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Modified Hybrid Stem Fixation in Revision TKA is Durable at 2 to 10 Years

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Hybrid revision knee component fixation, in which cement is placed in the metaphysis combined with a cementless diaphyseal engaging stem, provides ease of insertion, possibly improved component alignment, and easier removal if required, compared with fully cemented prostheses. The literature suggests the technique has a 2 to 5 year survivorship ranging from 81% to 94%.

Questions/purposes

To confirm the literature we asked whether (1) a modified hybrid fixation technique is durable and reliable at an average 5-year followup, (2) this method of fixation provides clinical improvements as assessed by knee scores, (3) there are radiographic findings unique to this fixation technique, (4) the degree of knee constraint influences clinical performance or radiographic findings, and (5) end-of-stem pain is associated with this fixation method?

Patients and Methods

We retrospectively reviewed all 83 patients who had 88 both-component revision TKAs using our modified hybrid fixation technique. We assessed the Knee Society scores and evaluated radiographs for radiolucent and radiosclerotic lines. The minimum followup was 24 months (average, 65 months; range, 24–126 months).

Results

Kaplan-Meier survivorship free of aseptic loosening was 100% at 5 years and 90% at 10 years. Postoperatively, the mean Knee Society pain and function scores both improved. Partial radiolucent lines were rare; two components were loose. We commonly observed radiosclerotic lines adjacent to stem extensions but these did not affect clinical scores or implant stability at last followup. Neither knee scores nor radiographic findings differed based on knee constraint. End-of-stem pain occurred rarely and was transient.

Conclusions

Modified hybrid fixation of revision knee arthroplasty using a diaphyseal engaging stem and cementation only in the metaphysis is durable at a mean 5 years followup.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Richard A. Berger MD (RAB) for participation in this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Washington Hospital Healthcare System, 2000 Mowry Avenue, Fremont, CA, 94536, USA

    Alexander P. Sah MD

  2. Rush University Medical Center, Chicago, IL, USA

    Sanjai Shukla MD, Craig J. Della Valle MD, Aaron G. Rosenberg MD & Wayne G. Paprosky MD

Authors
  1. Alexander P. Sah MD
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  2. Sanjai Shukla MD
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  3. Craig J. Della Valle MD
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  4. Aaron G. Rosenberg MD
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  5. Wayne G. Paprosky MD
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Corresponding author

Correspondence to Alexander P. Sah MD.

Additional information

One or more of the authors (CJDV) is a consultant for Angiotech, Biomet, Kinamed, and Smith & Nephew and receives research support from Zimmer. One or more of the authors (AGR, WGP) receive royalties from Zimmer.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Rush University Medical Center, Chicago, IL.

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Sah, A.P., Shukla, S., Della Valle, C.J. et al. Modified Hybrid Stem Fixation in Revision TKA is Durable at 2 to 10 Years. Clin Orthop Relat Res 469, 839–846 (2011). https://doi.org/10.1007/s11999-010-1569-0

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  • DOI: https://doi.org/10.1007/s11999-010-1569-0

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