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Midterm survival of cementless total knee arthroplasty with a three-dimensional printed metal-backed patellar
Ormonde Mahoney1, Manoshi Bhowmik-Stoker2, Denis Nam3
1Athens Orthopedic Clinic, Athens, GA, USA.
Introduction:
Historically, metal-backed patellar components have shown high early failure rates due to fracture, lack of osseous integration, and polyethylene wear and dissociation. We aimed to describe the survival outcomes of cementless total knee arthroplasty (TKA) utilizing the first widely used additively manufactured 3-dimensionally printed metal-backed patellar component (AM-MBP) to compare these to other cementless as well as cemented TKA cohorts.
Methods:
There were 35,087 primary cementless TKA procedures in patients ≥65 years of age that utilized the AM-MBP component during the calendar years 2012 to 2020 that were identified from the American Joint Replacement Registry (AJRR). This AM-MBP cohort was benchmarked against age-similar (≥65 years) cohorts representing all other cementless primary TKA with a patellar component (aggregate cementless, n = 10,755) and all cemented TKA with a patellar component (aggregate cemented, n = 550,908). Cumulative percent revision curves and hazard ratios for all-cause revision were estimated using Cox proportional hazards models that adjusted for age and sex.
Results:
The cumulative percent all-cause revision (95 % confidence interval (CI)) at 7-year follow-up was 1.9 % (1.7%, 2.1%; 1,051 at risk) for the AM-MBP and 2.5% (2.1%, 2.8%; 1,281 at risk) for other aggregated cementless. and 2.1% (2.1 %, 2.1 %; 105,641 at risk) for the aggregate cemented group. The adjusted hazard ratio for revision comparing AM-MBP with aggregate cementless was 0.77 (0.64, 0.93; P = 0.007), indicating a 23% decreased risk of revision for the AM-MBP group compared with all other cementless TKAs with a patellar component in the AJRR, controlling for age and sex.
Conclusions:
The improved survivability of primary cementless TKA with AM-MBP versus other cementless TKA suggests that the AM-MBP construct is durable in real-world use in the Medicare-eligible population (age ≥65 years) appears to be comparable to the average durability of other cementless constructs captured by the AJRR.
