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Primary Total Knee Arthroplasty Using a Cementless Highly Porous Titanium Tibial Baseplate: A Minimum 10-Year
Michal J Stoltz1, Maunil Mullick2, Langan S Smith3
1Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky.
Background:
Due to higher failure rates of cemented implants in obese, younger, and active men, along with increasing life span, cementless total knee arthroplasty (TKA) has had a resurgence given the potential of long-term biological fixation. The purpose of this study was to evaluate the clinical and radiographic results of primary TKA using a cementless, highly porous tibial baseplate, with a minimum 10-year follow-up.
Methods:
This was a retrospective review of 300 consecutive primary cementless TKAs using the same highly porous tibial baseplate. There were 35 patients (38 TKAs) deceased, 40 were lost to follow-up, and 10 patients had revisions, leaving 212 TKAs available for review. Outcome measures included range of motion, Knee Society Score (KSS), Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score, Forgotten Joint Score (FJS-12), Patient-Reported Outcomes Measurement Information System score, patient satisfaction, revision incidence, and radiographic findings.
Results:
The mean KSS function and knee score improved from 45.3 and 40.4 preoperatively to 77.7 and 90.1 postoperatively (P ≤ 0.0001). The mean postoperative KOOS JR and FJS-12 scores were 86.5 and 83.7, respectively. Range of motion improved from a preoperative mean of 104.9 degrees of flexion and 2.3 degrees of extension to 119 degrees of flexion and 0 degrees of extension at 10 years (P ≤ 0.0001). Of the primary TKAs in the cohort, 97.5% were either very satisfied or satisfied. There were 10 revisions: one aseptic tibial loosening, four instabilities, two extensor mechanism ruptures, one chronic patella subluxation/arthrotomy rupture, one infection, and one for unexplained pain. Survivorship with all-cause failure as the end point at 10 years was 96.7 and 99.7% for aseptic loosening.
Conclusions:
Current-generation cementless TKA using a highly porous tibial baseplate with a keel and four pegs at a minimum 10-year follow-up provided effective pain relief, high patient satisfaction, and 96.7% survivorship.
