Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis

Wang, Changyao; Pfitzner, Tilman; Roth, Philipp von; Mayr, Hermann O.; Sostheim, Michael; Hube, Robert

doi:10.1007/s00167-015-3820-4

Cited by 64 publications

(57 citation statements)

References 53 publications

(105 reference statements)

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“…42 The only meta-analysis addressing this question was performed by Wang et al When examining 17 observational studies, they found no superiority of either stem, with no significant difference in reoperation, aseptic loosening, and infection. 43 After a thorough evaluation of the best evidence in the literature, it is clear that no consensus can be made about cementing versus hybrid fixation of stems in rTKA. Each technique has its advantages and limitations.…”

Section: Outcomes and Conclusionmentioning

confidence: 99%

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

2019

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Successful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, there remains two options to assist with fixation, either fully cementing the entire implant or using a “hybrid” system, which combines an uncemented press-fit diaphyseal stem with cement in both the metaphysis and metaphysis–diaphysis junction of the keel. In this review, we discuss the history of these two techniques, evaluate the theoretical benefits and pitfalls, and assess the best evidence supporting each in the literature. To conclude, we will examine future directions and questions needed to better elucidate the best treatment options in a variety of revision scenarios.

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Section: Outcomes and Conclusionmentioning

confidence: 99%

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

2019

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“…In their study with 84 knee revisions, Lachiewizc et al found no significant difference between cemented and uncemented pediculated fixation when used in knee revisions due to loosening [21]. Similarly, a recent meta-analysis failed to demonstrate that any fixation technique was superior [22].…”

Section: Stem Fixation/stemsmentioning

confidence: 94%

Rotating Hinge Implants in Knee Arthroplasty

Petershofer

Trieb

2019

Z Orthop Unfall

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Due to demographic transition an increasing number of primary knee arthroplasty is expected. A consequence is a rise in frequency in revision knee arthroplasty. Rotating hinge prostheses are a development of former hinge prostheses, due to changes in implant design the outcome of modern rotating hinge implants clearly improved in comparison to former models. Interpretation of outcome in present literature is difficult due to the small number of cases and the heterogeneous indications. Nevertheless the use of rotating hinge knee prostheses in primary and revision arthroplasty is associated with good clinical outcomes, when indicated appropriately.

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“…Based on the available literature, no superiority of any type of stem fixation has been found26). Due to the inhomogeneity of failure mechanism, bone stock, implant design, and comorbidities, a strictly randomized controlled trial (RCT) for revision TKA is nearly impossible to compare the outcomes according to the cementation technique26). A recent RCT27) performed radiostereometric analysis with (1) constructs of the same length, (2) the same Anderson Orthopaedic Research Institute type of bone defect, (3) implants with the same level of constraint, and (4) exclusion of re-revision TKAs.…”

Section: Introductionmentioning

confidence: 99%

“…Both techniques have their own advantages and disadvantages (Table 2)20,26). Based on the available literature, no superiority of any type of stem fixation has been found26).…”

Section: Introductionmentioning

confidence: 99%

“…Both techniques have their own advantages and disadvantages (Table 2)20,26). Based on the available literature, no superiority of any type of stem fixation has been found26). Due to the inhomogeneity of failure mechanism, bone stock, implant design, and comorbidities, a strictly randomized controlled trial (RCT) for revision TKA is nearly impossible to compare the outcomes according to the cementation technique26).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Stem Fixation in Revision Total Knee Arthroplasty: Indications, Stem Dimensions, and Fixation Methods

Kang

Park

Song

2018

Knee Surg Relat Res

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Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxta-articular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxta-articular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless press-fit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.

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Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis

Abstract: Systematic review of Level IV, Therapeutic studies, Level IV.

Cited by 64 publications

References 53 publications

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

Rotating Hinge Implants in Knee Arthroplasty

Stem Fixation in Revision Total Knee Arthroplasty: Indications, Stem Dimensions, and Fixation Methods

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