Cemented Versus Cementless Total Knee Arthroplasty in Obese Patients With Body Mass Index ≥35 kg/m(2): A Contemporary Analysis of 812 Patients.

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Abstract

[Indexed for MEDLINE] 11. J Arthroplasty. 2018 Apr;33(4):1089-1093. doi: 10.1016/j.arth.2017.11.048. Epub 2017 Dec 2. Results of Cemented vs Cementless Primary Total Knee Arthroplasty Using the Same Implant Design. Miller AJ(1), Stimac JD(2), Smith LS(2), Feher AW(3), Yakkanti MR(4), Malkani AL(5). Author information: (1)University of Louisville School of Medicine, Louisville, Kentucky. (2)KentuckyOne Health Medical Group, Louisville, Kentucky. (3)Franciscan Health Total Joint Reconstruction, Carmel, Indiana. (4)Louisville Orthopaedic Clinic, Louisville, Kentucky. (5)Department of Orthopaedic Surgery, University of Louisville Adult Reconstruction Program, Louisville, Kentucky. BACKGROUND: Although cemented total knee arthroplasty (TKA) continues to be the gold standard, there are patient populations with higher failure rates with cemented TKAs such as the obese, morbidly obese, and younger active males. Cementless TKA usage continues to increase because of the potential benefits of long-term biologic fixation similar to the rise in cementless total hip arthroplasty. The purpose of this study was to evaluate the clinical and radiographic results of cementless TKA using a novel highly porous cementless tibial baseplate. METHODS: This was a retrospective matched case-control study of 400 primary TKAs comparing cementless vs cemented TKAs using the same implant design (Stryker Triathlon; Stryker Inc, Mahwah, NJ). Two-hundred patients with a mean age of 64 years (range 42-88 years) and body mass index (BMI) of 33.9 kg/m2 (range 19.7-57.1 kg/m2) were matched to 200 primary cemented TKA patients with a mean age of 64 years (range 43-87 years) and BMI of 33.1 kg/m2 (range 22.2-53.2 kg/m2). The mean follow-up in the cementless group was 2.4 years (range 2-3.5 years) and in the cemented group was 5.3 years (range 2-10.9 years). Clinical and radiographic analyses were evaluated. Statistical analysis was performed using the Microsoft Excel, version 15.21.1. RESULTS: There was no statistical difference in age, BMI, and preoperative Knee Society Scores between the 2 groups (P = .22, P = .82, and P = .43, respectively). Patients in both groups had a similar incidence of postoperative complications (P = .90). Cementless group had 7 revisions with one aseptic loosening of the tibial component (0.5%). Cementless tibial baseplates demonstrated areas of increased bone density at the pegs of the tibial baseplate. The cemented group had 8 total revisions with 5 cases of aseptic loosening (2.5%). CONCLUSION: Early results of cementless TKA using a highly porous tibial baseplate designed with a keel and 4 pegs appear promising with one case of aseptic loosening at minimum 2-year follow-up. As the demographics of patients undergoing TKA change to include younger, obese, and more active patients, along with increased life expectancy, the use of a highly porous cementless tibial baseplate may be beneficial in providing long-term durable biologic fixation similar to the success of cementless total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2017.11.048