Asokan Ajay, Plastow Ricci, Kayani Babar, Radhakrishnan Ganan T, Magan Ahmed A, Haddad Fares S
Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.
Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.
Bone Jt Open. 2021 Jan 22;2(1):48-57. doi: 10.1302/2633-1462.21.BJO-2020-0172.R1. eCollection 2021 Jan.
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article: 2021;2(1):48-57.
由于具有概念上的优势，包括改善骨整合以实现生物固定、提高手术效率以及减少与骨水泥嵌塞和骨水泥碎屑磨损相关的全身并发症，非骨水泥型膝关节置换术近来再度受到欢迎。越来越多的年轻且需求较高的患者需要进行膝关节置换术，因此，人们乐观地认为非骨水泥固定可能会改善植入物的生存率和功能结果。与骨水泥型植入物相比，国家关节注册处（NJR）目前报告非骨水泥全膝关节置换术（TKA）的翻修率较高，但在单髁膝关节置换术（UKA）中则较低。然而，最近的研究开始显示非骨水泥型植入物有出色的结果，尤其是UKA，其表现优于骨水泥型品种。非骨水泥TKA尚未显示出长期益处，目前在短期至中期队列研究中的表现与骨水泥型相当。然而，有了包括3D打印涂层、机器人辅助手术、放射立体测量分析以及运动学或功能性膝关节对线原则等新概念，人们希望它们可能有助于长期改善非骨水泥TKA的结果。此外，尽管由于新型植入物涂层，非骨水泥型植入物的成本仍然较高，但据推测，通过提高手术效率和可能降低翻修成本，可以实现成本效益。关于固定方法之间的长期结果以及现代非骨水泥膝关节置换术的成本效益，一级数据很少。本综述探讨了有关非骨水泥膝关节置换术的最新文献，涉及临床结果、植入物生存率、并发症和成本效益；提供简要更新以协助临床医生进行植入物选择。引用本文：2021；2(1):48 - 57。
