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Problems with cementless total knee arthroplasty at 11 years followup
R A Berger1, J H Lyon, J J Jacobs
1Department of Orthopedic Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA.
Clinical Orthopaedics and Related Research
|November 22, 2001
Summary
Cementless total knee arthroplasty shows excellent femoral fixation but high revision rates for metal-backed patellar components and aseptic loosening in tibial components. These mixed results led to abandoning cementless fixation.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Clinical Orthopedics
Background:
- Cementless total knee arthroplasty (TKA) aims for bone ingrowth and long-term fixation.
- The posterior cruciate ligament is often retained in TKA procedures.
- Patellar component design and fixation methods vary, impacting outcomes.
Purpose of the Study:
- To prospectively evaluate the long-term outcomes of cementless total knee arthroplasty retaining the posterior cruciate ligament.
- To assess the performance of cementless femoral, patellar, and tibial components.
- To identify failure modes and revision rates associated with cementless TKA.
Main Methods:
- Prospective follow-up of 131 consecutive cementless TKAs in 102 patients.
- Analysis of revision rates, loosening, wear, and osteolysis for femoral, patellar, and tibial components.
- Categorization of patellar components into metal-backed and all-polyethylene designs.
Main Results:
- Excellent cementless femoral component fixation with no revisions for loosening or osteolysis.
- High revision rate (48%) for metal-backed patellar components due to loosening and polyethylene wear.
- Significant aseptic loosening (8%) and osteolytic lesions (12%) observed in cementless tibial components.
Conclusions:
- Cementless femoral fixation in TKA demonstrates excellent long-term results.
- Metal-backed patellar components exhibit high failure and revision rates.
- Cementless tibial fixation shows concerning rates of aseptic loosening and osteolysis, prompting a shift away from this fixation method.
