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Published on: May 20, 2019
Tibial fixation without screws in cementless knee arthroplasty
Ian P Holloway1, Patrick J Lusty, William L Walter
1Sydney Hip & Knee Surgeons, Sydney, Australia.
The Journal of Arthroplasty
|December 6, 2008
Summary
This study evaluated cementless fixed-bearing tibial trays without screws. While offering reliable stability, a notable polyethylene failure rate requires attention for future orthopedic implant designs.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Cementless total knee arthroplasty (TKA) aims for bone ingrowth and long-term implant stability.
- Fixed-bearing tibial trays are commonly used, but fixation methods vary.
- The use of screw holes in tibial baseplates is a debated topic in TKA design.
Purpose of the Study:
- To assess the clinical and radiographic outcomes of a cementless fixed-bearing tibial tray design that omits screw holes.
- To evaluate implant survivorship, patient-reported outcomes, and radiologic findings at medium-term follow-up.
Main Methods:
- Retrospective review of 216 primary TKAs in 191 patients using a specific cementless fixed-bearing tibial tray without screw holes.
- Clinical assessment included Hospital for Special Surgery (HSS) scores.
- Radiographic evaluation focused on component stability, radiolucency, and osteolysis.
Main Results:
- Mean HSS scores improved significantly from 54 to 84.
- The overall reoperation rate was 12%, with revisions for tibial baseplates (4) and polyethylene inserts (5).
- Radiolucent lines were observed in 4% of tibial baseplates, and the tibial osteolysis rate was 4.1%. All components demonstrated radiographic stability.
Conclusions:
- The cementless fixed-bearing tibial tray without screw holes demonstrated reliable component stability at medium-term follow-up.
- While radiologic signs of loosening were minimal, the rate of polyethylene insert revision indicates a potential concern with this specific implant design.
