Pacoret Victor, Kalk Etienne, Labattut Ludovic, Girardot Guillaume, Baulot Emmanuel, Martz Pierre
Dijon University Hospital, Orthopedic and Traumatology Department, 21000 Dijon, France.
Orthopedic Center, 71640 Dracy-Le-Fort, France.
SICOT J. 2020;6:36. doi: 10.1051/sicotj/2020028. Epub 2020 Sep 8.
Knee osteoarthritis is the main indication for primary total knee arthroplasty (TKA). It is now accepted that cementless implantation of the femoral component provides equivalent results to cemented one, however, the optimal fixation method of the tibial component remains controversial. The purpose of this study was to compare the survivorship of cemented versus cementless tibial baseplate in primary total knee arthroplasty.
We carried out a retrospective, monocentric study, including 109 TKA (Zimmer Natural Knee II ultra-congruent mobile-bearing) implanted between 2004 and 2010 for primary osteoarthritis, comparing 2 groups depending on tibial component fixation method, one cemented (n = 68) and one cementless (n = 41). Clinical (Knee Society Rating System (KSS), Hospital for Special Surgery (HSS) scores, range of motion) and radiodiological outcomes were assessed at last follow-up with a minimal follow-up of 5 years.
Mean follow-up were 8.14 [5.31-12.7] and 8.06 [5.22-12.02] years, respectively, in cemented and cementless groups. The tibial component survival rate was 100% [95CI: 91.4-100] in the cementless group and 97.1% [95CI: 89.78-99.42] in the cemented group (2 aseptic loosenings) (p = 0.27). Radiolucent lines were present in 31.7% (n = 13) of the cementless and 44.1% (n = 30) of the cemented baseplates (p = 0.2). The postoperative KSS knee score was higher in the cementless group (99 ± 3 vs. 97 ± 7.5; p = 0.02), but there was no significant difference in KSS function, global KSS and HSS scores. Mean range of flexion was 120 ± 10° in the cementless group and 122.5 ± 15° in the cemented group (p = 0.37). No significant differences were found on the radiographic data or on complications.
In this study, the survival rate of the tibial component is not influenced by its fixation method at a mean follow-up of 8 years in osteoarthritis, which confirms the reliability of cementless fixation in primary TKA.
膝关节骨关节炎是初次全膝关节置换术（TKA）的主要适应证。目前已公认，股骨组件的非骨水泥植入与骨水泥植入效果相当，然而，胫骨组件的最佳固定方法仍存在争议。本研究的目的是比较初次全膝关节置换术中骨水泥固定与非骨水泥固定胫骨基板的生存率。
我们进行了一项回顾性单中心研究，纳入2004年至2010年间因原发性骨关节炎而植入的109例TKA（Zimmer Natural Knee II超适配活动平台膝关节假体），根据胫骨组件固定方法将患者分为两组，一组为骨水泥固定（n = 68），另一组为非骨水泥固定（n = 41）。在最后一次随访时评估临床（膝关节协会评分系统（KSS）、特种外科医院（HSS）评分、活动范围）和放射学结果，最短随访时间为5年。
骨水泥固定组和非骨水泥固定组的平均随访时间分别为8.14 [5.31 - 12.7]年和8.06 [5.22 - 12.02]年。非骨水泥固定组胫骨组件生存率为100% [95%置信区间：91.4 - 100]，骨水泥固定组为97.1% [95%置信区间：89.78 - 99.42]（2例无菌性松动）（p = 0.27）。非骨水泥基板中有31.7%（n = 13）出现透光线，骨水泥基板中有44.1%（n = 30）出现透光线（p = 0.2）。非骨水泥固定组术后KSS膝关节评分更高（99 ± 3 vs. 97 ± 7.5；p = 0.02），但在KSS功能评分、KSS整体评分和HSS评分方面无显著差异。非骨水泥固定组平均屈曲范围为120 ± 10°，骨水泥固定组为122.5 ± 15°（p = 0.37）。在放射学数据或并发症方面未发现显著差异。
在本研究中，对于骨关节炎患者，平均随访8年时胫骨组件的生存率不受其固定方法的影响，这证实了初次全膝关节置换术中非骨水泥固定的可靠性。
