Impact of stem profile on the revisability and the need for osteotomy in well-fixed cemented revision total knee arthroplasty implants.
Conical stems
Osteotomy
Revisability
Revision total knee arthroplasty
Stem design
Stem removal
Well-fixed cemented stems
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
16
02
2022
accepted:
18
07
2022
pubmed:
6
8
2022
medline:
2
2
2023
entrez:
5
8
2022
Statut:
ppublish
Résumé
While re-revision total knee arthroplasty (ReRTKA) steadily increases, the ease and bone-sparing removal of RTKA implants is gaining more and more in importance. Biomechanical data suggest that cemented conical stems can be removed significantly easier than cylindrical stems. However, no clinical evidence exists supporting this observation. Aim of this study was to compare the revisability and need for osteotomy (OT) between removals of well-fixed cemented conical vs. cylindrical RTKA stems. 55 removals of well-fixed full-cemented RTKA stems (29 knees) performed between 2016 and 2018 were retrospectively analyzed. Main outcome variables were: bone loss, fractures, osteotomy incidence, surgery duration, early postoperative complications (EPC), hemoglobin drop and blood transfusion. SPSS was used for the statistical analysis. 44.8% were conical, 48.3% cylindrical, and 6.9% combined stem designs. Causes for re-revision were PJI (75.9%), malposition (17.2%) and persistent pain (6.9%). 10 stem removals (18.2%) required an OT (four femoral, six tibial): eight stems (14.5%) had cylindrical and two (3.6%) conical designs (P = 0.041). Fractures were noted solely in removals without OT (11.1% vs. 0%,). There was a tendency to more bone loss in cylindrical stem revisions (53.8% vs. 32%, P = 0.24). A longer overall surgery time was observed in revisions of cylindrical stems (+ 37 min, P = 0.05). There was higher hemoglobin drop and need for blood transfusion in revisions of cylindrical stems or after OT but without reaching statistical significance. The EPC rates were slightly higher in ReRTKA on cylindrical stems (P = 0.28). Well-fixed cemented conical stems may be revision friendlier with less demands on OT and shorter overall surgery time than cemented cylindrical stems.
Identifiants
pubmed: 35930052
doi: 10.1007/s00402-022-04559-2
pii: 10.1007/s00402-022-04559-2
pmc: PMC9886614
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
469-479Informations de copyright
© 2022. The Author(s).
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