Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up

Martino, Ivan De; D’Apolito, Rocco; Sculco, Peter K.; Poultsides, Lazaros; Gasparini, Giorgio

doi:10.1016/j.arth.2016.03.057

Cited by 54 publications

(42 citation statements)

References 45 publications

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“…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.…”

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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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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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“…The route of TXA administration was different, and most regimens were administered intravenously (IV). The blood transfusion protocol was repeated in 9 studies, of which only one RCT had a wider blood transfusion indication [1] than the other 8 observational studies (haemoglobin level, <10 g/dL; haematocrit level, <30%). In summary, the pre-recorded demographic data and blood variables showed no statistically significant differences between the TXA and control groups.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The main advantages of our research include the following: (1) We searched for all available clinical trials that directly compared the safety and efficacy of TXA in rTJA (TKA and THA).…”

Section: Limitations and Strengthsmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are major orthopaedic treatment procedures for end-stage knee or hip diseases [1,2]. Over time, the use of revision joint arthroplasty has been increasingly considered as the prevalence of primary total joint arthroplasty (pTJA) has significantly increased, especially among young people [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Is tranexamic acid effective and safe for patients undergoing revision total hip and knee arthroplasty: a meta-analysisIs

Zong

et al. 2019

Preprint

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Background: The use of tranexamic acid (TXA) during primary total joint arthroplasty （pTJA） is well documented. However, whether TXA is safe for patients undergoing revision total joint arthroplasty (rTJA) remains to be resolved. Methods: This meta-analysis included 12 studies that involved 2195 cases. The primary outcomes were indicators of TXA effectiveness during perioperative perid, including blood loss, haemoglobin (Hb) level changes, allogeneic blood transfusion (ABT) rate, and number of red blood cell (RBC) units transfused per patient. The secondary outcomes included thromboembolic complications, non-thromboembolic complications, and length of hospital stay. Results: TXA administration was associated with statistically significant decreases in the primary outcomes, including ABT rate (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.14–0.41; P < 0.00001), change in Hb level (mean difference [MD], −0.84; 95% CI, −1.28 to −0.41; P=0.002), and number of RBC units transfused per patient (MD, −0.49; 95% CI, −0.61 to −0.38; P < 0.00001) in the patients undergoing rTJA. Secondary outcome assessments showed no statistically significant differences in venous thromboembolism (OR, 0.99; 95% CI, 0.31–3.14; P=0.98) and non-thromboembolic complications (OR, 0.54; 95% CI, 0.18–1.68; P=0.29) between the patients who received and those who did not receive TXA in the revision total knee arthroplasty subgroup, while a significant decrease in length of hospital stay was found in those who received TXA (MD, −2.89; 95% CI, −4.85 to −0.93; P=0.004). Conclusion: In this meta-analysis, we found that the use of TXA acid can effectively reduce the number of blood transfusions in patients undergoing TJA without increasing the complication rate.

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“…Primary total knee arthroplasty (TKA) provides good long-term outcomes with respect to pain relief and functional recovery in patients with knee osteoarthritis, rheumatoid arthritis (RA), and other knee degenerative diseases [1,2]. The 10-year survival rate of primary TKA is reportedly 95.5-97.7% [3,4,5]. The most common cause of TKA failure is prosthesis loosening [6,7], particularly on the tibial side [8,9].…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of the effect of tibial prosthesis extension stem length in total knee arthroplasty in the Chinese population

Li¹,

Gao²,

Ding³

et al. 2019

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BackgroundThis study aimed to determine the longest usable range of tibial prosthesis extension stems in Chinese patients undergoing primary total knee arthroplasty and to analyze the effect of different stem lengths on prosthesis stability within this range.MethodsWe conducted three-dimensional modeling and simulated surgery in patients with genu varum to measure the longest usable range of tibial prothesis stems, identify impinged cortices under tibial posterior slope cut of 0° and 3°, and analyze factors influencing the longest stem length. We built finite element models according to the longest usable range of extension stems to simulate tibial prostheses with different stem lengths, measure the stress distribution of tibias and prostheses and the relative displacement of distal ends of prostheses, and investigate the effect of different stem extension lengths on prosthesis stability.ResultsWe simulated osteotomy with a tibial posterior slope cut of 0° and 3°, under which the maximum tibial prosthesis stem length was 83 mm (79±24 mm). The simulated tibial cut with a tibial posterior slope of 3° indicated the maximum tibial prosthesis stem length to be 83 mm (83±20 mm). According to the longest usable range of extension stems, we defined five groups for finite element analysis with 40-mm, 50-mm, 60-mm, 70-mm, and 80-mm stem lengths and analyzed each group for posterior slopes of 0° and 3°. The 80-mm stem length models showed minimum relative displacement of the distal end of tibial prosthesis (0°: 2.63, 1.61±0.05 µm; 3°: 1.48, 1.44±0.09 µm), whereas the 40-mm stem length models showed maximum relative displacement (0°: 3.16, 3.19±0.12 µm; 3°: 1.84, 1.81±0.07 µm). As the length of tibial prosthesis stems increased from 40 to 70 mm, the relative displacement of the distal end of prosthesis decreased for both posterior slopes but was insignificant when stem lengths increased to 70–80 mm.ConclusionsBased on the results, we suggest that using the longest tibial stem is not always necessarily a better option to increase stability, as the prosthesis shows greater stability in only a specific range of increased length but shows insignificant change when the length is greatly increased.

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Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up

Cited by 54 publications

References 45 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

Is tranexamic acid effective and safe for patients undergoing revision total hip and knee arthroplasty: a meta-analysisIs

Finite element analysis of the effect of tibial prosthesis extension stem length in total knee arthroplasty in the Chinese population

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Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up

Cited by 54 publications

References 45 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

Is tranexamic acid effective and safe for patients undergoing revision total&nbsp;hip and knee&nbsp;arthroplasty: a meta-analysisIs

Finite element analysis of the effect of tibial prosthesis extension stem length in total knee arthroplasty in the Chinese population

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Is tranexamic acid effective and safe for patients undergoing revision total hip and knee arthroplasty: a meta-analysisIs