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Lower revision rates for cemented fixation in a long-term survival analysis of three different LCS designs

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Background

In primary Total Knee Arthroplasty (TKA), it is still not clear if cemented or uncemented fixation has the best long-term survival. The Low Contact Stress (LCS) mobile-bearing (MB) knee system was introduced in 1977. The aim of this study is to investigate the long-term survival of this design with a minimum of 15-year follow-up.

Methods

A retrospective analysis was performed, with the primary endpoint for survival defined as revision. Cox regression analysis was performed to assess the association between type of fixation and the risk of revision, while correcting for potential confounders (diagnosis, design, age and sex).

Results

1271 cases were included with inflammatory joint disease (IJD) (657 cases) and non-IJD (614 cases). TKAs were performed cemented in 522 cases and uncemented in 749 cases. A bicruciate retaining design was used in 180 cases, a rotating platform design in 174 cases and an anterior posterior glide posterior cruciate-retaining (PCR) design in 916 cases. Cumulative incidence of component revision at 15 years was 2.7% (95% CI 1.6; 4.5) for cemented and 10% (95% CI 8.1; 12.4) for uncemented TKA, respectively. The 20-year cumulative incidence was 2.9% (95% CI 1.7; 4.7) for cemented and 10.9% (95% CI 8.8; 13.4) for uncemented TKA, respectively. Age, non-IJD and PCR design were associated with a significantly higher risk of revision, regardless of the type of fixation.

Conclusion

Long-term survival for patients undergoing cemented or uncemented TKA using the LCS MB system revealed lower revision rates for cemented fixation. Revision risk was higher in younger, non-IJD patients who had the PCR design, regardless of the type of fixation. For the LCS MB TKA design, it is recommended to use cemented fixation.

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Acknowledgements

The authors would like to thank Dr. L. Václavů for her language proofing.

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Authors and Affiliations

  1. SCORE Foundation, Specialized Center of Orthopedic Research and Education/Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101AE, Amsterdam, The Netherlands

    Bas van Ooij, Dave R. de Keijzer, Daniël Hoornenborg, Inger N. Sierevelt & Daniël Haverkamp

  2. Cohesie, Occupational Health Service, Baron van Nagellstraat 9, 3781 AP, Voorthuizen, The Netherlands

    Bas van Ooij

  3. Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Dave R. de Keijzer

  4. Orthopedic Department, Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands

    Inger N. Sierevelt

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  1. Bas van Ooij
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Correspondence to Bas van Ooij.

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Ethical approval

The procedures of this study were approved by the local ethical board of the former Slotervaart Medical Centre (local registration number P1833, in compliance with the Helsinki Declaration).

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van Ooij, B., de Keijzer, D.R., Hoornenborg, D. et al. Lower revision rates for cemented fixation in a long-term survival analysis of three different LCS designs. Knee Surg Sports Traumatol Arthrosc 30, 2707–2713 (2022). https://doi.org/10.1007/s00167-021-06587-8

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