Good long-term results following cementless TKA with a titanium plasma coating

Bouras, Theodoros; Bitas, Vasileios; Fennema, Peter; Korovessis, Panagiotis

doi:10.1007/s00167-015-3769-3

Cited by 28 publications

(22 citation statements)

References 32 publications

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“…The implant system used in the present study has been used for many years in our clinic, with an overall 10-year survival rate of around 95%. Notably, this is in line with the survival rate reported in the peer-reviewed literature and in the UK National Joint Registry for the study device [ 18 , 32 ]. It has to be noted that the 10-year survival rates in the present study do not largely differ from the “Benchmark” of 95%, i.e., the upper limits of the confidence intervals were greater than or approached 95%.…”

Section: Discussionsupporting

confidence: 88%

“…Our definition of focal osteolysis was any progressive osteolytic lesion at the bone–implant interface [ 17 ]. Our definition of loss of fixation was a continuous RLL greater than 1 mm in all zones, or a change in the position of the implant [ 18 ]. Mechanical axis alignment was measured via long-leg standing lower extremity radiographs both preoperatively and postoperatively.…”

Section: Methodsmentioning

confidence: 99%

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Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

Hommel¹,

Kunze²,

Hommel³

et al. 2017

TOORTHJ

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Background:There is ongoing debate about how to obtain correct rotational alignment in total knee arthroplasty (TKA). Two commonly used techniques are the measured resection (MR) and the gap balancing (GB) technique.Objective:The objective of the present study was to analyze which of these two techniques confers a clinical advantage up to 10 years postoperatively.Methods:Two hundred patients were randomized to either MR or GB. The primary outcome was the Knee Society Knee Score (KS) 10 years postoperatively. Secondary outcomes were passive range of motion, the Knee Society Function Score (FS), and the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), along with implant survival. We employed a two one-sided test (TOST) and linear mixed models to assess clinical outcomes.Results:Mean KS was 82 (95% confidence interval (CI), 80 – 83) and 77 (95% CI, 76 – 79) in the GB and MR group, respectively. The TOST test and linear mixed model both revealed statistical significance (p < 0.001). In addition, GB yielded better postoperative FS and WOMAC. However, between-group differences were consistently small. Implant survival rates at 10 years, with survival for any reason as the endpoint of interest, were 93.7% (95% CI, 86.4% and 97.1%) and 89.8% (95% CI, 81.9% - 94.4%) for the GB group and the MR group, respectively (p = 0.302).Conclusion:Gap-balancing is a safe and reliable technique. KS for the two study groups at 10 years can be considered equivalent, and the small postoperative advantages may not extend beyond clinical relevance.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

Hommel¹,

Kunze²,

Hommel³

et al. 2017

TOORTHJ

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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%

“…In several recent reports, these newer generation implants have demonstrated comparable to superior results to the gold-standard cemented protheses. 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.…”

mentioning

confidence: 99%

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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“…[10][11][12] Recent advances in cementless TKA designs have shown excellent results, with several studies demonstrating survivorship rates above 90% at mid-to long-term follow-up. [13][14][15][16][17] In fact, a recent metaanalysis reported that cementless TKA had a better all-cause survivorship when compared with cemented fixation. 18 While some authors recommend the use of antibioticimpregnated cement for primary TKA, 19,20 others have reported no significant benefits of its use.…”

mentioning

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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Good long-term results following cementless TKA with a titanium plasma coating

Abstract: IV.

Cited by 28 publications

References 32 publications

Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty

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

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

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