David A Crawford1, Keith R Berend2, Denis Nam3, Robert L Barrack3, Joanne B Adams4, Adolph V Lombardi2. 1. Joint Implant Surgeons, Inc, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio. 2. Joint Implant Surgeons, Inc, New Albany, Ohio; Mount Carmel Health System, New Albany, Ohio; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Department of Orthopaedic Surgery, Washington University, Chesterfield, Missouri. 4. Joint Implant Surgeons, Inc, New Albany, Ohio.
Abstract
BACKGROUND: Total knee arthroplasty is overall a very successful surgery, but complications do occur. These complications include aseptic loosening of the tibial component, and obese patients are among the highest risk group. High-viscosity cement (HVC) has been implicated as a possible cause for aseptic loosening of the tibial component. The purpose of this study was to evaluate the incidence of aseptic loosening of the tibial component in obese patients with the use of HVC and standard tibial tray. METHODS: We identified 1366 obese patients (1851 knees) with a body mass index >35 kg/m2 and 2-year minimum follow-up who underwent primary total knee arthroplasty using HVC and a symmetrical, grit-blasted, cobalt-chrome tibial component with 40-mm stem. Preoperative and postoperative range of motion, Knee Society (KS) scores, complications, and reoperations were evaluated. Specifically, we assessed the rate of tibial aseptic loosening. RESULTS: At a mean 5.4 years follow-up, only 1 in 1851 knees had aseptic loosening of the tibial component for an incidence of 0.054%. There was a mean increase of 3.3 degrees of knee range of motion. KS pain level decreased by 38.6 points (50 point scale). KS clinical scores improved by 52.2, Knee Society functional scores improved by 19.5, University of California, Los Angeles, activity score improved by 0.9, and Oxford Knee Score by 15.7. All these improvements were statistically significant with P < .001. CONCLUSION: Standard tibial components and HVC can be used in most patients, including the high-risk obese group, with low rates of tibial aseptic loosening.
BACKGROUND: Total knee arthroplasty is overall a very successful surgery, but complications do occur. These complications include aseptic loosening of the tibial component, and obesepatients are among the highest risk group. High-viscosity cement (HVC) has been implicated as a possible cause for aseptic loosening of the tibial component. The purpose of this study was to evaluate the incidence of aseptic loosening of the tibial component in obesepatients with the use of HVC and standard tibial tray. METHODS: We identified 1366 obesepatients (1851 knees) with a body mass index >35 kg/m2 and 2-year minimum follow-up who underwent primary total knee arthroplasty using HVC and a symmetrical, grit-blasted, cobalt-chrome tibial component with 40-mm stem. Preoperative and postoperative range of motion, Knee Society (KS) scores, complications, and reoperations were evaluated. Specifically, we assessed the rate of tibial aseptic loosening. RESULTS: At a mean 5.4 years follow-up, only 1 in 1851 knees had aseptic loosening of the tibial component for an incidence of 0.054%. There was a mean increase of 3.3 degrees of knee range of motion. KSpain level decreased by 38.6 points (50 point scale). KS clinical scores improved by 52.2, Knee Society functional scores improved by 19.5, University of California, Los Angeles, activity score improved by 0.9, and Oxford Knee Score by 15.7. All these improvements were statistically significant with P < .001. CONCLUSION: Standard tibial components and HVC can be used in most patients, including the high-risk obese group, with low rates of tibial aseptic loosening.
Authors: Lena Keppler; Steffen Klingbeil; Alexander Martin Keppler; Johannes Becker; Christian Fulghum; Björn Michel; Kilian Voigts; Wolfgang Reng Journal: BMC Musculoskelet Disord Date: 2022-06-21 Impact factor: 2.562