Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Driesman, Adam; Macaulay, William; Schwarzkopf, Ran

doi:10.1055/s-0039-1678686

Cited by 18 publications

(13 citation statements)

References 41 publications

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“…Biomechanical studies have supported the use of both cemented and press-fit stems in enhancing stability and fixation in the setting of revision TKA. Stems act synergistically with metaphyseal structural support and help to reduce micromotion by bypassing deficient or damaged areas to gain fixation [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty

et al. 2020

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Background: Constraint choice in revision total knee arthroplasty depends on the stability of the collateral ligaments and on the severity of bone loss, but the least degree of constraint necessary is recommended. The purpose of this retrospective matched-paired study was to compare clinical results, radiographic outcome and the survival of a stemmed medial pivot revision implant in aseptic revision TKA vs. medial pivot implant in primary TKA. Methods: Records were reviewed for 69 cases of aseptic revision TKA using Advance® Medial Pivot Stemmed Revision Knee system between 2002 and 2016. These patients were then matched in a 1:2 ratio control group of patients who received a primary TKA with Advance® Medial Pivot system. American Knee Society Score and Visual Analogue Scale pain score were recorded. Alignment, loosening, and incidence of radiolucent lines were evaluated on X-rays. Implant survival was assessed by Kaplan-Meier survival analysis. Results: The primary TKA group had significant superior AKSS clinical and functional score at baseline (52.3 and 68.2 points, respectively) and at last follow up (84.6 and 68.6 points) compared with the revision TKA group (47.9 and 40.9 points; 78.4 and 59.9 points; P b 0.05). No significant difference was observed in the mean change from baseline to last follow up of AKSS score between the two groups (P N 0.05). Radiographical outcome and implant survival were similar in the two groups (P N 0.05). Conclusion: The authors support the use of this revision system in knees with collateral ligaments competence and mild-to-moderate bone defect.

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Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty

et al. 2020

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“…While augments and sleeves greatly enhanced the modern surgeon’s ability to gain solid fixation in metaphyseal bone, stems continue to be useful in revision TKA to bypass defects and enhance the structural stability of revision components[16]. In revision surgery, the surgeon chose a cementless stem to bypass the metaphyseal defect.…”

Section: Discussionmentioning

confidence: 99%

Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report

Du¹,

Sun²,

Ni³

et al. 2019

WJCC

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BACKGROUNDA recurrent valgus deformity was a common complication after total knee arthroplasty (TKA) in patients with valgus deformity. However, re-revision surgery for re-recurrent valgus deformity after revision TKA in patients with valgus deformity before primary TKA was uncommon.CASE SUMMARYWe reported a 72-year-old female patient with two recurrent valgus deformities after TKA for a valgus knee deformity who underwent two revision surgeries to rectify the deformity. In the re-revision surgery, bone defects were successfully reconstructed by the augments and cement in combination with screws and a sleeve. An appropriate neutral alignment of the lower limb was restored by the perfect femoral entry point and the long diaphyseal cementless stem. Adequate fixation of the metaphysis and diaphysis of the femur was obtained by the sleeve and long diaphyseal cementless stem. The patient was pain-free and deformity-free for 2.5 years.CONCLUSIONThe management of bone defects, the choice of the stem and the femoral entry point were of vital importance in the revision or re-revision TKA for a recurrent valgus deformity.

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“…3 ), even if, in the available literature, no clear superiority of any type of stem fixation has been found. 19 Disadvantages of the use of cementless stems include a possible inferior immediate fixation, the possibility of ‘end-of-stem’ pain for diaphyseal edge loading, and distortion of proper condylar implant position in cases with anatomical deformities in either metaphyseal or diaphyseal regions. The geometrical centres of the tibial epiphysis and diaphysis are often not aligned, and linking zone 1 to zone 3 with an offset stem is required to avoid component overhang and bone uncoverage.…”

Section: Reconstructionmentioning

confidence: 99%

Revision knee surgery: the practical approach

Salari¹,

Baldini²

2021

EFORT Open Reviews

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Revision total knee arthroplasty (rTKA) is a challenging procedure with often unreproducible results. A step-by-step approach is fundamental to achieving good outcomes. Successful surgery requires a correct diagnosis of the original cause of failure. Only with an accurate and detailed plan can surgeons overcome difficulties presented in this scenario. Any bone loss should be prevented during prosthetic component removal. Efficient tools must be chosen to avoid time-consuming manoeuvres. Joint reconstruction based on a ‘dual-zone’ fixation is essential to provide a long-term survivorship of the implant. The use of relatively short fully cemented stems combined with a biological metaphyseal fixation is highly recommended by authors. Flexion and extension gaps are accurately balanced after the establishment of the tibial platform. Varus-valgus laxity is commonly managed with a condylar constrained prosthesis. If hinged implants are required, a stronger implant fixation is needed to counteract constraints forces. Cite this article: EFORT Open Rev 2021;6:495-500. DOI: 10.1302/2058-5241.6.210018

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Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Cited by 18 publications

References 41 publications

Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty

Clinical and radiological results of a stemmed medial pivot revision implant in aseptic total knee revision arthroplasty

Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report

Revision knee surgery: the practical approach

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