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Long-term survival of fully cemented stem in re-revision total knee arthroplasty performed on femur with diaphyseal deformation due to implant loosening

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Abstract

Purpose

The study aims to analyze long-term clinical and radiographic results, and survival of re-revision total knee arthroplasty (TKA) using fully cemented stems performed on femurs with diaphyseal deformation.

Methods

Thirty-seven re-revision TKAs using fully cemented stems performed in femoral diaphyseal deformations, characterized as diaphyseal canal enlargement and cortex deformation due to aseptic loosening of previously implanted stems, between 2003 and 2015 were retrospectively reviewed. The mean follow-up period was 10.0 years. Clinically, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Radiographically, mechanical axis (MA) and component positions were measured. Complications and survival rates were also analyzed.

Results

Clinically, the WOMAC significantly improved at final follow-up (61.2 vs 47.2, p < 0.001), but not the ROM (95.5 vs 102.5, p = 0.206). Radiographically, the MA and component positions were appropriate, with no changes in component positions from immediately post-operative to final follow-up, but with MA change from varus 2.9° to 3.7° (p = 0.020). Two cases (5.4%) with history of previous infections developed periprosthetic joint infection (PJI). Debridement with polyethylene insert exchange following antibiotic suppression were performed in those cases because of concern for difficult implant-cement removal. The five and ten year survival rates were 100% and 93.2%, respectively.

Conclusion

Fully cemented stems are viable in providing long-term satisfactory survival after re-revision TKA in patients with femoral diaphyseal deformation. However, it should be used carefully for those with previous infections.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, Korea

    Sang Jun Song, Hyun Woo Le & Cheol Hee Park

  2. Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea

    Dae Kyung Bae

Authors
  1. Sang Jun Song
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  2. Hyun Woo Le
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  3. Dae Kyung Bae
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  4. Cheol Hee Park
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Contributions

The following authors have made substantial contributions to the followings: (1) the conception and design of the study (S. J. S., C. H. P.), provision of study materials or patients (D. K. B.), acquisition of data (H. W. L., C. H. P.), analysis and interpretation of data (S. J. S., H. W. L., and C. H. P.), (2) drafting the article (S. J. S., H. W. L., D. K. B., and C. H. P.), (3) revision of the article (S. J. S., H. W. L., D. K. B., and C. H. P.), and (3) final approval of the version to be submitted (S. J. S., H. W. L., D. K. B., and C. H. P.).

Corresponding author

Correspondence to Cheol Hee Park.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Institutional Review Board of Kyung Hee University Medical Center.

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Informed consent was obtained from all individual participants included in the study.

Consent for publication

There is no any individual person’s data in any form.

Competing interests

The authors declare no competing interests.

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Song, S.J., Le, H.W., Bae, D.K. et al. Long-term survival of fully cemented stem in re-revision total knee arthroplasty performed on femur with diaphyseal deformation due to implant loosening. International Orthopaedics (SICOT) 46, 1521–1527 (2022). https://doi.org/10.1007/s00264-022-05412-2

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  • DOI: https://doi.org/10.1007/s00264-022-05412-2

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