Evolution of Tibial Fixation in Total Knee Arthroplasty

Lombardi, Adolph V.; Berasi, Carl C.; Berend, Keith R.

doi:10.1016/j.arth.2007.02.006

Cited by 97 publications

(66 citation statements)

References 30 publications

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“…Over the last 30 years, cemented, cementless, and hybrid fixation options have been used with various TKA implant systems [7]. Cemented components are most widely used and are considered the most reliable method of fixation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of cemented fixation in TKA is more common and has demonstrated durable long-term results [7]. Uncemented tibial components have been used over the last 30 years with some conflicting results regarding durability and reliability.…”

Section: Introductionmentioning

confidence: 99%

“…The biomechanical properties of these materials (ie, lower modulus of elasticity similar to bone, possible decreased stress shielding, and higher porosity with improved friction fit, initial stability, and bone ingrowth) may help overcome shortcomings seen with previous uncemented tibial designs. Some surgeons, however, remain skeptical about the durability of uncemented tibial fixation, whereas others wonder whether soft tissues might adversely adhere to these porous metals and cause knee stiffness or pain [1,7], and still others have voiced concerns with the use of highly porous metals in primary TKA pertaining to the possibility of difficult revisions and the cost of the implants.…”

Section: Introductionmentioning

confidence: 99%

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The Mark Coventry Award

Pulido

Abdel

Lewallen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Although highly porous metals have demonstrated excellent bone ingrowth properties and so are an intriguing option for fixation in total knee arthroplasty (TKA), some surgeons are skeptical about the durability of uncemented tibial fixation and the potential for soft tissues to adhere to these porous metals and perhaps cause knee stiffness or pain. Questions/purposesThe purpose of this study was to compare, in the context of a randomized clinical trial, a highly porous metal tibia compared with a traditional modular cemented tibia in terms of survivorship, Knee Society scores, range of motion (ROM), and complications. MethodsFrom 2003 to 2006, 397 patients (age 67.8 ± 8.7 years; 54% female) were randomized to three groups: (1) traditional modular cemented tibia; (2) cemented highly porous metal tibia; and (3) uncemented highly porous metal tibia. The same posterior-stabilized femoral component and patella component were cemented in every case. Stratified randomization was done for surgeon, patient's age, sex, and body mass index. Survivorship at 5 years was compared between the groups, as were Knee Society scores, ROM, and complications. Radiographic assessment included alignment, radiolucency, and implant migration/loosening. Patients were followed until death, revision, or for a minimum of 2 years (mean, 5 years; range, 2-9 years). Four patients were lost to followup before 2 years. ResultsHighly porous metal tibias (both uncemented and cemented) were no different from traditional cemented modular tibial modular components in terms of survivorship at 5 years using a intention-to-treat analysis (96.8% [1]; 97.6% [2]; 96.7% [3]; p = 0.59). A per-protocol analysis revealed that no highly porous metal tibia was revised for aseptic loosening. Highly porous metal tibias performed comparably to traditional cemented modular tibias in terms of Knee Society scores, ROM, and the frequency of complications. ConclusionsAt 5 years this randomized clinical trial demonstrated that highly porous metal tibias provided comparably durable fixation and reliable pain relief and restoration of function when compared with a traditional cemented modular tibia in TKA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Mark Coventry Award

Pulido

Abdel

Lewallen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Cementless fixation may result in durable biological fixation with more physiologic transfer of stresses to underlying bone and, therefore, perhaps preservation of bone mineral density. Earlier cementless implants showed the possibility of achieving these goals, but they experienced a high rate of complications and failures, particularly of the patellar and tibial components [26,37,47,52,65]. For this reason, some authors recommended a hybrid technique using a cemented tibial component and uncemented femoral component [26,47].…”

Section: Introductionmentioning

confidence: 99%

“…To date, a cemented TKA has been considered the accepted standard [11,37,40], with predictable and durable results [12,17,21,35,48,53,54]. The survivorship of a welldesigned and properly positioned cemented TKA at 10 to 20 years exceeds 90%, resulting in stability, increased mobility, and reduction of pain for many patients [38,49].…”

Section: Introductionmentioning

confidence: 99%

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Fernández-Fairén

Hernández-Vaquero

Murcia

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup. Questions/purposes We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant.Methods We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied. Results At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was À4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups. Conclusions Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.

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A New Era in Porous Metals: Applications in Orthopaedics

Levine¹

2008

Adv Eng Mater

148

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The development of porous metals and coatings has revolutionized the field of orthopaedics. However, most implants are fabricated utilizing traditional materials (i.e. sintered beads, fiber metal, plasma spray), which have several inherent limitations. Several new porous metals have been recently introduced to improve upon the biomaterial properties of these traditional metals. Tritanium (Stryker, Mahwah, NJ), Regenerex (Biomet, Warsaw, IN), Stiktite (Smith and Nephew, Memphis, TN), and Trabecular Metal (Zimmer, Warsaw, IN) are currently available for use in orthopaedic surgery, all with a characteristic appearance similar to cancellous bone. The open‐cell structure of these materials affords several intriguing properties, including; high volumetric porosity (60–80 %), low modulus of elasticity, and high frictional characteristics. The following represents a review of the biomaterial properties and applications in orthopaedic surgery for this new class of highly porous metals.

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Evolution of Tibial Fixation in Total Knee Arthroplasty

Cited by 97 publications

References 30 publications

The Mark Coventry Award

The Mark Coventry Award

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

A New Era in Porous Metals: Applications in Orthopaedics

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