Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis

Purpose Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was perfo...

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Published in:Knee Surgery, Sports Traumatology, Arthroscopy Sports Traumatology, Arthroscopy, 2016-10, Vol.24 (10), p.3200-3211
Main Authors: Wang, Changyao, Pfitzner, Tilman, von Roth, Philipp, Mayr, Hermann O., Sostheim, Michael, Hube, Robert
Format: Article
Language:English
Subjects:
Arthroplasty, Replacement, Knee - methods
Bone Cements
Humans
Knee
Knee Prosthesis
Medicine
Medicine & Public Health
Orthopedics
Prosthesis Failure
Reoperation
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container_start_page 3200
container_title Knee Surgery, Sports Traumatology, Arthroscopy
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creator Wang, Changyao
Pfitzner, Tilman
von Roth, Philipp
Mayr, Hermann O.
Sostheim, Michael
Hube, Robert
description Purpose Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation. Methods Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model. Results Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up
doi_str_mv 10.1007/s00167-015-3820-4
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The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation. Methods Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model. Results Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up &lt;60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices. Conclusion There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA. Level of evidence Systematic review of Level IV, Therapeutic studies, Level IV.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-015-3820-4</identifier><identifier>PMID: 26685696</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Arthroplasty, Replacement, Knee - methods ; Bone Cements ; Humans ; Knee ; Knee Prosthesis ; Medicine ; Medicine &amp; Public Health ; Orthopedics ; Prosthesis Failure ; Reoperation</subject><ispartof>Knee Surgery, Sports Traumatology, Arthroscopy, 2016-10, Vol.24 (10), p.3200-3211</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-a52d39bdfd0509dd6c3fa92768290b8caad67e1b0f37fe370a138720bd42ee383</citedby><cites>FETCH-LOGICAL-c405t-a52d39bdfd0509dd6c3fa92768290b8caad67e1b0f37fe370a138720bd42ee383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>313,314,780,784,792,27922,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26685696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Changyao</creatorcontrib><creatorcontrib>Pfitzner, Tilman</creatorcontrib><creatorcontrib>von Roth, Philipp</creatorcontrib><creatorcontrib>Mayr, Hermann O.</creatorcontrib><creatorcontrib>Sostheim, Michael</creatorcontrib><creatorcontrib>Hube, Robert</creatorcontrib><title>Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis</title><title>Knee Surgery, Sports Traumatology, Arthroscopy</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation. Methods Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model. Results Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up &lt;60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices. Conclusion There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA. 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The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation. Methods Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model. Results Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up &lt;60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices. Conclusion There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA. Level of evidence Systematic review of Level IV, Therapeutic studies, Level IV.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26685696</pmid><doi>10.1007/s00167-015-3820-4</doi><tpages>12</tpages></addata></record>
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source Wiley; Springer Nature; SPORTDiscus with Full Text
subjects Arthroplasty, Replacement, Knee - methods
Bone Cements
Humans
Knee
Knee Prosthesis
Medicine
Medicine & Public Health
Orthopedics
Prosthesis Failure
Reoperation
title Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis
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