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
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 11/2013

01-11-2013 | Clinical Research

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Authors: Mariano Fernandez-Fairen, MD, PhD, Daniel Hernández-Vaquero, MD, PhD, Antonio Murcia, MD, PhD, Ana Torres, MD, PhD, Rafael Llopis, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 11/2013

Login to get access

Abstract

Background

Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup.

Questions/purposes

We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant.

Methods

We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied.

Results

At 5-year followup the KSS mean was 90.4 (range, 68–100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56–99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0–51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4–61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was −4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups.

Conclusions

Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.

Level of Evidence

Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
Literature
1.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger T Jr, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rotschild B, Segal M, Sokoloff L, Wolfe F. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049.CrossRefPubMed
2.
Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45:384–391.CrossRefPubMed
3.
Arnold JB, Walters JL, Solomon LB, Thewlis D. Does the method of component fixation influence clinical outcomes after total knee replacement? A systematic literature review. J Arthroplasty. 2013;28:740–746.CrossRefPubMed
4.
5.
Baker PN, Khaw FM, Kirk LM, Esler CN, Gregg PJ. A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis. J Bone Joint Surg Br. 2007;89:1608–1614.PubMed
6.
Balla VK, Bodhak S, Bose S, Bandyopadhyay A. Porous tantalum structures for bone implants: fabrication, mechanical and in vitro biological properties. Acta Biomater. 2010;6:3349–3359.CrossRefPubMed
7.
Bassett RW. Results of 1,000 Performance knees: cementless versus cemented fixation. J Arthroplasty. 1998;13:409–413.CrossRefPubMed
8.
Bertin KC. Tibial component fixation in total knee arthroplasty: a comparison of pegged and stemmed designs. J Arthroplasty. 2007;22:670–678.CrossRefPubMed
9.
Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA. All-polyethylene compared with metal-backed tibial components in total knee arthroplasty at ten years: a prospective, randomized controlled trial. J Bone Joint Surg Am. 2009;91:1587–1594.CrossRefPubMed
10.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMed
11.
Clarke HD, Cushner FD. Monoblock tibial components in total knee arthroplasty. Tech Knee Surg. 2008;7:115–125.CrossRef
12.
Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients: long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997;79:575–582.PubMed
13.
Duffy GP, Crowder AR, Trousdale RR, Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty. 2007;22(6 suppl 2):67–70.CrossRefPubMed
14.
Dunbar MJ, Wilson DA, Hennigar AW, Amirault JD, Gross M, Reardon GP. Fixation of Trabecular Metal knee arthroplasty component: a prospective randomized study. J Bone Joint Surg Am. 2009;91:1578–1586.CrossRefPubMed
15.
Escobar A, Quintana JM, Bilbao A, Azkárate J, Güenaga JI. Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis: Western Ontario and McMaster Universities Osteoarthritis Index. Clin Rheumatol. 2002;21:466–471.CrossRefPubMed
16.
Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.PubMed
17.
Forster MC. Survival analysis of primary cemented total knee arthroplasty: which designs last? J Arthroplasty. 2003;18:265–270.CrossRefPubMed
18.
Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994–2000. Acta Orthop Scand. 2002;73:117–129.CrossRefPubMed
19.
Gandhi R, Tsvetkov D, Davey JR, Mahomed NN. Survival and clinical function of cemented and uncemented prostheses in total knee replacement: a meta-analysis. J Bone Joint Surg Br. 2009;91:889–895.PubMed
20.
Ghalayini SR, Helm AT, McLauchlan GJ. Minimum 6 year results of an uncemented trabecular metal tibial component in total knee arthroplasty. Knee. 2012;19:872–874.CrossRefPubMed
21.
Gill GS, Joshi AB. Long-term results of Kinematic Condylar knee replacement: an analysis of 404 knees. J Bone Joint Surg Br. 2001;83:355–358.CrossRefPubMed
22.
Harrison AK, Gioe TJ, Simonelli C, Tatman PJ, Schoeller MC. Do porous tantalum implants help preserve bone?: evaluation of tibial bone density surrounding tantalum tibial implants in TKA. Clin Orthop Relat Res. 2010;468:2739–2745.CrossRefPubMed
23.
Henricson A, Linder L, Nilsson KG. A trabecular metal tibial component in total knee replacement in patients younger than 60 years: a two-year radiostereophotogrammetric analysis. J Bone Joint Surg Br. 2008;90:1585–1593.PubMed
24.
Hofmann AA, Evanich JD, Ferguson RP, Camargo MP. Ten- to 14-year clinical follow-up of the cementless Natural Knee system. Clin Orthop Relat Res. 2001;388:85–94.CrossRefPubMed
25.
Hofmann AA, Heithoff SM, Camargo M. Cementless total knee arthroplasty in patients 50 years or younger. Clin Orthop Relat Res. 2002;404:102–107.CrossRefPubMed
26.
Illgen R, Tueting J, Enright T, Schreibman K, McBeath A, Heiner J. Hybrid total knee arthroplasty: a retrospective analysis of clinical and radiographic outcomes at average 10 years follow-up. J Arthroplasty. 2004;19(7 suppl 2):95–100.CrossRefPubMed
27.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;284:13–14.
28.
Joshi AB, Gill GS, Smith PL. Outcome in patients lost to follow-up. J Arthroplasty. 2003;18:149–153.CrossRefPubMed
29.
Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis: a follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop. 2010;81:413–419.CrossRefPubMed
30.
Kamath AF, Lee GC, Sheth NP, Nelson CL, Garino JP, Israelite CL. Prospective results of uncemented tantalum monoblock tibia in total knee arthroplasty: minimum 5-year follow-up in patients younger than 55 years. J Arthroplasty. 2011;26:1390–1395.CrossRefPubMed
31.
Kane RL, Saleh KJ, Wilt TJ, Bershaddsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1719–1724.CrossRefPubMed
32.
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.CrossRefPubMed
33.
Khaw FM, Kirk LM, Morris RW, Gregg PJ. A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement: ten-year survival analysis. J Bone Joint Surg Br. 2002;84:658–666.CrossRefPubMed
34.
Klein GR, Levine HB, Hartzband MA. Removal of a well-fixed trabecular metal monoblock tibial component. J Arthroplasty. 2008;23:619–622.CrossRefPubMed
35.
Laskin RS. The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res. 2001;388:95–102.CrossRefPubMed
36.
Levine BR, Sporer S, Poggie RA, Della Valle CJ, Jacobs JJ. Experimental and clinical performance of porous tantalum in orthopedic surgery. Biomaterials. 2006;27:4671–4681.CrossRefPubMed
37.
Lombardi AV Jr, Berasi CC, Berend KR. Evolution of tibial fixation in total knee arthroplasty. J Arthroplasty. 2007;22(4 suppl 1):25–29.CrossRefPubMed
38.
Long WJ, Scuderi GR. Cement fixation in primary total knee arthroplasty. Tech Knee Surg. 2011;10:148–153.CrossRef
39.
Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res. 2000;380:85–90.CrossRefPubMed
40.
Milchteim C, Unger AS. Cementless fixation in high performance knee design. Tech Knee Surg. 2011;10:136–142.CrossRef
41.
Minoda Y, Kobayashi A, Iwaki H, Ikebuchi M, Inori F, Takaoka K. Comparison of bone mineral density between porous tantalum and cemented tibial total knee arthroplasty components. J Bone Joint Surg Am. 2010;92:700–706.CrossRefPubMed
42.
Nakama GY, Peccin MS, Almeida GJ, Lira Neto Ode A, Queiroz AA, Navarro RD. Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev. 2012;10:CD006193.PubMed
43.
44.
Nilsson KG, Kärrholm J, Ekelund L, Magnusson P. Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthritis and rheumatoid arthritis: randomized study using roentgen stereophotogrammetric analysis. J Arthroplasty. 1991;6:265–278.CrossRefPubMed
45.
O’Keefe TJ, Winter S, Lewallen DG, Robertson DD, Poggie RA. Clinical and radiographic evaluation of a monoblock tibial component. J Arthroplasty. 2010;25:785–792.CrossRefPubMed
46.
Park JW, Kim YH. Simultaneous cemented and cementless total knee replacement in the same patients: a prospective comparison of long-term outcomes using an identical design of NexGen prosthesis. J Bone Joint Surg Br. 2011;93:1479–1486.CrossRefPubMed
47.
Parker DA, Rorabeck CH, Bourne RB. Long-term followup of cementless versus hybrid fixation for total knee arthroplasty. Clin Orthop Relat Res. 2001;388:68–76.CrossRefPubMed
48.
Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term followup. Clin Orthop Relat Res. 2001;388:18–25.CrossRefPubMed
49.
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003:85:259–265.PubMed
50.
Ritter MA, Herbst SA, Keating EM, Faris PM. Radiolucency at the bone-cement interface in total knee replacement: the effects of bone-surface preparation and cement technique. J Bone Joint Surg Am. 1994;76:60–65.PubMed
51.
Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty. 2010;25:507–513.CrossRefPubMed
52.
Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975–1997: an update with special emphasis on 41,223 knees operated on in 1988–1997. Acta Orthop Scand. 2001;72:503–513.CrossRefPubMed
53.
Rodricks DJ, Patil S, Pulido P, Colwell WC Jr. Press-fit condylar design total knee arthroplasty: fourteen to seventeen-year follow-up. J Bone Joint Surg Am. 2007;89:89–95.CrossRefPubMed
54.
Rodríguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res. 2001;388:10–17.CrossRefPubMed
55.
Sambaziotis C, Lovy AJ, Koller KE, Bloebaum RD, Hirsh DM, Kim SJ. Histologic retrieval analysis of a porous tantalum metal implant in an infected primary total knee arthroplasty. J Arthroplasty. 2012;27:1413.e5–9.
56.
Sanchez Marquez JM, Del Sel N, Leali A, Gonzalez Della Valle A. Case reports: tantalum debris dispersion during revision of a tibial component for TKA. Clin Orthop Relat Res. 2009;467:1107–1110.
57.
Shields RK, Enloe LJ, Leo KC. Health related quality of life in patients with total hip or knee replacement. Arch Phys Med Rehabil. 1999;80:572–579.CrossRefPubMed
58.
Stern SH, Wills RD, Gilbert JL. The effect of tibial stem design on component micromotion in knee arthroplasty. Clin Orthop Relat Res. 1997;345:44–52.CrossRefPubMed
59.
Stilling M, Madsen F, Odgaard A, Rømer L, Andersen NT, Rahbek O, Søballe K. Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh: a randomized clinical RSA study on cementless tibial components. Acta Orthop. 2011;82:177–186.CrossRefPubMed
60.
61.
62.
Toksvig-Larsen S, Ryd L, Lindstrand A. Early inducible displacement of tibial components in total knee prostheses inserted with and without cement: a randomized study with roentgen stereophotogrammetric analysis. J Bone Joint Surg Am. 1998;80:83–89.CrossRefPubMed
63.
Unger AS, Duggan JP. Midterm results of a porous tantalum monoblock tibia component: clinical and radiographic results of 108 knees. J Arthroplasty. 2011;26:855–860.CrossRefPubMed
64.
Voigt J, Mosier M. Cemented all-polyethylene and metal-backed polyethylene tibial components used for primary total knee arthroplasty: a systematic review of the literature and meta-analysis of randomized controlled trials involving 1798 primary total knee implants. J Bone Joint Surg Am. 2011;93:1790–1798.CrossRefPubMed
65.
Whiteside LA. Does fixation matter: cementless fixation for primary TKA. Tech Knee Surg. 2011;10:129–135.CrossRef
66.
Whiteside LA, Vigano R. Young and heavy patients with a cementless TKA do as well as older and lightweight patients. Clin Orthop Relat Res. 2007;464:93–98.PubMed
67.
Wilson DA, Richardson G, Hennigar AW, Dunbar MJ. Continued stabilization of trabecular metal tibial monoblock total knee arthroplasty components at 5 years: measured with radiostereometric analysis. Acta Orthop. 2012;83:36–40.CrossRefPubMed
68.
Zardiackas LD, Parsell DE, Dillon LD, Mitchell DV, Nunnery LA, Poggie R. Structure, metallurgy, and mechanical properties of a porous tantalum foam. J Biomed Mater Res. 2001;58:180–187.CrossRefPubMed
Metadata
Title
Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial
Authors
Mariano Fernandez-Fairen, MD, PhD
Daniel Hernández-Vaquero, MD, PhD
Antonio Murcia, MD, PhD
Ana Torres, MD, PhD
Rafael Llopis, MD, PhD
Publication date
01-11-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 11/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-3183-4

Other articles of this Issue 11/2013

Clinical Orthopaedics and Related Research® 11/2013 Go to the issue

Clinical Research

Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report?

Letter to the Editor

Letter to the Editor: Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

CORR Insights®

CORR Insights®: Bariatric Orthopaedics: Total Knee Arthroplasty in Super-obese Patients (BMI > 50 kg/m2). Survivorship and Complications

Basic Research

Bone Microarchitecture of the Talus Changes With Aging

Reply to the Letter to the Editor

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

CORR Insights®

CORR Insights®: Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial