Cementless Total Knee Arthroplasty in Patients Older Than 75 Years

Newman, Jared M.; Khlopas, Anton; Chughtai, Morad; Gwam, Chukwuweike U.; Yakubek, George; Harwin, Steven F.; Mont, Michael A.

doi:10.1055/s-0037-1599253

Cited by 27 publications

(12 citation statements)

References 49 publications

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“…Although cementless TKA prostheses have been first developed over three decades ago, recent advances in implant manufacturing and engineering have substantially improved their clinical success rate as demonstrated by emerging recent reports. 3,4,6,[8][9][10][11][12][13][14] In this study, we demonstrated excellent survivorship and clinical outcomes of cementless TKAs that utilized highly porous titanium-coated base plates at mean follow-up of 36 months. There are several limitations to this study.…”

Section: Discussionmentioning

confidence: 97%

“…New generation cementless implants have avoided several shortcomings of earlier models that did not demonstrate a clinically relevant advantage. [1][2][3][4][5] Advances in implant manufacturing technology allowed these implants to possess improved bioengineering designs, leading to better osteointegration. 6,7 With improved bony ingrowth, more durable fixation and longevity are expected.…”

mentioning

confidence: 99%

“…In addition, their clinical success has been demonstrated in patients who had altered bone quality 1,3,4,[8][9][10][11][12][13][14][15][16] such as rheumatoid arthritis (RA), elderly patients, and those with knee osteonecrosis. 3,4 One of the increasingly utilized newer generation cementless implants are the trabecular metal-based tibial base plates which are produced using additive manufacturing or three-dimensional printing technology. The highly porous titanium coating of these implants biologically resembles bone structure and allows for an environment friendly to osteoblast colonization and bone ingrowth.…”

mentioning

confidence: 99%

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Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up

et al. 2019

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Newer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016. A total of 523 patients were identified. Of this cohort, 496 patients had a minimum of 2-year follow-up and were included in our final analysis. Among these patients, 72 had bilateral TKA yielding a total of 568 TKAs. There were 133 men and 363 women who had a mean body mass index of 33 kg/m2 (range, 20–61 kg/m2). The mean age was 66 years (range, 33–88 years). Average follow-up was 36 months (range, 24–48 months). Indications for TKA included osteoarthritis in 432 patients (87%), rheumatoid arthritis in 40 patients (8%), and knee osteonecrosis in 24 (5%) patients. Implant survivorship was defined as any revision leading to explantation of the base plate for any reason. Kaplan–Meier analysis was performed to determine all-cause implant survivorship at final follow-up for every patient. Complications were assessed using the Knee Society standardized list of TKA complications. Clinical outcomes were determined using the Knee Society pain and function scores. Range-of-motion values were also collected. There were a total of four failures, all were due to aseptic loosening with a survivorship rate of 99% at mean follow-up of 3 years (95% confidence interval = 0.984–0.999). In addition, there were a total of 12 surgical and 10 medical complications. Surgical complications did not affect the base plate or result in any additional implant revisions. A total of nine patients had thromboembolic disease complications; all received medical treatment and recovered adequately. Radiological evaluation did not show any signs of loosening or failures in other patients at final follow-up. Knee Society Scores for pain and function improved from 55 and 56 points preoperatively to 92 and 84 points at 2 years postoperatively. Our results are in concordance with the excellent clinical outcomes and survivorship demonstrated for the newer generation cementless TKA implants. In our experience, 3D printed titanium base plates demonstrated clinical success and excellent survivorship at minimum follow-up of 2 years.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

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confidence: 99%

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Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up

et al. 2019

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“…Moreover, they reported only three cases of necessary revision surgery and one patient listed for patella resurfacing. An additional study by Newman et al 24 retrospectively reviewed 142 cementless TKAs in patients older than 75 years of age, demonstrating a survivorship of 98.6% and a low rate of medical and surgical complications. One patient suffered a posttraumatic patellar fracture that had a stable implant and was treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Cementless-Backed Patellar Components

et al. 2020

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Because of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the: (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 261 patients who underwent cementless TKA by a single, high-volume academic surgeon were studied. Patients had a mean age of 66 years and were distributed between 192 women (74%) and 69 men. All patients received the same cementless tibial, femoral, and patellar components. Mean follow-up period was 4.5 years (range, 4–5 years). Primary outcomes evaluated included all postoperative complications, with particular emphasis on the patellar component. Only one patellar loosened leading to a patellar aseptic loosening rate of 0.3% (1 of 261). The one patellar loosening was the component being dislodged after a manipulation under anesthesia (MUA) at 6 weeks. This was revised to a cemented component and the patient is doing well 4 years later. A second patient experienced a patellar tendon rupture, later surgically repaired. Another patient sustained a patella fracture that was managed nonoperatively. The fracture healed by 1 year and the patient continued to have an otherwise successful outcome, now at 2 years follow-up. No progressive radiolucencies, subsidence, or changes in initial postoperative axial alignment were observed at final follow-up. The results from this study highlight a 98% success rate at mean 4.5 years follow-up in a large cohort of patients with a diverse spread of demographic details. Specific to the patella, only one patient experienced an adverse event, which was managed nonoperatively. Therefore, based on this data, patellar fixation in cementless TKA can be considered a safe technique.

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“…Newman et al 34 retrospectively reviewed 134 patients (142 knees) over 75 years of age who underwent cementless TKA after a mean follow-up of 4 (range, 2-8) years. The preoperative diagnosis was osteoarthritis in 107 patients, RA in 21 patients, and osteonecrosis in 6 patients.…”

Section: Older Agementioning

confidence: 99%

Cementless Fixation for Total Knee Arthroplasty in Various Patient Populations: A Literature Review

et al. 2020

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The number of total knee arthroplasties (TKAs) performed in the United States has increased considerably in recent years, with a major contribution from younger patients. Maximizing survivorship of these implants has always been a point of emphasis. Early TKA designs with cementless fixation were associated with high rates of complications and implant failures. However, recent advances in cementless designs have shown excellent results. The decision to use cemented or cementless fixation for patients undergoing TKA is typically based on the surgeon's experience and preference. However, several patient characteristics must also be taken into account. The purpose of this review was to describe the clinical outcomes of studies in which a cementless TKA system was utilized for patients who (1) were less than 60 years of age, (2) were greater than 75 years of age, (3) were obese, (4) had rheumatoid arthritis, and (5) had osteonecrosis of the knee. Based on the studies included in this review, it appears that cementless fixation is a viable option for patients who have all of the above demographics.

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Cementless Total Knee Arthroplasty in Patients Older Than 75 Years

Cited by 27 publications

References 49 publications

Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up

Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up

Outcomes of Cementless-Backed Patellar Components

Cementless Fixation for Total Knee Arthroplasty in Various Patient Populations: A Literature Review

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