Skip main navigation
Close Drawer MenuOpen Drawer Menu

We use cookies to give you the best experience on our website. To find out more about how we use cookies and how to change your settings, see our Privacy Policy.

Accept
Knee

Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial

CrossMark LogoCrossMark
    Published Online:31 Jul 2020https://doi.org/10.1302/0301-620X.102B8.BJJ-2019-1448.R1

    Abstract

    Aims

    Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design.

    Methods

    Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2 (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up.

    Results

    At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001)

    Conclusion

    Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation.

    Cite this article: Bone Joint J 2020;102-B(8):1025–1032.

    References

    • 1. No authors listed. Hip and Knee Arthroplasty Annual Report. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). 2014. https://aoanjrr.sahmri.com/documents/10180/172286/Annual+Report+2014 (date last accessed 29 May 2020). Google Scholar
    • 2. No authors listed. New Zealand Joint Registry Ten Year Report January 1999 to December 2008. New Zealand Orthopaedic Association. 2009. https://nzoa.org.nz/system/files/NJR%2010%20Year%20Report.pdf (date last accessed 29 May 2020). Google Scholar
    • 3. No authors listed. National Joint Registry 15th Annual Report 2018. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. https://www.hqip.org.uk/wp-content/uploads/2018/11/NJR-15th-Annual-Report-2018.pdf (date last accessed 29 May 2020). Google Scholar
    • 4. Chakrabarty G, Vashishtha M, Leeder D. Polyethylene in knee arthroplasty: A review. J Clin Orthop Trauma. 2015;6(2):108–112. Crossref, Medline, Google Scholar
    • 5. Naudie DDR, Ammeen DJ, Engh GA, Rorabeck CH. Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg. 2007;15(1):53–64. Crossref, Medline, ISI, Google Scholar
    • 6. Tanner MG, Whiteside LA, White SE. Effect of polyethylene quality on wear in total knee arthroplasty. Clin Orthop Relat Res. 1995;317:83–88. Google Scholar
    • 7. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today—has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774–1778. Crossref, Medline, ISI, Google Scholar
    • 8. Berger RA, Lyon JH, Jacobs JJ, et al. Problems with cementless total knee arthroplasty at 11 years followup. Clin Orthop Relat Res. 2001;392:196–207. Crossref, Google Scholar
    • 9. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85-A(2):259–265. Crossref, Google Scholar
    • 10. Cohen R. A porous tantalum trabecular metal: basic science. Am J Orthop (Belle Mead NJ). 2002;31(4):216–217. Medline, Google Scholar
    • 11. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81-B(5):907–914. Link, Google Scholar
    • 12. Niemeläinen M, Skyttä ET, Remes V, Mäkelä K, Eskelinen A. Total knee arthroplasty with an uncemented trabecular metal tibial component: a registry-based analysis. J Arthroplasty. 2014;29(1):57–60. Crossref, Medline, ISI, Google Scholar
    • 13. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80-B(1):63–69. Link, Google Scholar
    • 14. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14. Google Scholar
    • 15. McCaskie AW, Deehan DJ, Green TP, et al. Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years. J Bone Joint Surg Br. 1998;80(6):971–975. Link, Google Scholar
    • 16. Khaw FM, Kirk LMG, Morris RW, Gregg PJ, randomised A. controlled trial of cemented versus cementless press-fit condylar total knee replacement. Ten-year survival analysis. J Bone Joint Surg Br. 2002;84(5):658–666. Link, Google Scholar
    • 17. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233. Crossref, Medline, ISI, Google Scholar
    • 18. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12. Google Scholar
    • 19. Kamath AF, Lee G-C, Sheth NP, et al. Prospective results of uncemented tantalum monoblock tibia in total knee arthroplasty: minimum 5-year follow-up in patients younger than 55 years. J Arthroplasty. 2011;26(8):1390–1395. Crossref, Medline, ISI, Google Scholar
    • 20. Clement ND, MacDonald D, Simpson AH. The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1933–1939. Crossref, Medline, ISI, Google Scholar
    • 21. Lee WC, Kwan YH, Chong HC, Yeo SJ. The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3354–3359. Crossref, Medline, ISI, Google Scholar
    • 22. Castagnini F, Sudanese A, Bordini B, et al. Total Knee Replacement in Young Patients: Survival and Causes of Revision in a Registry Population. J Arthroplasty. 2017;32(11):3368–3372. Crossref, Medline, ISI, Google Scholar
    • 23. Evans JT, Walker RW, Evans JP, et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):655–663. Crossref, Medline, ISI, Google Scholar
    • 24. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57–63. Crossref, Medline, ISI, Google Scholar
    • 25. Noiseux NO, Long WJ, Mabry TM, Hanssen AD, Lewallen DG. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties. J Arthroplasty. 2014;29(3):617–620. Crossref, Medline, ISI, Google Scholar
    • 26. Wegrzyn J, Kaufman KR, Hanssen AD, Lewallen DG. Performance of porous tantalum vs. titanium cup in total hip arthroplasty: randomized trial with minimum 10-year follow-up. J Arthroplasty. 2015;30(6):1008–1013. Crossref, Medline, ISI, Google Scholar
    • 27. Fernandez-Fairen M, Hernández-Vaquero D, Murcia A, Torres A, Llopis R. Trabecular metal in total knee arthroplasty associated with higher knee scores: a randomized controlled trial. Clin Orthop Relat Res. 2013;471(11):3543–3553. Crossref, Medline, ISI, Google Scholar
    • 28. Hu B, Chen Y, Zhu H, Wu H, Yan S. Cementless Porous Tantalum Monoblock Tibia vs Cemented Modular Tibia in Primary Total Knee Arthroplasty: A Meta-Analysis. J Arthroplasty. 2017;32(2):666–674. Crossref, Medline, ISI, Google Scholar
    • 29. DeFrancesco CJ, Canseco JA, Nelson CL, Israelite CL, Kamath AF. Uncemented tantalum monoblock tibial fixation for total knee arthroplasty in patients less than 60 years of age: mean 10-year follow-up. J Bone Joint Surg Am. 2018;100-A(10):865–870. Crossref, ISI, Google Scholar
    • 30. Nafei A, Nielsen S, Kristensen O, Hvid I. The press-fit Kinemax knee arthroplasty. High failure rate of non-cemented implants. J Bone Joint Surg Br. 1992;74-B(2):243–246. Link, ISI, Google Scholar
    • 31. Kim YH, Oh JH, Oh SH. Osteolysis around cementless porous-coated anatomic knee prostheses. J Bone Joint Surg Br. 1995;77(2):236–241. Link, Google Scholar
    • 32. Nelissen RG, Valstar ER, Rozing PM. The effect of hydroxyapatite on the micromotion of total knee prostheses. A prospective, randomized, double-blind study. J Bone Joint Surg Am. 1998;80-A(11):1665–1672. Crossref, Google Scholar
    • 33. Harwin SF, Patel NK, Chughtai M, et al. Out- comes of newer generation cementless total knee arthroplasty: beaded periapatite-coated vs highly porous titanium-coated implants. J Arthroplasty. 2017;32(7):2156–2160. Crossref, Medline, ISI, Google Scholar
    • 34. Yayac M, Harrer S, Hozack W, Parvizi J, Coutney M. The use of cementless components does not significantly increase procedural costs in total knee arthroplasty. J Arthroplasty. 2019. Google Scholar

    Submit a Letter to the Editor about this article