Outcomes of Newer Generation Cementless Total Knee Arthroplasty: Beaded Peri-apatite-coated Versus Highly Porous Titanium-coated Implants

• Published in: The Journal of arthroplasty 2017
• Main Authors: Harwin, Steven F., M.D, Patel, Nirav K., M.D., M.S., F.R.C.S, Chughtai, Morad, M.D, Khlopas, Anton, M.D, Ramkumar, Prem N., M.D. M.B.A, Roche, Martin, M.D, Mont, Michael A., M.D
• Format: Article
• Language: English
• Subjects: Orthopedics
• ISSN: 0883-5403
• DOI: 10.1016/j.arth.2017.01.044

Abstract Introduction Newer generation cementless total knee arthroplasty (TKA) designs are available and have novel implant coatings. We aimed to evaluate and compare beaded peri-apatite (PA)-coated versus highly porous titanium-coated cementless total knee arthroplasties. Specifically, we compared: 1) survivorship; 2) Knee Society Scores and range-of-motion; 3) complications; and 4 ) radiographic findings. Methods There were 805 TKAs with beaded PA-coated tibial and patellar components (PA-group) (mean age 67 years; range, 41 to 86 years) and 219 TKAs with highly porous titanium-coated tibial and patella components (mean age 66, range 34 to 88 years). Mean follow-up was 4.4 years (range, 2 to 9 years; median, 4 years). Implant survivorship was calculated using Kaplan-Meier curves. Improvements in Knee Society Score (KSS) and range of motion were compared using paired Student’s t-tests. Complications were compared between the two groups utilizing Chi-square tests. Radiographic evaluation was performed using Knee Society Roentgenographic Evaluation and Scoring System. Results All-cause implant survivorship in beaded PA-coated group was 99.5% (95% CI, 97.9 to 99.9%) and 99.5% (95% CI, 92.7 to 99.9%) in highly porous titanium-coated group. There were no significant differences in the Knee Society Score (KSS) for pain and function. Improvement in flexion and extension was similar in the two groups. Overall complication rate (2.2% vs. 2.3%), p=0.274) and number of revisions (6 (0.8%) vs. 2 (0.2%), p=0.936) were similar in the two groups. Excluding the aseptic and septic failures, there were no progressive radiolucencies or osteolysis on radiographic evaluation. Discussion This study has shown good clinical and patient reported outcomes of cementless TKA for both implants. Future multicenter large scale clinical and cost-effectiveness studies are needed to determine the superiority of one cementless implant type over the other.