Hybrid Total Knee Arthroplasty Revisited: Midterm Followup of Hybrid versus Cemented Fixation in Total Knee Arthroplasty

Abstract

The optimal method of fixation in total knee arthroplasty is still debated. Hybrid total knee arthroplasty (TKA), with cemented tibial and cementless femoral components, is a proposed method of fixation to improve outcomes. Although several studies have shown favorable outcomes, there is still lack of consensus in the literature. We hypothesized that hybrid TKA yields similar clinical, radiographic, and survivorship results compared to fully cemented TKA. The clinical and radiographic outcomes of 304 cruciate retaining TKAs with minimum two-year followup, including 193 hybrid (mean followup of 4.1 years) and fully cemented TKAs (mean followup of 3.2 years) were evaluated. Knee society scores were similar between the two groups. The total number of femoral radiolucencies was also similar between the two groups, while a greater number of femoral Zone 4 radiolucencies were seen in the cemented group (9% versus 1.6%, P = 0.005). The hybrid group demonstrated a 99.2% survival rate of the femoral component out to seven years for aseptic loosening. No significant difference in survivorship was seen between the groups for all cause or aseptic failure at seven years. We conclude that hybrid fixation leads to similar intermediate-term outcomes as fully cemented components and remains a viable option in total knee arthroplasty.

Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up

“…Gao et al found no significant differences in clinical outcomes [50]. Pelt et al reported that hybrid fixation leads to similar intermediate-term outcomes as fully cemented components [51]. Several recent studies described similar results for cemented and uncemented TKA[18, 28-30, 32, 33, 52].…”

A 9-Year Outcome Study Comparing Cancellous Titanium-Coated Cementless to Cemented Tibial Components of a Single Knee Arthroplasty Design

“…In more recent publications with newer designs, satisfactory outcomes have been reported in the midterm and long term for cementless implants [41]. Due to the fact that in old and new observational studies nearly all failures for aseptic loosening were related to the tibial tray component, several surgeons have suggested the use of hybrid fixation in TKA because of the satisfactory midterm and long-term results [42]. In a Cochrane database report, evaluating cemented, cementless, or hybrid fixation options in TKA for osteoarthritis and other nontraumatic diseases, there was a smaller migration (assessed by RSA) of tibial components with cemented fixation in relation to cementless fixation, in studies with osteoarthritis and rheumatoid arthritis patients who underwent primary TKA, with a follow-up of 2 years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation [43].…”

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty

“…17 That same year, Pelt et al looked at 193 hybrid fixation stems and found a 99.2% rate of component survival at 7 years, again demonstrating a low prevalence of aseptic loosening. 18 Finally, Wood et al published their results of 135 revision TKAs, with a Kaplan-Meier's survivorship analysis at 12 years revealing a 98% probability of survival free from aseptic loosening. 19 Therefore, in light of recent publications, there is no current consensus on the preferred stem fixation.…”