Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2020

01-12-2020 | Knee-TEP | KNEE

Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up

Authors: Gaspard Fournier, Can Yener, Romain Gaillard, Raymond Kenney, Sébastien Lustig, Elvire Servien

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2020

Login to get access

Abstract

Purpose

Total knee arthroplasty (TKA) is frequently performed for obese patients. TKA in this population shows a high rate of complication, particularly tibial component loosening. The aim of this study is to compare the survival rate of tibial components in obese population using TKA with stem versus without stem.

Methods

From a prospective database of 4216 TKA, obese patients [body mass index (BMI) > 30 kg m²] with primary TKA using a tibial short stem extension (30 mm) at a minimum follow-up of 2 years were retrospectively reviewed and compared to a matched control group (1:3 ratio) with a standard tibial stem. Inclusion criteria were BMI > 30 kg m², first knee surgery and 24 months minimum of follow-up. The primary outcome was revision for tibial aseptic loosening. Secondary outcomes were all-cause revisions and Knee Society Scores (KSS).

Results

The final study population consisted of 35 TKA with tibial extension stem versus 105 TKA with standard stem. The mean age was 69.2 and 69.5 years, respectively, with a mean follow-up of 52 months. Both groups were comparable before surgery. After 2 years of follow-up, we observed seven tibial loosening in the group without stem (6.6%) versus no tibial loosening in the stemmed group (p < 0.001). The difference in KSS knee score (83 versus 86; p = 0.06) and the KSS function score (73 versus 77; p = 0.84) were not statistically significant at the final follow-up.

Conclusion

Using stemmed TKA for obese patients significantly decreased tibial loosening rate at minimum 2 years of follow-up.

Level of evidence

Case–control study, Level III.
Literature
1.
go back to reference Abdel MP, Bonadurer GF 3rd, Jennings MT, Hanssen AD (2015) Increased aseptic tibial failures in patients with a BMI >= 35 and well-aligned total knee arthroplasties. J Arthroplasty 30:2181–2184CrossRef Abdel MP, Bonadurer GF 3rd, Jennings MT, Hanssen AD (2015) Increased aseptic tibial failures in patients with a BMI >= 35 and well-aligned total knee arthroplasties. J Arthroplasty 30:2181–2184CrossRef
2.
go back to reference Angers-Goulet M, Bedard M (2017) Up to seven years' follow-up of short cemented stems in complex primary total knee arthroplasty: a prospective study. Knee 24:1166–1174CrossRef Angers-Goulet M, Bedard M (2017) Up to seven years' follow-up of short cemented stems in complex primary total knee arthroplasty: a prospective study. Knee 24:1166–1174CrossRef
3.
go back to reference Baker P, Muthumayandi K, Gerrand C, Kleim B, Bettinson K, Deehan D (2013) Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PLoS ONE 8:e59079CrossRef Baker P, Muthumayandi K, Gerrand C, Kleim B, Bettinson K, Deehan D (2013) Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PLoS ONE 8:e59079CrossRef
4.
go back to reference Barlow BT, Oi KK, Lee YY, Joseph AD, Alexiades MM (2017) Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3611–3619CrossRef Barlow BT, Oi KK, Lee YY, Joseph AD, Alexiades MM (2017) Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3611–3619CrossRef
5.
go back to reference Berend ME, Ritter MA, Hyldahl HC, Meding JB, Redelman R (2008) Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size. J Arthroplasty 23:104–109CrossRef Berend ME, Ritter MA, Hyldahl HC, Meding JB, Redelman R (2008) Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size. J Arthroplasty 23:104–109CrossRef
6.
go back to reference Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34CrossRef Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34CrossRef
7.
go back to reference Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217–1222CrossRef Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217–1222CrossRef
8.
go back to reference Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A (2009) Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord 10:29CrossRef Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A (2009) Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord 10:29CrossRef
9.
go back to reference Bozic KJ, Lau E, Ong K, Chan V, Kurtz S, Vail TP et al (2014) Risk factors for early revision after primary TKA in Medicare patients. Clin Orthop Relat Res 472:232–237CrossRef Bozic KJ, Lau E, Ong K, Chan V, Kurtz S, Vail TP et al (2014) Risk factors for early revision after primary TKA in Medicare patients. Clin Orthop Relat Res 472:232–237CrossRef
10.
go back to reference Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43CrossRef Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43CrossRef
11.
go back to reference Fehring TK, Fehring KA, Anderson LA, Otero JE, Springer BD (2017) Catastrophic varus collapse of the tibia in obese total knee arthroplasty. J Arthroplasty 32:1625–1629CrossRef Fehring TK, Fehring KA, Anderson LA, Otero JE, Springer BD (2017) Catastrophic varus collapse of the tibia in obese total knee arthroplasty. J Arthroplasty 32:1625–1629CrossRef
12.
go back to reference Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS (2004) Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 19:817–824CrossRef Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS (2004) Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 19:817–824CrossRef
13.
go back to reference Gaillard R, Lustig S, Peltier A, Villa V, Servien E, Neyret P (2016) Total knee implant posterior stabilised by a third condyle: design evolution and post-operative complications. Orthop Traumatol Surg Res 102:1061–1068CrossRef Gaillard R, Lustig S, Peltier A, Villa V, Servien E, Neyret P (2016) Total knee implant posterior stabilised by a third condyle: design evolution and post-operative complications. Orthop Traumatol Surg Res 102:1061–1068CrossRef
14.
go back to reference George J, Klika AK, Navale SM, Newman JM, Barsoum WK, Higuera CA (2017) Obesity epidemic: is its impact on total joint arthroplasty underestimated? An analysis of national trends. Clin Orthop Relat Res 475:1798–1806CrossRef George J, Klika AK, Navale SM, Newman JM, Barsoum WK, Higuera CA (2017) Obesity epidemic: is its impact on total joint arthroplasty underestimated? An analysis of national trends. Clin Orthop Relat Res 475:1798–1806CrossRef
15.
go back to reference Gopalakrishnan A, Hedley AK, Kester MA (2011) Magnitude of cement-device interfacial stresses with and without tibial stemming: impact of BMI. J Knee Surg 24:3–8CrossRef Gopalakrishnan A, Hedley AK, Kester MA (2011) Magnitude of cement-device interfacial stresses with and without tibial stemming: impact of BMI. J Knee Surg 24:3–8CrossRef
16.
go back to reference Issa K, Pivec R, Kapadia BH, Shah T, Harwin SF, Delanois RE et al (2013) Does obesity affect the outcomes of primary total knee arthroplasty? J Knee Surg 26:89–94CrossRef Issa K, Pivec R, Kapadia BH, Shah T, Harwin SF, Delanois RE et al (2013) Does obesity affect the outcomes of primary total knee arthroplasty? J Knee Surg 26:89–94CrossRef
17.
go back to reference Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 94:1839–1844CrossRef Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 94:1839–1844CrossRef
18.
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
19.
go back to reference Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax-Outcomes G (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83:1856–1864CrossRef Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax-Outcomes G (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83:1856–1864CrossRef
20.
go back to reference Matta J, Carette C, Rives Lange C, Czernichow S (2018) French and worldwide epidemiology of obesity. Presse Med 47:434–438CrossRef Matta J, Carette C, Rives Lange C, Czernichow S (2018) French and worldwide epidemiology of obesity. Presse Med 47:434–438CrossRef
21.
go back to reference Nadorf J, Kinkel S, Gantz S, Jakubowitz E, Kretzer JP (2017) Tibial revision knee arthroplasty with metaphyseal sleeves: the effect of stems on implant fixation and bone flexibility. PLoS ONE 12:e0177285CrossRef Nadorf J, Kinkel S, Gantz S, Jakubowitz E, Kretzer JP (2017) Tibial revision knee arthroplasty with metaphyseal sleeves: the effect of stems on implant fixation and bone flexibility. PLoS ONE 12:e0177285CrossRef
22.
go back to reference Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20:46–50CrossRef Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20:46–50CrossRef
23.
go back to reference Park MH, Bin SI, Kim JM, Lee BS, Lee CR, Kwon YH (2018) Using a tibial short extension stem reduces tibial component loosening after primary total knee arthroplasty in severely varus knees: long-term survival analysis with propensity score matching. J Arthroplasty 33:2512–2517CrossRef Park MH, Bin SI, Kim JM, Lee BS, Lee CR, Kwon YH (2018) Using a tibial short extension stem reduces tibial component loosening after primary total knee arthroplasty in severely varus knees: long-term survival analysis with propensity score matching. J Arthroplasty 33:2512–2517CrossRef
24.
go back to reference Parratte S, Ollivier M, Lunebourg A, Verdier N, Argenson JN (2017) Do stemmed tibial components in total knee arthroplasty improve outcomes in patients with obesity? Clin Orthop Relat Res 475:137–145CrossRef Parratte S, Ollivier M, Lunebourg A, Verdier N, Argenson JN (2017) Do stemmed tibial components in total knee arthroplasty improve outcomes in patients with obesity? Clin Orthop Relat Res 475:137–145CrossRef
25.
go back to reference Scott CE, Biant LC (2012) The role of the design of tibial components and stems in knee replacement. J Bone Joint Surg Br 94:1009–1015CrossRef Scott CE, Biant LC (2012) The role of the design of tibial components and stems in knee replacement. J Bone Joint Surg Br 94:1009–1015CrossRef
26.
go back to reference Si HB, Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD et al (2015) The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1824–1832CrossRef Si HB, Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD et al (2015) The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1824–1832CrossRef
27.
go back to reference Steere JT, Sobieraj MC, DeFrancesco CJ, Israelite CL, Nelson CL, Kamath AF (2018) Prophylactic tibial stem fixation in the obese: comparative early results in primary total knee arthroplasty. Knee Surg Relat Res 30:227–233CrossRef Steere JT, Sobieraj MC, DeFrancesco CJ, Israelite CL, Nelson CL, Kamath AF (2018) Prophylactic tibial stem fixation in the obese: comparative early results in primary total knee arthroplasty. Knee Surg Relat Res 30:227–233CrossRef
28.
go back to reference Wagner ER, Kamath AF, Fruth K, Harmsen WS, Berry DJ (2016) Effect of body mass index on reoperation and complications after total knee arthroplasty. J Bone Joint Surg Am 98:2052–2060CrossRef Wagner ER, Kamath AF, Fruth K, Harmsen WS, Berry DJ (2016) Effect of body mass index on reoperation and complications after total knee arthroplasty. J Bone Joint Surg Am 98:2052–2060CrossRef
Metadata
Title
Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up
Authors
Gaspard Fournier
Can Yener
Romain Gaillard
Raymond Kenney
Sébastien Lustig
Elvire Servien
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Keywords
Knee-TEP
Knee-TEP
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05860-6

Other articles of this Issue 12/2020

Knee Surgery, Sports Traumatology, Arthroscopy 12/2020 Go to the issue