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Cementless Total Knee Arthroplasty in the Morbidly Obese Patient Using a Highly Porous Tibial Baseplate: Minimum
Arun C Nadar1, Essa Gul2, Langan S Smith3
1Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky.
Background:
Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) have demonstrated higher revision incidence. Cementless TKA implants have demonstrated good five-year results in this patient population. The purpose of this study was to review 10-year results of primary TKA in morbidly obese (body mass index ≥ 39.5) patients using a highly porous, cementless tibial baseplate.
Methods:
This is a retrospective study of 114 TKAs in morbidly obese patients who underwent primary cementless TKA with a minimum 10-year follow-up. There were 25 TKAs lost to follow-up, leaving 89 TKAs in 74 patients who had a mean follow-up of 124.7 months (range, 116.9 to 141.9). The average age was 57 years (range, 36 to 73), and the average body mass index was 46.1 (range, 39.5 to 63.9). Clinical results, patient-reported outcome measures, radiographs, and complications were reviewed.
Results:
There were nine revisions, including two for tibial component aseptic loosening (2.3%), two for instability (2.3%), two for deep infection (2.3%), two for extensor mechanism rupture (2.3%), and one for patellar dislocation (1.1%). The two aseptic loosening cases occurred within eight months of the index TKA. The Knee Society Score improved from a mean of 36.2 to 88.3, 86.5, and 90.4 at 2-, 5-, and 10-year follow-up, respectively. The Knee Society Score function score improved from a mean of 41.5 to 68.7, 75.3, and 80.4 at 2-, 5-, and 10-year follow-up, respectively. Survivorship was 97.8% with aseptic loosening as the end point at 12 years and 89.9% for all-cause revision.
Conclusions:
Cementless TKA using a highly porous tibial baseplate in morbidly obese patients demonstrated excellent results with 97.8% survivorship at 12 years with aseptic loosening as the end point. Cementless TKA with the benefit of at least 10 years of biologic fixation can be an alternative mode of fixation compared to cement fixation in this challenging patient population.
