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Chahidi E, Martinov S, Simion F, Mercier C, Sabot L, Kyriakydis T, Callewier A, Hernigou J. Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis. SICOT J 2024; 10:22. [PMID: 38819292 DOI: 10.1051/sicotj/2024017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. METHODS Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. RESULTS When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. CONCLUSION We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period.
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Affiliation(s)
- Esfandiar Chahidi
- Université Libre de Bruxelles, Av. Franklin Roosevelt 50, 1050 Brussels, Belgium
| | - Sagi Martinov
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals, Rue Louis Caty 136, 7331 Saint-Ghislain, Hainaut, Belgium
| | - Filip Simion
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals, Rue Louis Caty 136, 7331 Saint-Ghislain, Hainaut, Belgium
| | - Camille Mercier
- Université Libre de Bruxelles, Av. Franklin Roosevelt 50, 1050 Brussels, Belgium
| | - Liam Sabot
- Université Libre de Bruxelles, Av. Franklin Roosevelt 50, 1050 Brussels, Belgium
| | - Theofylaktos Kyriakydis
- 2nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital, Thessaloniki, Hellas, Greece
| | - Antoine Callewier
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals, Rue Louis Caty 136, 7331 Saint-Ghislain, Hainaut, Belgium
| | - Jacques Hernigou
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals, Rue Louis Caty 136, 7331 Saint-Ghislain, Hainaut, Belgium - Laboratoire de Biochimie Osseuse et Métabolique ULB, Bone and Metabolic Biochemistry Research Laboratory, Université Libre de Bruxelles, Lenniksebaan 808, 1070 Brussels, Belgium
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Reading L, Brown C, Pasqualini I, Huffman N, Piuzzi NS. 24-Year-Old Patient with Klippel-Trenaunay Syndrome Underwent Cementless Robotic Cruciate-Retaining TKA: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00008. [PMID: 38608129 DOI: 10.2106/jbjs.cc.23.00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
CASE A 24-year-old man with Klippel-Trenaunay syndrome (KTS) presented with severe knee osteoarthritis unresponsive to conservative measures. Owing to end-stage, debilitating arthritic symptoms, surgery was pursued. Careful preoperative, multidisciplinary planning/treatment included magnetic resonance imaging to characterize the venous malformations throughout the right lower extremity, preoperative sclerotherapy, sirolimus, and robotic-assisted cementless total knee arthroplasty (TKA). CONCLUSION Cementless robotic-assisted TKA with selective patellar resurfacing can be a viable option for young KTS patients with severe osteoarthritis when a meticulous multidisciplinary approach, including sclerotherapy and advanced imaging, is undertaken to analyze vascular abnormalities, minimize surgical risks, preserve bone stock, and optimize outcomes.
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Affiliation(s)
- Landon Reading
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Colin Brown
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | | | - Nickelas Huffman
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Frazer A, Lim JBT, Teeter MG, Howard J, Vasarhelyi EM, Lanting BA. Gap patterns and radiographic follow-up of newer-generation cementless total knee arthroplasty designs. Can J Surg 2024; 67:E85-E90. [PMID: 38453351 PMCID: PMC10927283 DOI: 10.1503/cjs.008223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Interest in cementless total knee arthroplasty (TKA) has increased with advancement of biomaterials and implant design and associated improved longevity. We sought to evaluate the gap patterns and radiolucent zones radiographically for 2 newer-generation cementless TKA designs. METHODS We retrospectively reviewed our single-institution database between January 2017 and December 2019. We identified patients with a porous keeled tibia base-plate with 4-bullet cruciform spikes and peri-apatite coated femoral component (study group 1) and patients who received a cementless porous coated femoral component and rotating platform tibia baseplate with 4 peripheral porous coated pegs around a central cone (study group 2). We identified gap patterns at 6 weeks and at 1 year or more postoperatively on radiographs, noting indications for reoperation. RESULTS We identified 228 patients in study group 1 and 41 patients in study group 2. At 1-year follow-up, we found evidence of resolved femoral gaps in 52 (72.2%) of 72 patients in study group 1 and 10 (58.8%) of 17 patients in study group 2 (p = 0.124). We identified 27 (84.3%) of 32 patients in study group 1 and 7 (70.0%) of 10 patients in study group 2 with resolved tibia gaps (p = 0.313). After 1 year, there were significantly more Zone 3a femoral zonal radiolucent gaps (p = 0.001) and Zone 8 tibia zonal radiolucent gaps (p = 0.002) in study group 2 than in study group 1. There were 4 reoperations for study group 1 and 0 reoperations for study group 2. CONCLUSION The modern cementless TKA systems have varied gap patterns in postoperative radiographs, which may be attributed to the implant design. Most radiolucent gaps resolve radiographically on follow-up.
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Affiliation(s)
- Abigail Frazer
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Jason B T Lim
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Matthew G Teeter
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - James Howard
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Edward M Vasarhelyi
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Brent A Lanting
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
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Kakoulidis P, Panagiotidou S, Profitiliotis G, Papavasiliou K, Tsiridis E, Topalis C. Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:3684-3700. [PMID: 36522493 DOI: 10.1007/s00167-022-07238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters. METHODS A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. RESULTS Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05). DISCUSSION The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Panagiotis Kakoulidis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Sousana Panagiotidou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | | | - Kyriakos Papavasiliou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Christos Topalis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Uivaraseanu B, Vesa C, Tit D, Abid A, Maghiar O, Maghiar T, Hozan C, Nechifor A, Behl T, Patrascu J, Bungau S. Therapeutic approaches in the management of knee osteoarthritis (Review). Exp Ther Med 2022; 23:328. [DOI: 10.3892/etm.2022.11257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Bogdan Uivaraseanu
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Cosmin Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Delia Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Areha Abid
- Department of Food Science, Faculty of Agricultural and Food Sciences, University of Debrecen, Debrecen 4032, Hungary
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Teodor Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Calin Hozan
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410081, Romania
| | - Aurelia Nechifor
- Department of Analytical Chemistry and Environmental Engineering, Polytechnic University of Bucharest, Bucharest 011061, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Jenel Patrascu
- Department of Orthopedics, Urology and Medical Imaging, Faculty of Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
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