Study finds low rates of periprosthetic fractures after cemented, cementless TKAs
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Key takeaways:
- Cemented and cementless TKA yielded low rates of periprosthetic fractures at 3-month and 10-year follow-up.
- Women had the highest risk for periprosthetic fracture.
Both cemented and cementless total knee arthroplasty yielded low rates of periprosthetic fractures at 3-month and 10-year follow-up with women at highest risk for fractures, according to published results.
Researchers used the National Joint Registry and Hospital Episodes Statistics database to analyze two propensity-matched cohorts of 22,477 cemented TKAs and 22,477 cementless TKAs performed between Jan. 1, 2004, and Dec. 31, 2018. The primary outcome measure was cumulative periprosthetic fracture rates as calculated with Kaplan Meier analysis.
In the cemented vs. cementless groups, cumulative periprosthetic fracture rates were 0.02% and 0.04% at 3 months and 1.2% and 1.4% at 10 years, respectively. Researchers also found no significant differences in fracture rates between fixation types on subgroup analyses of sex, BMI and age. They noted women were at the highest risk for periprosthetic fracture for cemented (odds ratio = 2.35) and cementless TKA (OR = 2.97).
“We conclude that the periprosthetic fracture risk requiring readmission following cemented and cementless TKAs is equivalent,” the researchers wrote in the study.
Perspective
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The authors present a large, propensity-matched comparison study of 22,477 cementless and cemented TKAs. This is a well-designed study using Kaplan-Meier analysis and Cox regression analyses to assess 3-month and 10-year fracture rates, as well as to compare the two groups.
They found no difference at any time point for periprosthetic fractures between the two cohorts. The overall fracture incidence was low at 0.88% in the cemented group and 1.01% in the cementless group. BMI, age and gender did not impact the risk of fracture when comparing the two groups. For both groups, odds of fracture increased for female patients (OR of 2.35 and 2.97 for cemented and cementless cases, respectively) and age greater than 75 years.
This study rightfully concludes that cementless TKA is a viable option for appropriately selected patients. The overall fracture risk is low at 10-year follow-up (1.4%) and, regardless of fixation choice, specific care and preventative measures should be employed in elderly, female patients. Modern improvements in implants and instrumentation have led to equivalent risk of fracture between cemented and cementless TKAs.
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