Journal of Knee Surgery最新文献

{"title":"Radiographic Assessment of Total Knee Arthroplasty Alignment With and Without Accelerometer-Based Navigation at a Resident Training Institution.","authors":"Brett G Brazier, Christian B Allen, Daryl G Hilyard, Darshan S Shah, David E Vizurraga, Donald N Hope","doi":"10.1055/a-2481-8647","DOIUrl":"10.1055/a-2481-8647","url":null,"abstract":"<p><p>Malalignment and lack of surgeon experience are cited as risk factors for prosthetic failure and the need for subsequent revision surgery in total knee arthroplasty (TKA). Various conventional (CON) and computer-assisted surgical (CAS) methods have been developed to try and prevent malalignment and limit outliers. One of these methods is through an accelerometer-based CAS (aCAS), which intraoperatively helps determine the angulation and amount of resection necessary to restore alignment in TKA. The purpose of this study was to determine the number of TKA alignment outliers in TKAs performed both with CON and aCAS methods at a single training institution in cases that trainees were involved in. In this retrospective single-center study, radiographic analysis of 150 primary TKAs performed at our training institution was performed. The medial distal femoral angle (DFA), medial proximal tibial angle (PTA), and posterior slope angle (PSA) were evaluated on immediate postoperative radiographs of 75 aCAS and 75 CON knees. Outlier measurements were defined as DFA outside of 5 ± 3 degrees valgus, PTA > ± 3 degrees from neutral axis, and PSA outside 0 to 7 degrees for cruciate retaining and 0 to 5 degrees for posterior stabilized implants. Data was analyzed using chi-squared, analysis of variance, and Student's <i>t</i>-tests. There was no significant difference found between these two groups in the total number of outliers (8% aCAS vs. 9.8% CON, <i>p</i> = 0.508). Additionally, there was also no significant difference found for any of the radiographic measurements independently; DFA (8% vs. 8%, <i>p</i> = 1.00), PTA (4% vs. 9%, <i>p</i> = 0.184), and PSA (12% vs. 12%, <i>p</i> = 1.00), when comparing aCAS and CON TKAs. Primary TKAs performed at a single training institution demonstrated no significant difference between aCAS and CON methods in the total number of outliers or in the number of outliers for each postoperative radiographic measurement. This study would suggest that there is no advantage in limiting outliers when utilizing aCAS for TKAs at training institutions in cases that trainees are involved in. LEVEL OF EVIDENCE:  Level III Retrospective Cohort Study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Bedside-to-Bench-to-Bedside Journey to Advance Osteochondral Allograft Transplantation towards Biologic Joint Restoration.","authors":"James L Cook, James P Stannard, Aaron Stoker, Kylee Rucinski, Brett D Crist, Cristi Cook, Cory R Crecelius, Chantelle Bozynski, Keiichi Kuroki, Lisa A Royse, Renee Stucky, Clark T Hung, Matthew J Smith, Kyle Schweser, Clayton W Nuelle, Steven F DeFroda","doi":"10.1055/a-2506-2675","DOIUrl":"https://doi.org/10.1055/a-2506-2675","url":null,"abstract":"<p><p>More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering healthcare decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (>65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients. For younger adults and those who wish to remain highly active, artificial arthroplasties are associated with significantly higher levels of pain, complications, morbidity, dysfunction, and likelihood for revision. Unfortunately, non-surgical management strategies and surgical treatment options other than joint replacement are often not indicated and have not proven to be consistently successful for this large and growing population of patients. As such, these patients are often relegated to postpone surgery, take medications including opioids, profoundly alter their lifestyle, and live with pain and disability until artificial arthroplasty is more likely to meet their functional demands without high risk for early revision. As such, our research team set out to develop, test, and validate biologic joint restoration strategies that could provide consistently successful options for young and active patients with joint disorders who were not considered ideal candidates for artificial arthroplasty. In pursuit of this goal, we implemented a targeted bedside-to-bench-to-bedside translational approach to hypothesis-driven studies designed to address this major unmet need in orthopaedics by identifying and overcoming key clinical limitations and obstacles faced by healthcare teams and patients in realizing optimal outcomes after biologic joint restoration. The objective for this article is to condense more than two decades of rigorous patient-centered research aimed at optimizing osteochondral and meniscus allograft transplantation towards more consistently successful management of complex joint problems in young and active patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Lateral Extra-Articular Tenodesis for Ongoing Instability Following Anterior Cruciate Ligament (ACL) Reconstruction with an Intact Graft is Effective and Has Low Surgical Morbidity.","authors":"Peter S E Davies, Cameron Muirhead, Alistair I W Mayne, Jay R Ebert, Peter K Edwards, Ashley Simpson, Andy Williams, Peter D'Alessandro","doi":"10.1055/a-2481-8771","DOIUrl":"10.1055/a-2481-8771","url":null,"abstract":"<p><p>The management of persisting instability following anterior cruciate ligament reconstruction (ACLR) includes isolated lateral extra-articular tenodesis (LEAT). The present study investigates the outcomes following isolated LEAT to address ongoing instability following ACLR without LEAT. Patients with ongoing symptomatic instability following ACLR with a radiologically intact and well-positioned graft who underwent an isolated LEAT between January 2017 and March 2022 were retrospectively recruited. Patients completed patient-reported outcome measures at baseline and mean 26 months postoperatively. Twelve knees in 11 patients underwent an isolated LEAT. All Knee Injury and Osteoarthritis Outcome Score domains improved significantly between pre- and postoperative measurements (pain 60.9-91.7, <i>p</i> = 0.002; symptoms 62.5-93.8, <i>p</i> = 0.003; activities of daily living 64.3-95.2, <i>p</i> = 0.002; sport 61.9-82.5, <i>p</i> = 0.012; quality of life 17.2-80.2, <i>p</i> = 0.002). One patient required revision ACL surgery 19 months following their subsequent LEAT procedure. An isolated LEAT demonstrated clinically significant improvements in patient function and activity with acceptable surgical morbidity and should be considered as an option for appropriate cases with instability despite an intact ACL graft. LEVEL OF EVIDENCE:  Level IV prospective case series.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size-Up, Size-Down: Accuracy of Component Sizing with Computerized Tomography and Robotic-Assisted Total Knee Arthroplasty.","authors":"James P Henry, Brienne Paradis, Aleksandra Qilleri, Nadia Baichoo, Keith R Reinhardt, James D Slover, Jonathan R Danoff, James A Germano","doi":"10.1055/s-0044-1800976","DOIUrl":"https://doi.org/10.1055/s-0044-1800976","url":null,"abstract":"<p><p>Templating prior to total knee arthroplasty (TKA) can help to improve surgical efficiency and potentially improve alignment and outcomes. The purpose of this article is to evaluate the ability of computed tomography (CT)-based preoperative templating to accurately predict implant sizes. A total of 724 Stryker MAKO robotic-assisted TKA cases were retrospectively evaluated from a prospectively collected database between January 2020 and October 2023. Cases were performed by one of three adult reconstruction fellowship-trained orthopaedic surgeons from a health system that includes an academic level one trauma center, an ambulatory surgery center, and a community hospital. Out of the 724 cases, 391 were preoperatively templated independently by the surgeon and the company representative (MAKO Product Specialist [MPS]). The remaining 333 cases were only templated prior to incision by the MPS. Final implant sizes of the tibial and femoral components were compared to preoperative templates. The MPS was able to preoperatively predict the final tibial and femoral implants within one size in 97.2 and 97.8% of cases, respectively. A surgeon and MPS combined preoperative templating increased accuracy to predict the final tibial and femoral implants within one size in 98.9 and 99.5% of cases, respectively. Height and weight were positively correlated with the final implant size (<i>p</i> < 0.001). Non-surgeons can reliably predict implanted components in CT-based preoperative templating in the majority of cases, which is further enhanced by surgeon review and adjustments. In no cases in our series were the final size components implanted greater than two sizes larger or smaller. Our findings suggest that there is opportunity to avoid waste by processing fewer trial implants and transporting fewer components. This would likely decrease overall case cost and improve efficiency in the operating room. Level of evidence: III (retrospective cohort).</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fate of the DAIR, Outcomes After One Year: a large database study.","authors":"Andrew Ryan Grant, Darren Nin, Ya-Wen Chen, Ruijia Niu, Michael Esantsi, Carl Talmo, Brian Hollenbeck, David Chang, David Mattingly, Eric L Smith","doi":"10.1055/a-2501-1024","DOIUrl":"https://doi.org/10.1055/a-2501-1024","url":null,"abstract":"<p><strong>Introduction: </strong>Debridement with antibiotics and implant retention (DAIR) is commonly utilized for prosthetic joint infection (PJI) for total knee arthroplasty (TKA); particularly in cases of acute PJI 1. Reported success rates of DAIR have been highly variable, but the overall success rate of DAIR cohort studies is ~70-80% 2. However, no large database studies have investigated the success rate of DAIR. Therefore, we seek to provide a framework for large-database analysis of PJI interventions and their outcomes and to assess the success rate of DAIR. Methods We queried the MarketScan Database for patients who underwent a DAIR (CPT 27310 and/or CPT 27486) procedure for indication of PJI (ICD-10 T84.53 OR T84.54) between 1/1/2017 to 12/31/2021. We identified reoperations (i.e. Stage-1 revision, amputation, or arthrodesis) indicating failure of DAIR. Failure of DAIR treatment was defined by subsequent reoperation. We also identified prescriptions of suppression antibiotics more than 6 months after DAIR 3. Results We identified 1018 patients who underwent a DAIR procedure for PJI. Of these patients, 195 (19.2%) underwent reoperation within one year and an additional 178 (17.5%) were prescribed suppressive antibiotics. For 780 patients with a minimum of two years of follow up, 164 (21%) underwent reoperation and an additional 179 (22.9%) were prescribed suppressive antibiotics. Patients with obesity and patients under age 60 had significantly higher rates of having reoperation or suppressive antibiotics at one year following DAIR. Conclusion DAIR is a viable option in the treatment of PJI with an approximately 19% rate of reoperation at two years. Our findings are consistent with that of previously published literature.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-articular adductor canal block has equivalent analgesic effect to traditional ultrasound-guided adductor canal block after total knee arthroplasty: a prospective randomized controlled trial.","authors":"Deyong Huang, Dazhi Zhang, Yi Jiang, Jun Yi, Ke Sun, Hongyi Shao","doi":"10.1055/a-2501-1143","DOIUrl":"https://doi.org/10.1055/a-2501-1143","url":null,"abstract":"<p><strong>Introduction: </strong>An adductor canal block (ACB) is widely accepted as a regional nerve block for pain management following total knee arthroplasty (TKA). However, no consensus exists concerning whether the analgesic effect is greater when joint surgeons perform intra-articular ACBs (IA-ACBs) or when anesthesiologists perform ultrasound-guided ACBs (UG-ACBs). We hypothesized that intra-articular ACBs (IA-ACBs) performed by joint surgeons and UG-ACBs performed by anesthesiologists based on peri-articular injections (PAI) would yield equivalent analgesic effects.</p><p><strong>Material and methods: </strong>This prospective randomized controlled trial included 61 patients who underwent IA-ACBs and 56 patients who received UG-ACB with additional PAI for post-TKA pain management. The primary outcome was postoperative pain assessed using numeric rating scale scores （NRS） at rest and during exercise. Secondary outcomes included opioid consumption and functional recovery. We also investigated local and systemic adverse events, including nausea, vomiting, and wound complications.</p><p><strong>Results: </strong>Both groups of patients experienced comparable analgesic effects for both IA-ACB and UG-ACB pain management; however, those who received IA-ACBs were prescribed more opioid equivalents than those in the UG-ACB group on postoperative day 1 (P = 0.048). No differences between the groups were observed regarding local or systemic adverse events.</p><p><strong>Conclusions: </strong>IA-ACBs performed by joint surgeons provided equivalent analgesic effects to UG-ACBs performed by anesthesiologists. However, IA-ACBs may lead to a higher postoperative requirement for opioid analgesics.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of Clinical Outcomes of the Subchondroplasty® Procedure for Treatment of Symptomatic Bone Marrow Lesions of the Knee.","authors":"Steven B Cohen, Christopher Hajnik, Gregory L Loren, Sam Akhavan, Patrick J DeMeo, Douglas J Wyland, Thomas Youm, Laith M Jazrawi, Robert J Daley, Jack Farr, Patrick Reischling, Jennifer Woodell-May","doi":"10.1055/a-2501-0910","DOIUrl":"https://doi.org/10.1055/a-2501-0910","url":null,"abstract":"<p><strong>Introduction: </strong>Bone Marrow Lesions (BMLs) have a strong correlation to patient reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty® (SCP) Procedure uses AccuFill®, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML.</p><p><strong>Methods: </strong>This observational, prospective, multicenter, cohort study evaluated the effect of the SCP Procedure at two-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill®. Patient reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance images (MRI) were performed at baseline and up to 24 months post-operatively. Patient selection was not limited based on degree of osteoarthritis (OA) as determined radiologically by Kellgren-Lawrence (K-L) grade. For a subset of subjects, patient reported outcomes were collected up to five years including pain evaluation, patient knee global assessment, and satisfaction with the procedure.</p><p><strong>Results: </strong>Pre-operative radiographs indicated moderate to severe osteoarthritis (K-L grades 2-4) in 65 subjects (92.8%). Significant improvements (p<0.0001) in mean VAS Pain, IKDC, mKSS and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at two years. The subset of subjects followed for five years demonstrated low pain scores and high procedure satisfaction.</p><p><strong>Conclusion: </strong>This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after two years. The survivorship rate from arthroplasty at two years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alignment Strategies in Total Knee Arthroplasty: The Rise and Role of Enabling Technology.","authors":"Darren B Chen","doi":"10.1055/s-0044-1795074","DOIUrl":"https://doi.org/10.1055/s-0044-1795074","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) remains the gold standard surgical care for end-stage knee arthritis. Since its inception, TKA has seen many transformative factors with advances in material properties, implant design, and fixation. Improvements in implant longevity has culminated in TKA being recognized as one of modern medicine's most successful surgical procedures. Patient satisfaction, however, remains a significant challenge. Recent studies report that patient satisfaction with current implants and techniques remains at 80 to 90%, suggesting that up to one in five patients remain dissatisfied with their procedure. A balanced knee, defined as equal medial and lateral gaps in knee extension and flexion, is a desired outcome in TKA. This has been shown to be associated with improved clinical outcomes. Given the poor rate of surgeon-defined balance, intraoperative knee balance can be confirmed with objective load data using sensor-embedded smart inserts or by measuring gaps using computer-assisted or robotic platforms. Currently, there is no consensus on the correct alignment or laxity targets for individualized alignment strategies in TKA, and further research in this area is required to answer this. Tremendous advances in our understanding of knee anatomy and kinematics have come to light in the recent past, and these insights have spawned interest in alternative alignment techniques in TKA. More recently, an appreciation of individual knee phenotypes and associated classification systems have provided a platform and the scientific justification behind these contemporary alignment strategies. Paired with enabling technologies, it is becoming an accepted paradigm that surgeons have the ability to select a desired alignment target when undertaking an individualized alignment strategy in TKA and execute the surgery with a high degree of precision. It is hoped that this may reduce the rate of dissatisfaction following TKA and improve clinical outcomes. This review article provides an overview of the concepts of knee phenotypes, current alignment strategies in TKA, and the emerging benefits of enabling technologies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leaving the Patella Unresurfaced Does Not Increase the Risk of Short-Term Revision Following Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry.","authors":"Dencel A García Vélez, Anirudh Buddhiraju, Ryland Kagan, Isabella Zaniletti, Ayushmita De, Harpal S Khanuja, Christopher E Pelt, Vishal Hegde","doi":"10.1055/a-2468-6289","DOIUrl":"10.1055/a-2468-6289","url":null,"abstract":"<p><p>The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR).The AJRR was queried for all patients aged 65 years and older undergoing elective TKA between January 2012 and March 2020 with a minimum 2-year follow-up. Cases were linked using supplemental Centers for Medicare and Medicaid data. Cases with hybrid fixation, highly constrained implants, and revision components were excluded. Patients were categorized into two groups: those with a resurfaced patella and those without. Cumulative incidence function (CIF) curves and cause-specific Cox models were utilized to assess all-cause revision risk, adjusting for sex, age, femoral design (cruciate retaining vs. posterior stabilized), fixation type (cemented vs. cementless), and Charlson Comorbidity Index.Of the 390,304 TKAs with minimum 2-year follow-up in our cohort, 22,829 had no patellar resurfacing performed. Adjusted hazard ratios (HRs) revealed no significant difference in all-cause revision (HR = 0.96, 95% confidence interval [CI]: 0.81-1.13, <i>p</i> = 0.656), revision for mechanical loosening (HR = 1.61 [0.88, 2.93], <i>p</i> = 0.122), or revision for infection (HR = 1.02 [0.79, 1.33], <i>p</i> = 0.860) associated with patellar resurfacing status.Our study found that patients with an unresurfaced patella do not face an increased short-term revision risk following TKA. These findings challenge the necessity of routine patellar resurfacing and underscore the importance of considering other factors, such as femoral design, patient comorbidities, and implant-related variables in revision risk stratification.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survivorship of Primary NexGen Knee Replacement: Comparing Cementless Trabecular Metal to Other Designs of Tibial Component.","authors":"Ayooluwa S Ayoola, Michael A Charters, Hamza M Raja, Luke Weseman, Peter L Lewis, Yi Peng, Wayne Trevor North","doi":"10.1055/a-2376-6889","DOIUrl":"10.1055/a-2376-6889","url":null,"abstract":"<p><p>The impact of cementless trabecular metal (TM) implants on implant survivorship are not well delineated. This study compares primary total knee arthroplasty (TKA) revision rates of cemented knee replacements with two cementless knee replacement designs-cementless TM and a non-TM cementless design. Data from a national registry queried TKA procedures performed for osteoarthritis from 1999 to 2020. The risk of revision of Zimmer NexGen TKA using cementless TM, cementless non-TM, and cemented non-TM were compared. Analyses included Kaplan-Meier estimates of survivorship and Cox hazard ratios (HR), stratified by age and gender. Cementless TM components had higher risks of revision compared with cementless non-TM implants (HR = 1.49; <i>p</i> ≤ 0.001). Cementless TM implants showed higher risks of revision compared with cemented non-TM prostheses for the first 2 years (HR = 1.75, <i>p</i> < 0.001). Non-TM prostheses posed equal risk of revision for cementless and cemented fixations (HR = 0.95, <i>p</i> = 0.522). Patients aged 55 to 64 years and 65 to 74 years had a higher risk of revision for cementless TM compared with cementless non-TM (HR = 1.40, <i>p</i> = 0.033 and HR = 1.79, <i>p</i> < 0.001, respectively) and cemented non-TM implants (HR = 1.51, <i>p</i> < 0.001 and HR = 1.54, <i>p</i> < 0.001, respectively). The study shows there is an increased risk of revision with TM cementless implants for patients aged 55 to 74 years. These results do not support the use of TM tibial implants for patients of this age group for primary TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"949-958"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}