What is the role of cemented fixation in total knee arthroplasty? The two-year results of a randomized RSA controlled trial
- 1 January 2021
- journal article
- research article
- Published by British Editorial Society of Bone & Joint Surgery in The Bone & Joint Journal
- Vol. 103B (1), 98-104
- https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-0788.R1
Abstract
Aims For many designs of total knee arthroplasty (TKA) it remains unclear whether cemented or uncemented fixation provides optimal long-term survival. The main limitation in most studies is a retrospective or non-comparative study design. The same is true for comparative trials looking only at the survival rate as extensive sample sizes are needed to detect true differences in fixation and durability. Studies using radiostereometric analysis (RSA) techniques have shown to be highly predictive in detecting late occurring aseptic loosening at an early stage. To investigate the difference in predicted long-term survival between cemented, uncemented, and hybrid fixation of TKA, we performed a randomized controlled trial using RSA. Methods A total of 105 patients were randomized into three groups (cemented, uncemented, and hybrid fixation of the ACS Mobile Bearing (ACS MB) knee system, implantcast). RSA examinations were performed on the first day after surgery and at scheduled follow-up visits at three months, six months, one year, and two years postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and after two years follow-up. Patients and follow-up investigators were blinded for the result of randomization. Results RSA secondary stabilization did not show a significant difference between the three types of fixation. A maximum total point motion of less than 0.2 mm in the second postoperative year was shown in each group, which suggests stabilization of the implant. At 24 months after surgery, PROMs significantly improved compared to baseline in all treatment groups. No significant difference was observed between the three groups. Conclusion Secondary stabilization measurements in this study demonstrated no significant difference between the groups. In all groups migration stabilized after initial settling of the implant. For this implant the long-term outcome is not expected to be influenced by the type of fixation to the bone.Keywords
This publication has 39 references indexed in Scilit:
- World Medical Association Declaration of HelsinkiJama-Journal Of The American Medical Association, 2013
- Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplastyKnee Surgery, Sports Traumatology, Arthroscopy, 2013
- Early migration of tibial components is associated with late revisionActa Orthopaedica, 2012
- Cementless fixation in total knee arthroplastyThe Journal of Bone and Joint Surgery. British volume, 2012
- Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseasesEmergencias, 2012
- Hybrid Component Fixation in Total Knee ArthroplastyThe Journal of Arthroplasty, 2012
- The Anatomical Graduated Component total knee replacementThe Journal of Bone and Joint Surgery. British volume, 2009
- The Dutch version of the knee injury and osteoarthritis outcome score: A validation studyHealth and Quality of Life Outcomes, 2008
- Uncemented HA-coated Implant is the Optimum Fixation for TKA in the Young PatientClinical Orthopaedics and Related Research, 2006
- Accurate accuracy assessment: Review of basic principles (Acta Orthop Scand 1999; 70 (4): 319-321)Acta Orthopaedica, 2000