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

Knee Surgery, Sports Traumatology, Arthroscopy volume 24, pages 3200–3211 (2016)Cite this article

Abstract

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 <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.

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Acknowledgments

Foundation items: Natural Science Foundation of Shandong Province, China (No. 2009ZRB14311). The authors would like to thank Dr. for his critical review of the manuscript.

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Affiliations

  1. Department of Joint Surgery, Hospital of Qingdao University, Qingdao, China

    Changyao Wang

  2. Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Tilman Pfitzner & Philipp von Roth

  3. Orthopädische Chirurgie München, Steinerstraβe 6, 81369, Munich, Germany

    Hermann O. Mayr, Michael Sostheim & Robert Hube

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  1. Changyao Wang
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  2. Tilman Pfitzner
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Correspondence to Robert Hube.

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Wang, C., Pfitzner, T., von Roth, P. et al. Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis. Knee Surg Sports Traumatol Arthrosc 24, 3200–3211 (2016). https://doi.org/10.1007/s00167-015-3820-4

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  • DOI: https://doi.org/10.1007/s00167-015-3820-4

Keywords

  • Total knee arthroplasty
  • Stem revision
  • Cementing
  • Knee prosthesis
  • Prosthesis failure