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Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2 years follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the clinical results, radiographic loosening and early complications between patients undergoing primary knee arthroplasty (TKA) with tibial short stem extension and those with standard stem for gross varus deformities at minimum two years after surgery.

Methods

From a prospective TKA database of 4216 patients, patients with a primary TKA with a tibial short stem extension (30 mm) for severe varus deformity (hip-kneeankle angle, HKA < 170°) and a minimum follow-up of 2 years, were reviewed and compared to a matched control group with tibial components with a standard stem, in a

1:3 ratio. Demographics, surgical parameters, pre- and postoperative alignment and outcome parameters were collected for all patients. The primary outcome was aseptic loosening of the tibial component. Secondary outcomes were knee society scores (KSS), postoperative HKA, general postoperative complications and implant survival rates.

Results

Forty-five patients with tibial short stem extensions (mean HKA 166.2°) were compared in a 1:3 ratio to a matched case–control group of 135 patients with standard stems (mean HKA 167.1°) at a mean follow-up of 57 and 64 months respectively after primary TKA. In the extension stem group, 4 patients encountered complications

(8.9%) versus 12 patients in the standard stem group (8.9%). There were no cases of tibial component loosening in the short extension stem versus four cases in the standard stem group (3%). This difference was significant between groups, p = 0.04.

Conclusion

In patients with varus deformities > 10°, undergoing primary total knee arthroplasty, prophylactic use of a tibial short extension stem may lead to less loosening of the tibial component. In this study, 3% of patient with big varus deformity without stemmed TKA had a tibial implant loosening versus 0% in the stemmed TKA group.

Level of evidence

Level III, case–control study

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France

    Gaspard Fournier, Bart Muller, Romain Gaillard, Cécile Batailler, Sébastien Lustig & Elvire Servien

  2. Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Cécile Batailler & Sébastien Lustig

  3. EA 7424 - Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France

    Elvire Servien

Authors
  1. Gaspard Fournier
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  2. Bart Muller
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  3. Romain Gaillard
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  4. Cécile Batailler
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  5. Sébastien Lustig
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  6. Elvire Servien
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Contributions

GF: study design, data collection, statistical analysis, literature review and manuscript writing. BM: literature review and manuscript writing. RG: study design and manuscript editing. CB: manuscript editing and literature review. SL: study design and manuscript editing. ES: study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gaspard Fournier.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. GF, BM, CB and RG declare that they have no conflict of interest. SL: consultant for Smith and Nephew, Stryker, Medacta, Heraeus, Depuy Synthes, Groupe Lepine, institutional research support from Corin and Amplitude. ES: institutional research support from Corin.

Ethical approval

All the procedures performed in the study were in accordance with the ethical standards of the institutional review board/international ethics commitee for each center and with the 1964 Helsinki Declaration and its later amendments.

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Fournier, G., Muller, B., Gaillard, R. et al. Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 28, 3780–3786 (2020). https://doi.org/10.1007/s00167-020-05848-2

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  • DOI: https://doi.org/10.1007/s00167-020-05848-2

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