Cementless Highly Porous Titanium Tibial Base Plate in Total Knee Arthroplasty – Midterm Outcomes.
DOI:
https://doi.org/10.15438/rr.11.1.235Keywords:
cementless tibia, Regenerex, cementless total knee arthropasty, VanguardAbstract
Introduction & Aims
TKA in more active and young patients has prompted the interest in more durable and biological methods of Osteo-integration with cementless components. With the emergence of improved biomaterials like porous titanium and the success, search for a cementless TKA with long-term durability and survivorship may have ended. This is a retrospective study of 492 consecutive TKAs using Cementless tibial fixation, reporting on the early 4 years clinical and radiological outcomes.
Method
We studied 492 TKAs performed consecutively by a single surgeon between 1stJan. 2010 and 31stDec. 2015 using a cementless, fixed bearing tibial tray (porous–Regenerex, Vanguard, Zimmer-Biomet) and a cementless femoral component (Vanguard) with no exclusion criteria. Clinical and radiological follow-up was done on these patients and in addition a comprehensive joint registry review was performed on the whole cohort (Level II evidence).
Results
The average Knee Society Score at final follow-up was 89.33, average pre-op being 42.06. Average post-op WOMAC score was 43.45 and average pre-op was 77.78. On radiological examination, no patients had osteolysis around tibial base plate. In our series 9 patients were revised, out of which only 4 patients had the tibial tray and femoral component revised and 5 patients had patella resurfacing or liner exchange. Overall survivorship of the cementless tibial component is excellent with a survivorship of 99.4% at 5.9 years based on a comprehensive AOANJRR data.
Conclusions
Cementless tibial fixation using a porous titanium construct can provide stable bone ingrowth fixation on the tibial side with excellent and predictable early 4 to 5 year clinical and radiological outcomes.
References
Lombardi AV Jr, Berasi CC, Berend KR. Evolution of tibial fixation in total knee arthroplasty. J Arthroplasty. 2007; 22:25–29.
Nilsson KG, Karrholm J, Carlsson L, Dalen T. Hydroxyapatite coating versus cemented fixation of the tibial component in total knee arthroplasty: prospective randomized comparison of hydroxyapatite-coated and cemented tibial components with 5-year follow-up using radiostereometry. J Arthroplasty Jan 1999; 14(1):9–20.
Nehme A, Lewallen DG, Hanssen AD. Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res. 2004; 429:201–208.
Barrack RL, Nakamura SJ, Hopkins SG, Rosenzweig S. Winner of the 2003 James A. Rand young investigator’s award. Early failure of cement-less mobile-bearing total knee arthroplasty. J Arthroplasty. 2004; 19:101–106.
Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg (Br) Sep 1999;81(5):907–14.
Meneghini RM, Mont MA, Backstein DB, Bourne RB, Dennis DA, Scuderi GR. Development of a Modern Knee Society Radiographic Evaluation System and Methodology for Total Knee Arthroplasty. The Journal of arthroplasty. 2015;30(12):2311-4.
Orthopaedic Registeries : The Australian Experience. 385 EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180071
Biomet Orthopedics, Inc. 01–50-0926 P.O. Box 587 56 East Bell Drive Warsaw, Indiana 46581 Regenerex® Porous Titanium Construct - Biomet/Regenerex-Brochure.pdf.
Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H. The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop. 2009;33(5):1263–8.
Ledin H., Aspenberg P., Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop. 2012;83:499.
Harwin SF, Kester MA, Malkani AL, Manley MT. Excellent fixation achieved with cementless posteriorly stabilized total knee arthroplasty. The Journal of arthroplasty. 2013;28(1):7-13.
Moran CG, Pinder IM, Lees TA, Midwinter MJ. Survivorship analysis of the uncemented porous-coated anatomic knee replacement. The Journal of bone and joint surgery American volume. 1991;73(6):848-57.
Berger RA, Lyon JH, Jacobs JJ, Barden RM, Berkson EM, Sheinkop MB, et al. Problems with cementless total knee arthroplasty at 11 years followup. Clinical orthopaedics and related research. 2001(392):196-207
Rosenberg AG, Andriacchi TP, Barden R, Galante JO. Patellar component failure in cementless total knee arthroplasty. Clinical orthopaedics and related research. 1988(236):106-14.
Whiteside LA. Effect of porous-coating configuration on tibial osteolysis after total knee arthroplasty. Clinical orthopaedics and related research. 1995(321):92-7.
Stilling M, Madsen F, Odgaard A, Romer L, Andersen NT, Rahbek O, et al. Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh: a randomized clinical RSA study on cementless tibial components. Acta orthopaedica. 2011;82(2):177-86.
Ian P. Holloway, Patrick J. Lusty, William L. Walter, William K. Walter, Bernie A. Zicat. Tibial Fixation Without Screws in Cementless Knee Arthroplasty. The Journal of Arthroplasty Vol. 25 No. 1, 2010.
Hayakawa K, Date H, Tsujimura S, Nojiri S, Yamada H, Nakagawa K. Mid-term results of total knee arthroplasty with a porous tantalum monoblock tibial component. The Knee. 2014;21(1):199-203.
Hofmann AA, Evanich JD, Ferguson RP, Camargo MP. Ten- to 14-year clinical followup of the cementless Natural Knee system. Clinical orthopaedics and related research. 2001(388):85-94.
Dunbar MJ, Wilson DA, Hennigar AW, Amirault JD, Gross M, Reardon GP. Fixation of a trabecular metal knee arthroplasty component. A prospective randomized study. J Bone Joint Surg Am. 2009; 91:1578–1586.
Niemelainen M, Skytta ET, Remes V, Makela K, Eskelinen A. Total knee arthroplasty with an uncemented trabecular metal tibial component: a registry-based analysis. J Arthroplasty. 2014; 29:57–60.
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.
Winther N, Jensen C, Petersen M, Lind T, Schroder H, Petersen M. Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A prospective randomized study. International orthopaedics. 2016;40(2):285-94.
Winther NS, Jensen CL, Jensen CM, Lind T, Schroder HM, Flivik G, et al. Comparison of a novel porous titanium construct (Regenerex(R)) to a well proven porous coated tibial surface in cementless total knee arthroplasty - A prospective randomized RSA study with two-year follow-up. The Knee. 2016;23(6):1002-11.
Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. The Journal of Arthroplasty. 2010;25(4):507-13.
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