Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2016

01-10-2016 | Knee

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

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

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2016

Login to get access

Abstract

Purpose

Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation.

Methods

Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model.

Results

Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up <60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices.

Conclusion

There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA.

Level of evidence

Systematic review of Level IV, Therapeutic studies, Level IV.
Literature
1.
Bae DK, Song SJ, Heo DB, Lee SH, Song WJ (2013) Long-term survival rate of implants and modes of failure after revision total knee arthroplasty by a single surgeon. J Arthroplasty 28:1130–1134CrossRefPubMed
2.
Beckmann J, Lüring C, Springorum R, Köck FX, Grifka J, Tingart M (2011) Fixation of revision TKA: a review of the literature. Knee Surg Sports Traumatol Arthrosc 19:872–879CrossRefPubMed
3.
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.
Bottner F, Laskin R, Windsor RE, Haas SB (2006) Hybrid component fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:127–131CrossRefPubMed
5.
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 468:45–51CrossRefPubMed
6.
Chon JG, Lombardi AV Jr, Berend KR (2004) Hybrid stem fixation in revision total knee arthroplasty (TKA). Surg Technol Int 12:214–220PubMed
7.
Clatworthy MG, Ballance J, Brick GW, Chandler HP, Gross AE (2001) The use of structural allograft for uncontained defects in revision total knee arthroplasty. A minimum 5 year review. J Bone Joint Surg Am 83(A3):404–411PubMed
8.
Completo A, Fonseca F, Simões JA (2008) Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech 41:560–566CrossRefPubMed
9.
Conditt MA, Parsley BS, Alexander JW, Doherty SD, Noble PC (2004) The optimal strategy for stable tibial fixation in revision total knee arthroplasty. J Arthroplasty 19(Supp 2):113–118CrossRefPubMed
10.
Dekkers OM, Egger M, Altman DG, Vandenbroucke JP (2012) Distinguishing case series from cohort studies. Ann Intern Med 156:37–40CrossRefPubMed
11.
12.
Edwards PK, Fehring TK, Hamilton WG, Perricelli B, Beaver WB, Odum SM (2014) Are cementless stems more durable than cemented stems in two-stage revisions of infected total knee arthroplasties? Clin Orthop Relat Res 472:206–211CrossRefPubMed
13.
Engh GA, Herzwurm PJ, Parks NL (1997) Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am 79:1030–1039PubMed
14.
Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMed
15.
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 416:217–224CrossRefPubMed
16.
Freeman MF, Tukey JW (1950) Transformations related to the angular and the square root. Ann Math Statist 21:607–611CrossRef
17.
Gililland JM, Gaffney CJ, Odum SM, Fehring TK, Peters CL, Beaver WB (2014) Clinical and radiographic outcomes of cemented versus diaphyseal engaging cementless stems in aseptic revision TKA. J Arthroplasty 29(9 Suppl):224–228CrossRefPubMed
18.
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 404:158–168CrossRefPubMed
19.
Greene JW, Reynolds SM, Stimac JD, Malkani AL, Massini MA (2013) Midterm results of hybrid cement technique in revision total knee arthroplasty. J Arthroplasty 28:570–574CrossRefPubMed
20.
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
21.
Haidukewych GJ, Hanssen A, Jones RD (2011) Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg 19:311–318CrossRefPubMed
22.
Hossain F, Patel S, Haddad FS (2010) Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 468:1221–1228CrossRefPubMedPubMedCentral
23.
Iamaguchi MM, de Castro FB, Gobbi RG, Tirico LE, Pécora JR, Camanho GL (2013) Results of revision total knee arthroplasty using press-fit cementless stem. Acta Ortop Bras 21:23–26CrossRefPubMedPubMedCentral
24.
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 16:759–767CrossRefPubMed
25.
Kim YH, Kim JS (2009) Revision total knee arthroplasty with use of a constrained condylar knee prosthesis. J Bone Joint Surg Am 91:1440–1447CrossRefPubMed
26.
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 89:780–785CrossRefPubMed
27.
Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 467:2606–2612CrossRefPubMedPubMedCentral
28.
Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States: updated projections to. J Bone Joint Surg Am 96:624–630CrossRefPubMed
29.
Lachiewicz PF, Soileau ES (2014) A 30-mm cemented stem extension provides adequate fixation of the tibial component in revision knee arthroplasty. Clin Orthop Relat Res. doi:10.​1007/​s11999-014-3529-6
30.
Luque R, Rizo B, Urda A, Garcia-Crespo R, Moro E, Marco F, López-Duran L (2014) Predictive factors for failure after total knee replacement revision. Int Orthop 38:429–435CrossRefPubMedPubMedCentral
31.
Mabry TM, Hanssen AD (2007) The role of stems and augments for bone loss in revision knee arthroplasty. J Arthroplasty 22:56–60CrossRefPubMed
32.
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 22:100–105CrossRefPubMed
33.
Manopoulos P, Havet E, Pearce O, Lardanchet JF, Mertl P (2012) Mid- to long-term results of revision total knee replacement using press-fit intramedullary stems with cemented femoral and tibial components. J Bone Joint Surg Br 94:937–940CrossRefPubMed
34.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 21:b2535CrossRef
35.
Mortazavi SM, Molligan J, Austin MS, Purtill JJ, Hozack WJ, Parvizi J (2011) Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop 35:1157–1164CrossRefPubMed
36.
Mortazavi SM, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J (2010) Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res 468:2052–2059CrossRefPubMedPubMedCentral
37.
Mow CS, Wiedel JD (1998) Revision total knee arthroplasty using the porous-coated anatomic revision prosthesis: 6–12-year results. J Arthroplasty 13:681–686CrossRefPubMed
38.
Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ (2006) Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res 446:45–50CrossRefPubMed
39.
Murray PB, Rand JA, Hanssen AD (1994) Cemented long-stem revision total knee arthroplasty. Clin Orthop Relat Res 309:116–123PubMed
40.
Nelson CL, Lonner JH, Rand JA, Lotke PA (2003) Strategies of stem fixation and the role of supplemental bone graft in revision total knee arthroplasty. J Bone Joint Surg Am 85:S52–S57CrossRefPubMed
41.
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 20:302–308CrossRefPubMed
42.
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 24:48–53CrossRefPubMed
43.
Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA (2012) The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol 26:637–647CrossRefPubMed
44.
Sah AP, Shukla S, Della Valle CJ, Rosenberg AG, Paprosky WG (2010) Modified hybrid stem fixation in revision TKA is durable at 2–10 years. Clin Orthop 469:839–846CrossRefPubMedPubMedCentral
45.
Shannon BD, Klassen JF, Rand JA, Berry DJ, Trousdale RT (2003) Revision total knee arthroplasty with cemented components and uncemented intramedullary stems. J Arthroplasty 18:27–32CrossRefPubMed
46.
Slim K, Nini E, Forestier D, Kwiatkoski F, Panis Y, Chipponi J (2003) Methodolical index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed
47.
Stroup DF, BerlinJA MortonSC, OlkinI WilliamsonGD, RennieD MoherD, BeckerBJ SipeTA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMed
48.
Vince KG, Long W (1995) Revision knee arthroplasty. The limits of press fit medullary fixation. Clin Orthop Relat Res 317:172–177PubMed
49.
Whaley AL, Trousdale RT, Rand JA, Hanssen AD (2003) Cemented long-stem revision total knee arthroplasty. J Arthroplasty 18:592–599CrossRefPubMed
50.
Whiteside LA (2006) Cementless fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:140–148CrossRefPubMed
51.
Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467:810–817CrossRefPubMed
Metadata
Title
Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis
Authors
Changyao Wang
Tilman Pfitzner
Philipp von Roth
Hermann O. Mayr
Michael Sostheim
Robert Hube
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3820-4

Other articles of this Issue 10/2016

Knee Surgery, Sports Traumatology, Arthroscopy 10/2016 Go to the issue

Knee

Complications associated with 133 static, antibiotic-laden spacers after TKA

Knee

Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells: a randomized clinical trial

Knee

High rate of implant loosening for uncemented resurfacing-type medial unicompartmental knee arthroplasty

Knee

Modified fixations for distal femur fractures following total knee arthroplasty: a biomechanical and clinical relevance study

Knee

Medial femoral condyle fracture as an intraoperative complication of Oxford unicompartmental knee replacement

Knee

Balancing UKA: overstuffing leads to high medial collateral ligament strains