Skip to main content
SpringerLink
Log in

Hybrid stems are superior to cemented stems in revision total knee arthroplasty: a systematic review and meta-analysis of recent comparative studies

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The demand for revision total knee arthroplasty (TKA) has grown significantly in recent years. The two major fixation methods for stems in revision TKA include cemented and ‘hybrid’ fixation. We explore the optimal fixation method using data from recent, well-designed comparative studies.

Methods

We performed a systematic review of comparative studies published within the last 10 years with a minimum follow-up of 24 months. To allow for missing data, a random-effects meta-analysis of all available cases was performed. The odds ratio (OR) for the relevant outcome was calculated with 95% confidence intervals. The effects of small studies were analyzed using a funnel plot, and asymmetry was assessed using Egger’s test. The primary outcome measure was all-cause failure. Secondary outcome measures included all-cause revision, aseptic revision and radiographic failure.

Results

There was a significantly lower failure rate for hybrid stems when compared to cemented stems (p = 0.006) (OR 0.61, 95% CI 0.42–0.87). Heterogeneity was 4.3% and insignificant (p = 0.39). There was a trend toward superior hybrid performance for all other outcome measures including all-cause re-revision, aseptic re-revision and radiographic failure.

Conclusion

Recent evidence suggests a significantly lower failure rate for hybrid stems in revision TKA. There is also a trend favoring the use of hybrid stems for all outcome variables assessed in this study. This is the first time a significant difference in outcome has been demonstrated through systematic review of these two modes of stem fixation. We therefore recommend the use, where possible, of hybrid stems in revision TKA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 96(8):624–630

    Article  Google Scholar 

  2. Morgan-Jones R, Oussedik SI, Graichen H, Haddad FS (2015) Zonal fixation in revision total knee arthroplasty. Bone Joint J 97-B(2):147–149.

    Article  CAS  Google Scholar 

  3. Bottner F, Laskin R, Windsor RE, Haas SB (2006) Hybrid component fixation in revision total knee arthroplasty. Clin Orthopaedics Related Res 446:127–131

    Article  Google Scholar 

  4. Scott CE, Biant LC (2012) The role of the design of tibial components and stems in knee replacement. J Bone Joint Surg Br 94(8):1009–1015

    Article  CAS  Google Scholar 

  5. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3(3):e123–e130

    PubMed  PubMed Central  Google Scholar 

  6. Fehring TK, Odum S, Olekson C, Griffin WL, Mason JB, McCoy TH (2003) Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthopaedics Relat Res 416:217–224

    Article  Google Scholar 

  7. Chaimani A, Mavridis D, Higgins JPT, Salanti G, White IR (2018) Allowing for informative missingness in aggregate data meta-analysis with continuous or binary outcomes: extensions to metamiss. Stata J 18(3):716–740

    Article  Google Scholar 

  8. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  Google Scholar 

  9. Gililland JM, Gaffney CJ, Odum SM, Fehring TK, Peters CL, Beaver WB (2014) Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA. J Arthroplasty 29(9 Suppl):224–228.

    Article  Google Scholar 

  10. Lachiewicz PF, Kleeman LT, Seyler T (2018) Bearing surfaces for total hip arthroplasty. J Am Acad Orthop Surg 26(2):45–57

    Article  Google Scholar 

  11. Gomez-Vallejo J, Albareda-Albareda J, Seral-Garcia B, Blanco-Rubio N, Ezquerra-Herrando L (2018) Revision total knee arthroplasty: hybrid vs standard cemented fixation. J Orthop Traumatol 19(1):9

    Article  Google Scholar 

  12. Fleischman AN, Azboy I, Fuery M, Restrepo C, Shao H, Parvizi J (2017) Effect of stem size and fixation method on mechanical failure after revision total knee arthroplasty. J Arthroplasty 32(9S):S202-S208.e1.

    Article  Google Scholar 

  13. Edwards PK, Fehring TK, Hamilton WG, Perricelli B, Beaver WB, Odum SM (2014) Are cementless stems more durable than cemented stems in two-stage revisions of infected total knee arthroplasties? Clin Orthopaedics Related Res 472(1):206–211

    Article  Google Scholar 

  14. Heesterbeek PJ, Wymenga AB, van Hellemondt GG (2016) No difference in implant micromotion between hybrid fixation and fully cemented revision total knee arthroplasty: a randomized controlled trial with radiostereometric analysis of patients with mild-to-moderate bone loss. J Bone Joint Surg Am 98(16):1359–1369

    Article  CAS  Google Scholar 

  15. Kosse NM, van Hellemondt GG, Wymenga AB, Heesterbeek PJ (2017) Comparable stability of cemented vs press-fit placed stems in revision total knee arthroplasty with mild to moderate bone loss: 6.5-year results from a randomized controlled trial with radiostereometric analysis. J Arthroplasty 32(1):197–201.

    Article  Google Scholar 

  16. Lachiewicz PF, O'Dell JA (2020) Is there a difference between cemented and uncemented femoral stem extensions in revision knee arthroplasty? J Knee Surg 33(1):84–88. https://doi.org/10.1055/s-0038-1676567

    Article  PubMed  Google Scholar 

  17. Kang SG, Park CH, Song SJ (2018) Stem fixation in revision total knee arthroplasty: indications, stem dimensions, and fixation methods. Knee Surg Relat Res 30(3):187–192

    Article  Google Scholar 

  18. Wang C, Pfitzner T, von Roth P, Mayr HO, Sostheim M, Hube R (2016) Fixation of stem in revision of total knee arthroplasty: cemented versus cementless-a meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(10):3200–3211

    Article  Google Scholar 

  19. Magill P, Blaney J, Hill JC, Bonnin MP, Beverland DE (2016) Impact of a learning curve on the survivorship of 4802 cementless total hip arthroplasties. Bone Joint J 98-B(12):1589–1596.

    Article  CAS  Google Scholar 

  20. Haas SB, Insall JN, Montgomery W 3rd, Windsor RE (1995) Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 77(11):1700–1707

    Article  CAS  Google Scholar 

  21. Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthopaedics Relat Res 467(3):810–817

    Article  Google Scholar 

  22. Murray PB, Rand JA, Hanssen AD (1994) Cemented long-stem revision total knee arthroplasty. Clin Orthopaedics Related Res 309:116–123

    Google Scholar 

  23. Shannon BD, Klassen JF, Rand JA, Berry DJ, Trousdale RT (2003) Revision total knee arthroplasty with cemented components and uncemented intramedullary stems. J Arthroplasty 18(7 Suppl 1):27–32

    Article  Google Scholar 

  24. Chon JG, Lombardi AV Jr, Berend KR (2004) Hybrid stem fixation in revision total knee arthroplasty (TKA). Surg Technol Int 12:214–220

    PubMed  Google Scholar 

Download references

Acknowledgements

Linda Halton, for sourcing manuscripts.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Gerard A. Sheridan, Donald S. Garbuz & Bassam A. Masri

Authors
  1. Gerard A. Sheridan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald S. Garbuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bassam A. Masri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Gerard A. Sheridan—Data collection and manuscript preparation. Donald S. Garbuz—Study design, manuscript editing. Bassam A. Masri—Study design, manuscript editing.

Corresponding author

Correspondence to Gerard A. Sheridan.

Ethics declarations

Conflicts of interest

All authors declare that they have no conflict of interest.

Availability of data and material:

Available on request.

Ethics approval

Not required given the nature of the study (systematic review).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sheridan, G.A., Garbuz, D.S. & Masri, B.A. Hybrid stems are superior to cemented stems in revision total knee arthroplasty: a systematic review and meta-analysis of recent comparative studies. Eur J Orthop Surg Traumatol 31, 131–141 (2021). https://doi.org/10.1007/s00590-020-02752-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-020-02752-w

Keywords

Search

Navigation