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J Knee Surg
DOI: 10.1055/a-2332-5762
Special Focus Section

Selective Use of Modern Cementless Total Knee Arthroplasty is Not Associated with Increased Risk of Revision in Patients Aged 65 or Greater: An Analysis from the American Joint Replacement Registry

Ryland Kagan
1   Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
,
Christopher E. Pelt
2   Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
,
Harpal S. Khanuja
3   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland
,
Julius K. Oni 
3   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland
,
Isabella Zaniletti
4   Department of Registries and Data Science, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
,
Ayushmita De
4   Department of Registries and Data Science, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
,
Vishal Hegde
3   Department of Orthopaedic Surgery, The John Hopkins University, Baltimore, Maryland
› Author Affiliations Funding None.
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Abstract

Modern highly porous surfaces have increased confidence and use of cementless total knee arthroplasty (TKA) in the United States. As cementless TKA use increases, there remains a paucity of literature regarding associated risk of revision in patients aged ≥65 years. We analyzed the American Joint Replacement Registry (AJRR) data from January 2012 to March 2020 identifying patients aged ≥65 years undergoing primary TKA with linked cases to supplemental centers for Medicare and Medicaid data. Patients with hybrid fixation, reverse hybrid fixation, missing component data, highly constrained implants, and stem extension/augmentation were excluded. We identified 442,745 cemented TKAs and 19,841 modern cementless TKAs with a minimum of 2-year follow-up. Cumulative incident function (CIF) curves and cause-specific Cox models evaluated the risk of all-cause revision and revision for mechanical loosening, adjusting for body mass index (BMI), sex, age, cruciate retaining (CR) versus posterior stabilized (PS) femoral design, patellar resurfacing, and Charlson's comorbidity index (CCI). Patients with cementless compared with cemented TKA were younger (mean age: 71.9 vs. 73.2 years, p < 0.001), more likely to be male sex (48.8 vs. 39.0%, p < 0.001), more likely to have a CR femoral design (81.1 vs. 45.7%, p < 0.001), less likely to have patellar resurfacing (92.7 vs. 95.0%, p < 0.001), and had a lower CCI (mean: 2.9 vs. 3.1, p < 0.001). Adjusted hazard ratios (HRs) showed no difference in associated risk for all-cause revision (HR: 1.07; 95% confidence interval [CI]: 0.92–1.24; p = 0.382) or revision for mechanical loosening (HR: 1.38; 95% CI: 0.9–2.12; p = 0.14) for cementless versus cemented TKA. Our results suggest that current selective use of cementless fixation for TKA in patients aged ≥65 years in the United States is not associated with an increased risk of revision. While encouraging, further study is necessary to establish indications for use in this age group prior to broader adoption in this patient population.

Level of Evidence Therapeutic Level III.

Keywords

total knee arthroplasty - American Joint Replacement Registry - cementless total knee - registry


Publication History

Received: 15 April 2024

Accepted: 22 May 2024

Accepted Manuscript online:
24 May 2024

Article published online:
12 June 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Miller AJ, Stimac JD, Smith LS, Feher AW, Yakkanti MR, Malkani AL. Results of cemented vs cementless primary total knee arthroplasty using the same implant design. J Arthroplasty 2018; 33 (04) 1089-1093
    CrossrefPubMedGoogle Scholar
  • 2 Robertsson O, Bizjajeva S, Fenstad AM. et al. Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association. Acta Orthop 2010; 81 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 3 Berger RA, Lyon JH, Jacobs JJ. et al. Problems with cementless total knee arthroplasty at 11 years followup. Clin Orthop Relat Res 2001; (392) 196-207
    CrossrefPubMedGoogle Scholar
  • 4 Duffy GP, Berry DJ, Rand JA. Cement versus cementless fixation in total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 66-72
    CrossrefPubMedGoogle Scholar
  • 5 Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty 2010; 25 (04) 507-513
    CrossrefPubMedGoogle Scholar
  • 6 Wang H, Lou H, Zhang H, Jiang J, Liu K. Similar survival between uncemented and cemented fixation prostheses in total knee arthroplasty: a meta-analysis and systematic comparative analysis using registers. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3191-3197
    CrossrefPubMedGoogle Scholar
  • 7 Sumner DR, Kienapfel H, Jacobs JJ, Urban RM, Turner TM, Galante JO. Bone ingrowth and wear debris in well-fixed cementless porous-coated tibial components removed from patients. J Arthroplasty 1995; 10 (02) 157-167
    CrossrefPubMedGoogle Scholar
  • 8 Nodzo SR, Hohman DW, Hoy AS, Bayers-Thering M, Pavlesen S, Phillips MJ. Short term outcomes of a hydroxyapatite coated metal backed patella. J Arthroplasty 2015; 30 (08) 1339-1343
    CrossrefPubMedGoogle Scholar
  • 9 American Academy of Orthopaedic Surgeons. The eighths annual report of the AJRR on hip and knee arthroplasty. Available at: https://connect.registryapps.net/ . Accessed December 26, 2023
    PubMed
  • 10 Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented versus cementless total knee arthroplasty of the same modern design: a prospective, randomized trial. J Bone Joint Surg Am 2019; 101 (13) 1185-1192
    CrossrefPubMedGoogle Scholar
  • 11 Sinicrope BJ, Feher AW, Bhimani SJ. et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up. J Arthroplasty 2019; 34 (02) 309-314
    CrossrefPubMedGoogle Scholar
  • 12 Mont MA, Gwam C, Newman JM. et al. Outcomes of a newer-generation cementless total knee arthroplasty design in patients less than 50 years of age. Ann Transl Med 2017; 5 (Suppl. 03) S24
    CrossrefPubMedGoogle Scholar
  • 13 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 (08) 1390-1395
    CrossrefPubMedGoogle Scholar
  • 14 Dalury DF. Cementless total knee arthroplasty: current concepts review. Bone Joint J 2016; 98-B (07) 867-873
    CrossrefPubMedGoogle Scholar
  • 15 Smith PNGD, McAuliffe MJ, McDougall C. et al. Hip, Knee and Houlder Arthroplasty: 2023 Annual Report. Adelaide, South Australia:: Australian Orthopaedic Association National Joint Replacement Registry;; 2023
    CrossrefGoogle Scholar
  • 16 Reed M, Achakri H, Bridgens J. et al. National Joint Registry, England, Wales, Northern Ireland, the Isle of Man and Guernsey, 20th Annual Report 2023. London:: National Joint Registry;; 2022
    Google Scholar
  • 17 Jian YT, Yang Y, Tian T, Stanford C, Zhang XP, Zhao K. Effect of pore size and porosity on the biomechanical properties and cytocompatibility of porous NiTi alloys. PLoS One 2015; 10 (06) e0128138
    CrossrefPubMedGoogle Scholar
  • 18 Han Q, Wang C, Chen H, Zhao X, Wang J. Porous tantalum and titanium in orthopedics: a review. ACS Biomater Sci Eng 2019; 5 (11) 5798-5824
    CrossrefPubMedGoogle Scholar
  • 19 De Martino I, D'Apolito R, Sculco PK, Poultsides LA, Gasparini G. Total knee arthroplasty using cementless porous tantalum monoblock tibial component: a minimum 10-year follow-up. J Arthroplasty 2016; 31 (10) 2193-2198
    CrossrefPubMedGoogle Scholar
  • 20 Winther NS, Jensen CL, Jensen CM. et al. Comparison of a novel porous titanium construct (Regenerex®) to a well proven porous coated tibial surface in cementless total knee arthroplasty: a prospective randomized RSA study with two-year follow-up. Knee 2016; 23 (06) 1002-1011
    CrossrefPubMedGoogle Scholar
  • 21 Jones GG, Clarke S, Jaere M, Cobb J. 3D printing and unicompartmental knee arthroplasty. EFORT Open Rev 2018; 3 (05) 248-253
    CrossrefPubMedGoogle Scholar
  • 22 Murr LE, Amato KN, Li SJ. et al. Microstructure and mechanical properties of open-cellular biomaterials prototypes for total knee replacement implants fabricated by electron beam melting. J Mech Behav Biomed Mater 2011; 4 (07) 1396-1411
    CrossrefPubMedGoogle Scholar
  • 23 Hannon CP, Salih R, Barrack RL, Nunley RM. Cementless versus cemented total knee arthroplasty: concise midterm results of a prospective randomized controlled trial. J Bone Joint Surg Am 2023; 105 (18) 1430-1434
    CrossrefPubMedGoogle Scholar
  • 24 American Academy of Orthopaedic Surgeons (AAOS) American Joint Replacement Registry. (AJRR); . AJRR Annual Report. Rosemont, IL; AAOS; 2020