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      Long-term effects of cemented and cementless fixations of total knee arthroplasty: a meta-analysis and systematic review of randomized controlled trials

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          Abstract

          Background

          To determine the long-term effects (a minimum follow-up time 8.8 years) of cemented and cementless fixations used for total knee arthroplasty (TKA).

          Methods

          PubMed, EMBASE, Ovid, Cochrane Library, CINAHL, China National Knowledge Infrastructure and China Wangfang database were interrogated for appropriate randomized controlled trials (RCTs) through July 2020. Data were extracted and assessed for accuracy by 2 of the authors acting independently. Any controversial discrepancies were resolved after discussion with a third author.

          Result

          Eight RCTs were included with low to moderate bias risks. The cemented fixation of TKA was comparable to cementless fixation in terms of implant survival (relative risk, 1.016; 95% CI 0.978 to 1.056; P = 0.417), Knee Society (KS) knee score (standardized mean difference (SMD), − 0.107; 95% CI − 0.259 to 0.045; P = 0.168), KS function score (SMD − 0.065; 95% CI − 0.238 to 0.109; P = 0.463), KS pain score (SMD − 0.300; 95% CI − 0.641 to 0.042; P = 0.085), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (SMD − 0.117; 95% CI − 0.307 to 0.073; P = 0.227), HSS score (SMD − 0.027; 95% CI − 0.270 to 0.217; P = 0.829), range of motion (SMD 0.061; 95% CI − 0.205 to 0.327; P = 0.652) at ≥ 8.8 years of follow-up. In terms of radiographic outcomes at ≥ 8.8 years of follow-up, the incidence of a radiolucent line in the cementless group was lower than for the cemented group (SMD 3.828; 95% CI 2.228 to 6.576; P < 0.001). However, the maximum total point motion (MTPM) of the cementless group was greater than for the cemented group (SMD − 0.739; 95% CI − 1.474 to − 0.005; P = 0.048).

          Conclusions

          Long-term follow-up verified that cementless and cemented fixation have similar prosthesis survival rates, clinical scores and mobility. However, radiography suggested that each technique had an advantage with regard to the radiolucent line and MTPM.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13018-021-02762-2.

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          Most cited references34

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          Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial.

          Jason M Tanzer, G J Stackpool, J Krygier … (1999)
          We have studied the characteristics of bone ingrowth of a new porous tantalum biomaterial in a simple transcortical canine model using cylindrical implants 5 x 10 mm in size. The material was 75% to 80% porous by volume and had a repeating arrangement of slender interconnecting struts which formed a regular array of dodecahedron-shaped pores. We performed histological studies on two types of material, one with a smaller pore size averaging 430 microm at 4, 16 and 52 weeks and the other with a larger pore size averaging 650 microm at 2, 3, 4, 16 and 52 weeks. Mechanical push-out tests at 4 and 16 weeks were used to assess the shear strength of the bone-implant interface on implants of the smaller pore size. The extent of filling of the pores of the tantalum material with new bone increased from 13% at two weeks to between 42% and 53% at four weeks. By 16 and 52 weeks the average extent of bone ingrowth ranged from 63% to 80%. The tissue response to the small and large pore sizes was similar, with regions of contact between bone and implant increasing with time and with evidence of Haversian remodelling within the pores at later periods. Mechanical tests at four weeks indicated a minimum shear fixation strength of 18.5 MPa, substantially higher than has been obtained with other porous materials with less volumetric porosity. This porous tantalum biomaterial has desirable characteristics for bone ingrowth; further studies are warranted to ascertain its potential for clinical reconstructive orthopaedics.
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            Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030.

            Steven M Kurtz, Edmund Lau, Kevin Ong … (2009)
            Previous projections of total joint replacement (TJR) volume have not quantified demand for TJR surgery in young patients (< 65 years old). We developed projections for demand of TJR for the young patient population in the United States. The Nationwide Inpatient Sample was used to identify primary and revision TJRs between 1993 and 2006, as a function of age, gender, race, and census region. Surgery prevalence was modeled using Poisson regression, allowing for different rates for each population subgroup over time. If the historical growth trajectory of joint replacement surgeries continues, demand for primary THA and TKA among patients less than 65 years old was projected to exceed 50% of THA and TKA patients of all ages by 2011 and 2016, respectively. Patients less than 65 years old were projected to exceed 50% of the revision TKA patient population by 2011. This study underscores the major contribution that young patients may play in the future demand for primary and revision TJR surgery. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
            Article 0 comments Cited 151 times – based on 0 reviews     Review now
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              Survival and clinical function of cemented and uncemented prostheses in total knee replacement: a meta-analysis.

              Neel Gandhi, Yu. D. Tsvetkov, Raymond Davey … (2009)
              Using meta-analysis we compared the survival and clinical outcomes of cemented and uncemented techniques in primary total knee replacement. We reviewed randomised controlled trials and observational studies comparing cemented and uncemented fixation. Our primary outcome was survival of the implant free of aseptic loosening. Our secondary outcome was joint function as measured by the Knee Society score. We identified 15 studies that met our final eligibility criteria. The combined odds ratio for failure of the implant due to aseptic loosening for the uncemented group was 4.2 (95% confidence interval (CI) 2.7 to 6.5) (p < 0.0001). Subgroup analysis of data only from randomised controlled trials showed no differences between the groups for odds of aseptic loosening (odds ratio 1.9, 95% CI 0.55 to 6.40, p = 0.314). The weighted mean difference for the Knee Society score was 0.005 (95% CI -0.26 to 0.26) (p = 0.972). There was improved survival of the cemented compared to uncemented implants, with no statistically significant difference in the mean Knee Society score between groups for all pooled data.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Zhanpo Wu: wuzp99922@sina.com
                Zengxin Gao: 552366015@qq.com
                Journal
                Journal ID (nlm-ta): J Orthop Surg Res
                Journal ID (iso-abbrev): J Orthop Surg Res
                Title: Journal of Orthopaedic Surgery and Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1749-799X
                Publication date (Electronic): 12 October 2021
                Publication date PMC-release: 12 October 2021
                Publication date Collection: 2021
                Volume: 16
                Electronic Location Identifier: 590
                Affiliations
                [1 ]GRID grid.263826.b, ISNI 0000 0004 1761 0489, Department of Orthopedics, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, , Southeast University, ; No. 86 Chongwen Road, Lishui District, Nanjing, 211200 China
                [2 ]Department of Geriatrics, Kong Jiang Hospital of Yangpu District, Shanghai, China
                Article
                Publisher ID: 2762
                DOI: 10.1186/s13018-021-02762-2
                PMC ID: 8513310
                PubMed ID: 34641924
                SO-VID: 473b36c6-7d99-4aa4-a5d2-3460053afa18
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 14 March 2021
                Date accepted : 30 September 2021
                Categories
                Subject: Systematic Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Surgery
                Keywords: total knee arthroplasty,cemented fixation,prosthesis,point motion
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: total knee arthroplasty, cemented fixation, prosthesis, point motion

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