Abstract
A cementless femoral component may allow for a smaller surgical incision when a minimally invasive approach is used during primary total knee arthroplasty. Fixation by cement is the gold standard for total knee arthroplasty. The results of cementless total knee arthroplasty are mixed. Cementless femoral components have done well. Although some tibial components have performed well at long-term follow-up, others have been plagued by high rates of loosening and revision. The question remains whether the results of hybrid total knee arthroplasty, consisting of an uncemented femoral component and a cemented tibial component, will equal those of total knee replacement fixed with cement at long-term follow-up. The authors reviewed 148 hybrid total knee arthroplasties performed by a single surgeon between 1993 and 1995. At a mean follow-up of 14 years (range, 10–16) 5 knees (4%) had undergone revision of both the femoral and tibial components. Only 1 knee required revision for aseptic loosening. Two knees were revised for sepsis; 1 knee had been revised for fracture and 1 for instability. No additional femoral or tibial components were loose by radiographic criteria. Mild focal femoral osteolysis was identified in 3 knees (2%), and minor tibial osteolysis was present in 2 knees (1%). The rate of survivorship with revision for aseptic loosening as the end point was 99% (95% confidence interval, 0.97–100) at 16 years for both the femoral and tibial components. In this series, hybrid total knee arthroplasty showed excellent fixation at 16 years.
- 1.Callaghan JJ, Wells CW, Liu SS, Goetz DD, Johnston RC. Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am. 2010; 92(7):1635–1639.
10.2106/JBJS.I.01012 Crossref Medline, Google Scholar - 2.Ritter MA, Berend ME, Meding JB, Keating EM, Faris PM, Crites BM. Long-term follow-up of anatomic graduated components posterior cruciate-retaining total knee replacement. Clin Orthop Relat Res. 2001; (388):51–57.
10.1097/00003086-200107000-00009 Crossref Medline, Google Scholar - 3.Ritter MA. The anatomical graduated component total knee replacement: a long-term evaluation with a 20-year survival analysis. J Bone Joint Surg Br. 2009; 91:745–749.
10.1302/0301-620X.91B6.21854 Crossref Medline, Google Scholar - 4.Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year follow-up study. Clin Orthop Relat Res. 2001; (388):10–17.
10.1097/00003086-200107000-00004 Crossref Medline, Google Scholar - 5.Whiteside LA. Long-term followup of the bone-ingrowth Ortholoc knee system without a metal-backed patella. Clin Orthop Relat Res. 2001; (388):77–84.
10.1097/00003086-200107000-00012 Crossref Medline, Google Scholar - 6.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.
10.1097/00003086-200107000-00013 Crossref Medline, Google Scholar - 7.Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty. 2010; 25(4):507–513.
10.1016/j.arth.2009.04.018 Crossref Medline, Google Scholar - 8.Duffy GP, Berry DJ, Rand JA. Cement versus cementless fixation in total knee arthroplasty. Clin Orthop Relat Res. 1998; (356):66–72.
10.1097/00003086-199811000-00011 Crossref Medline, Google Scholar - 9.Barrack RL, Nakamura SJ, Hopkins SG, Rosenzweig S. Winner of the 2003 James A. Rand Young Investigator’s Award: early failure of cementless mobile-bearing total knee arthroplasty. J Arthroplasty. 2004; 19(7 suppl 2):101–106.
10.1016/j.arth.2004.06.007 Crossref Medline, Google Scholar - 10.Whiteside LA. Effect of porous-coating configuration on tibial osteolysis after total knee arthroplasty. Clin Orthop Relat Res. 1995; (321):92–97. Medline, Google Scholar
- 11.Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001; (392):315–318.
10.1097/00003086-200111000-00041 Crossref Medline, Google Scholar - 12.Drexler M, Dwyer T, Marmor M, Cementless fixation in total knee arthroplasty. J Bone Joint Surg Br. 2012; 94(suppl):85–89.
10.1302/0301-620X.94B11.30827 Crossref Medline, Google Scholar - 13.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.
10.1302/0301-620X.93B11.27507 Crossref Medline, Google Scholar - 14.Buechel FF. Long-term follow-up after mobile-bearing total knee replacement. Clin Orthop Relat Res. 2002; (404):40–50.
10.1097/00003086-200211000-00008 Crossref Medline, Google Scholar - 15.Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; (248):9–12. Medline, Google Scholar
- 16.Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958; 53:457–481.
10.1080/01621459.1958.10501452 Crossref, Google Scholar - 17.Schmalzried TP, Harris WH. Hybrid total hip replacement: a 6.5-year follow-up study. J Bone Joint Surg Br. 1993; 75(4):608–615. Crossref Medline, Google Scholar
- 18.Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term follow-up. Clin Orthop Relat Res. 2001; (388):18–25.
10.1097/00003086-200107000-00005 Crossref Medline, Google Scholar
