for aseptic tibial revision total knee arthroplasty: a comparison of sequential prospective cohorts

“…The final functional outcomes were consistent with those reported in case series using hybrid [13, 15, 34] or cemented [21] stem fixation. However, patients who underwent revision TKA can be expected to have lower functional scores compared to primary TKA [23]. On the other hand, there was difficulty in removing the cement and the medullary restrictor in the patient of the cemented group who required re‐revision for subsequent aseptic tibial loosening.…”