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Cementless fixation not linked with improved outcomes following TKA

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ORLANDO, Fla. — Cementless fixation for total knee arthroplasty was not associated with improved postoperative outcomes, according to a presenter here at the American Academy of Orthopaedic Surgeons Annual Meeting.

“We have not seen a situation where uncemented knees perform better than hybrid knees, and certainly if you do a [cruciate-retaining] knee, cementing the tibial component appears to be helpful,” Stephen Graves, MD, said in his presentation.

Graves and colleagues culled data from a national registry regarding 385,824 primary total knee arthroplasties (TKAs) performed for the treatment of osteoarthritis between 1999 and 2013. Of these, 200,476 procedures were cemented; 96,249 were hybrid procedures; and 89,099 were cementless. Time to first revision via Kaplan-Meier estimates of survivorship to calculate cumulative percent revision, outcomes of all three fixation methods, hazard ratios and Cox proportional hazard models were evaluated for a maximum of 13 years.

Men had the lowest rates of revision when hybrid fixation was used. This also was the case in patients aged 55 years to 64 years. Patients younger than 55 years had a high revision rate, regardless of the fixation method. The opposite was true in patients older than 75 years, as they had a low revision rate regardless of the type of fixation. Patients aged 65 years to 74 years had the lowest revision rates for hybrid and cemented fixation.

The hazard ratio for cementless vs. hybrid fixation was 1.18, while cementless vs. cemented fixation exhibited a hazard ratio of 1.11. Cruciate-retaining knees showed revision rates equal for both hybrid and cemented fixation, while posterior-stabilized knees had the lowest revision rates when both tibial and femoral components were cemented. — by Christian Ingram

Reference:

Graves S, et al. Paper #64. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Graves reports no relevant financial disclosures.