Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2011

01-06-2011 | Knee

Fixation of revision TKA: a review of the literature

Authors: J. Beckmann, C. Lüring, R. Springorum, F. X. Köck, J. Grifka, M. Tingart

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2011

Login to get access

Abstract

Purpose

Early aseptic loosening is a major complication in revision total knee arthroplasty (TKA). It is well accepted that intramedullary stems improve the anchoring of the prosthetic components; however, controversy still exists about the optimal fixation technique of the stems (cementless, hybrid, cemented).

Methods

A literature review was carried out in the main medical databases from 1980 to 04/2010 to evaluate the available literature by evidence-based criteria and to analyse the results of the single studies regarding fixation technique in knee revision arthroplasty.

Results

There are four studies regarding the cementless fixation. Eight studies reported the hybrid technique and five studies the cemented technique. Hybrid and cemented techniques are comparable regarding the survival of arthroplasties, the rate of aseptic loosening and the clinical outcome. However, most studies just show a low level of evidence (LoE III and IV), a small to medium number of cases and a short follow-up.

Conclusion

Based on the current literature, no final statement can be drawn regarding the optimal fixation technique in revision TKA. Future RCTs are needed to enable conclusive statements about the possible advantages and disadvantages of the single fixation techniques, although the clinical implementation often is critical.
Literature
1.
go back to reference Barrack RL, Rorabeck C, Burt M, Sawhney J (1999) Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 367:216–225PubMedCrossRef Barrack RL, Rorabeck C, Burt M, Sawhney J (1999) Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 367:216–225PubMedCrossRef
2.
go back to reference Barrack RL, Stanley T, Burt M, Hopkins S (2004) The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty 19:119–124PubMedCrossRef Barrack RL, Stanley T, Burt M, Hopkins S (2004) The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty 19:119–124PubMedCrossRef
3.
go back to reference Bertin KC, Freeman MA, Samuelson KM, Ratcliffe SS, Todd RC (1985) Stemmed revision arthroplasty for aseptic loosening of total knee replacement. J Bone Joint Surg Br 67:242–248PubMed Bertin KC, Freeman MA, Samuelson KM, Ratcliffe SS, Todd RC (1985) Stemmed revision arthroplasty for aseptic loosening of total knee replacement. J Bone Joint Surg Br 67:242–248PubMed
4.
go back to reference Bottner F, Laskin R, Windsor RE, Haas SB (2006) Hybrid component fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:127–131PubMedCrossRef Bottner F, Laskin R, Windsor RE, Haas SB (2006) Hybrid component fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:127–131PubMedCrossRef
5.
go back to reference Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51PubMedCrossRef Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51PubMedCrossRef
6.
go back to reference Burnett RS, Keeney JA, Maloney WJ, Clohisy JC (2009) Revision total knee arthroplasty for major osteolysis. Iowa Orthop J 29:28–37PubMed Burnett RS, Keeney JA, Maloney WJ, Clohisy JC (2009) Revision total knee arthroplasty for major osteolysis. Iowa Orthop J 29:28–37PubMed
7.
go back to reference Burns AW, Bourne RB, Chesworth BM, MacDonald SJ, Rorabeck CH (2006) Cost effectiveness of revision total knee arthroplasty. Clin Orthop Relat Res 446:29–33PubMedCrossRef Burns AW, Bourne RB, Chesworth BM, MacDonald SJ, Rorabeck CH (2006) Cost effectiveness of revision total knee arthroplasty. Clin Orthop Relat Res 446:29–33PubMedCrossRef
8.
go back to reference Chon JG, Lombardi AV Jr, Berend KR (2004) Hybrid stem fixation in revision total knee arthroplasty (TKA). Surg Technol Int 12:214–220PubMed Chon JG, Lombardi AV Jr, Berend KR (2004) Hybrid stem fixation in revision total knee arthroplasty (TKA). Surg Technol Int 12:214–220PubMed
9.
go back to reference Completo A, Fonseca F, Simoes JA (2008) Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech 41:560–566PubMedCrossRef Completo A, Fonseca F, Simoes JA (2008) Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech 41:560–566PubMedCrossRef
10.
go back to reference Completo A, Rego A, Fonseca F, Ramos A, Relvas C, Simoes JA (2010) Biomechanical evaluation of proximal tibia behaviour with the use of femoral stems in revision TKA: an in vitro and finite element analysis. Clin Biomech (Bristol, Avon) 25:159–165CrossRef Completo A, Rego A, Fonseca F, Ramos A, Relvas C, Simoes JA (2010) Biomechanical evaluation of proximal tibia behaviour with the use of femoral stems in revision TKA: an in vitro and finite element analysis. Clin Biomech (Bristol, Avon) 25:159–165CrossRef
11.
go back to reference Completo A, Simoes JA, Fonseca F (2009) Revision total knee arthroplasty: the influence of femoral stems in load sharing and stability. Knee 16:275–279PubMedCrossRef Completo A, Simoes JA, Fonseca F (2009) Revision total knee arthroplasty: the influence of femoral stems in load sharing and stability. Knee 16:275–279PubMedCrossRef
12.
go back to reference Completo A, Simoes JA, Fonseca F, Oliveira M (2008) The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA. Knee 15:227–232PubMedCrossRef Completo A, Simoes JA, Fonseca F, Oliveira M (2008) The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA. Knee 15:227–232PubMedCrossRef
13.
go back to reference Fehring TK, Odum S, Olekson C, Griffin WL, Mason JB, McCoy TH (2003) Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthop Relat Res 416:217–224PubMedCrossRef Fehring TK, Odum S, Olekson C, Griffin WL, Mason JB, McCoy TH (2003) Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthop Relat Res 416:217–224PubMedCrossRef
14.
go back to reference Garcia RM, Hardy BT, Kraay MJ, Goldberg VM (2010) Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis. Clin Orthop Relat Res 468:82–89PubMedCrossRef Garcia RM, Hardy BT, Kraay MJ, Goldberg VM (2010) Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis. Clin Orthop Relat Res 468:82–89PubMedCrossRef
15.
go back to reference Ghomrawi HM, Kane RL, Eberly LE, Bershadsky B, Saleh KJ, North American Knee Arthroplasty Revision Study G (2009) Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am 91:2838–2845PubMedCrossRef Ghomrawi HM, Kane RL, Eberly LE, Bershadsky B, Saleh KJ, North American Knee Arthroplasty Revision Study G (2009) Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am 91:2838–2845PubMedCrossRef
16.
go back to reference Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH (2002) Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res 404:158–168PubMedCrossRef Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH (2002) Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res 404:158–168PubMedCrossRef
17.
go back to reference Haas SB, Insall JN, Montgomery W 3rd, Windsor RE (1995) Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 77:1700–1707PubMed Haas SB, Insall JN, Montgomery W 3rd, Windsor RE (1995) Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 77:1700–1707PubMed
18.
go back to reference Jazrawi LM, Bai B, Kummer FJ, Hiebert R, Stuchin SA (2001) The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty. J Arthroplasty 16:759–767PubMedCrossRef Jazrawi LM, Bai B, Kummer FJ, Hiebert R, Stuchin SA (2001) The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty. J Arthroplasty 16:759–767PubMedCrossRef
19.
go back to reference Kim YH, Kim JS (2009) Revision total knee arthroplasty with use of a constrained condylar knee prosthesis. J Bone Joint Surg Am 91:1440–1447PubMedCrossRef Kim YH, Kim JS (2009) Revision total knee arthroplasty with use of a constrained condylar knee prosthesis. J Bone Joint Surg Am 91:1440–1447PubMedCrossRef
20.
go back to reference Kim YH, Kwon OS, Kim K (2008) Analysis of biomechanical effect of stem-end design in revision TKA using Digital Korean model. Clin Biomech (Bristol, Avon) 23:853–858CrossRef Kim YH, Kwon OS, Kim K (2008) Analysis of biomechanical effect of stem-end design in revision TKA using Digital Korean model. Clin Biomech (Bristol, Avon) 23:853–858CrossRef
21.
go back to reference Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedCrossRef Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedCrossRef
22.
go back to reference Lonner JH, Klotz M, Levitz C, Lotke PA (2001) Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty 16:107–111PubMedCrossRef Lonner JH, Klotz M, Levitz C, Lotke PA (2001) Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty 16:107–111PubMedCrossRef
23.
go back to reference Mabry TM, Hanssen AD (2007) The role of stems and augments for bone loss in revision knee arthroplasty. J Arthroplasty 22:56–60PubMedCrossRef Mabry TM, Hanssen AD (2007) The role of stems and augments for bone loss in revision knee arthroplasty. J Arthroplasty 22:56–60PubMedCrossRef
24.
go back to reference Mabry TM, Vessely MB, Schleck CD, Harmsen WS, Berry DJ (2007) Revision total knee arthroplasty with modular cemented stems: long-term follow-up. J Arthroplasty 22:100–105PubMedCrossRef Mabry TM, Vessely MB, Schleck CD, Harmsen WS, Berry DJ (2007) Revision total knee arthroplasty with modular cemented stems: long-term follow-up. J Arthroplasty 22:100–105PubMedCrossRef
25.
go back to reference Meijerink HJ, van Loon CJ, de Waal Malefijt MC, van Kampen A, Verdonschot N (2010) A sliding stem in revision total knee arthroplasty provides stability and reduces stress shielding. Acta Orthop 81:337–343PubMedCrossRef Meijerink HJ, van Loon CJ, de Waal Malefijt MC, van Kampen A, Verdonschot N (2010) A sliding stem in revision total knee arthroplasty provides stability and reduces stress shielding. Acta Orthop 81:337–343PubMedCrossRef
26.
go back to reference Mow CS, Wiedel JD (1994) Noncemented revision total knee arthroplasty. Clin Orthop Relat Res 309:110–115PubMed Mow CS, Wiedel JD (1994) Noncemented revision total knee arthroplasty. Clin Orthop Relat Res 309:110–115PubMed
27.
go back to reference Mow CS, Wiedel JD (1998) Revision total knee arthroplasty using the porous-coated anatomic revision prosthesis: six- to twelve-year results. J Arthroplasty 13:681–686PubMedCrossRef Mow CS, Wiedel JD (1998) Revision total knee arthroplasty using the porous-coated anatomic revision prosthesis: six- to twelve-year results. J Arthroplasty 13:681–686PubMedCrossRef
28.
go back to reference Murray PB, Rand JA, Hanssen AD (1994) Cemented long-stem revision total knee arthroplasty. Clin Orthop Relat Res 309:116–123PubMed Murray PB, Rand JA, Hanssen AD (1994) Cemented long-stem revision total knee arthroplasty. Clin Orthop Relat Res 309:116–123PubMed
29.
go back to reference Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-010-1074-8 Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc DOI 10.​1007/​s00167-010-1074-8
30.
go back to reference Parsley BS, Sugano N, Bertolusso R, Conditt MA (2003) Mechanical alignment of tibial stems in revision total knee arthroplasty. J Arthroplasty 18:33–36PubMedCrossRef Parsley BS, Sugano N, Bertolusso R, Conditt MA (2003) Mechanical alignment of tibial stems in revision total knee arthroplasty. J Arthroplasty 18:33–36PubMedCrossRef
31.
go back to reference Pellegrini VD Jr, O’Connor MI, Garvin KL, Lachiewicz PF (2009) Revision total knee arthroplasty: complicated cases. J Bone Joint Surg Am 91(Suppl 5):72–74PubMedCrossRef Pellegrini VD Jr, O’Connor MI, Garvin KL, Lachiewicz PF (2009) Revision total knee arthroplasty: complicated cases. J Bone Joint Surg Am 91(Suppl 5):72–74PubMedCrossRef
32.
go back to reference Peters CL, Craig MA, Mohr RA, Bachus KN (2003) Tibial component fixation with cement: full- versus surface-cementation techniques. Clin Orthop Relat Res:158–168 Peters CL, Craig MA, Mohr RA, Bachus KN (2003) Tibial component fixation with cement: full- versus surface-cementation techniques. Clin Orthop Relat Res:158–168
33.
go back to reference Peters CL, Erickson J, Kloepper RG, Mohr RA (2005) Revision total knee arthroplasty with modular components inserted with metaphyseal cement and stems without cement. J Arthroplasty 20:302–308PubMedCrossRef Peters CL, Erickson J, Kloepper RG, Mohr RA (2005) Revision total knee arthroplasty with modular components inserted with metaphyseal cement and stems without cement. J Arthroplasty 20:302–308PubMedCrossRef
34.
go back to reference Peters CL, Erickson JA, Gililland JM (2009) Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems. J Arthroplasty 24:48–53PubMedCrossRef Peters CL, Erickson JA, Gililland JM (2009) Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems. J Arthroplasty 24:48–53PubMedCrossRef
35.
go back to reference Peters CL, Hennessey R, Barden RM, Galante JO, Rosenberg AG (1997) Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study. J Arthroplasty 12:896–903PubMedCrossRef Peters CL, Hennessey R, Barden RM, Galante JO, Rosenberg AG (1997) Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study. J Arthroplasty 12:896–903PubMedCrossRef
36.
go back to reference Shannon BD, Klassen JF, Rand JA, Berry DJ, Trousdale RT (2003) Revision total knee arthroplasty with cemented components and uncemented intramedullary stems. J Arthroplasty 18:27–32PubMedCrossRef Shannon BD, Klassen JF, Rand JA, Berry DJ, Trousdale RT (2003) Revision total knee arthroplasty with cemented components and uncemented intramedullary stems. J Arthroplasty 18:27–32PubMedCrossRef
37.
go back to reference Skwara A, Figiel J, Knott T, Paletta JR, Fuchs-Winkelmann S, Tibesku CO (2009) Primary stability of tibial components in TKA: in vitro comparison of two cementing techniques. Knee Surg Sports Traumatol Arthrosc 17:1199–1205PubMedCrossRef Skwara A, Figiel J, Knott T, Paletta JR, Fuchs-Winkelmann S, Tibesku CO (2009) Primary stability of tibial components in TKA: in vitro comparison of two cementing techniques. Knee Surg Sports Traumatol Arthrosc 17:1199–1205PubMedCrossRef
38.
go back to reference Takahashi Y, Gustilo RB (1994) Nonconstrained implants in revision total knee arthroplasty. Clin Orthop Relat Res 309:156–162PubMed Takahashi Y, Gustilo RB (1994) Nonconstrained implants in revision total knee arthroplasty. Clin Orthop Relat Res 309:156–162PubMed
39.
go back to reference Vince KG, Long W (1995) Revision knee arthroplasty. The limits of press fit medullary fixation. Clin Orthop Relat Res 317:172–177PubMed Vince KG, Long W (1995) Revision knee arthroplasty. The limits of press fit medullary fixation. Clin Orthop Relat Res 317:172–177PubMed
40.
go back to reference Whaley AL, Trousdale RT, Rand JA, Hanssen AD (2003) Cemented long-stem revision total knee arthroplasty. J Arthroplasty 18:592–599PubMedCrossRef Whaley AL, Trousdale RT, Rand JA, Hanssen AD (2003) Cemented long-stem revision total knee arthroplasty. J Arthroplasty 18:592–599PubMedCrossRef
41.
go back to reference Whiteside LA (2006) Cementless fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:140–148PubMedCrossRef Whiteside LA (2006) Cementless fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:140–148PubMedCrossRef
42.
go back to reference Whiteside LA (1993) Cementless revision total knee arthroplasty. Clin Orthop Relat Res 286:160–167PubMed Whiteside LA (1993) Cementless revision total knee arthroplasty. Clin Orthop Relat Res 286:160–167PubMed
43.
go back to reference Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467:810–817PubMedCrossRef Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467:810–817PubMedCrossRef
44.
go back to reference Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A:1–3PubMed Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A:1–3PubMed
Metadata
Title
Fixation of revision TKA: a review of the literature
Authors
J. Beckmann
C. Lüring
R. Springorum
F. X. Köck
J. Grifka
M. Tingart
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1249-3

Other articles of this Issue 6/2011

Knee Surgery, Sports Traumatology, Arthroscopy 6/2011 Go to the issue