在一组使用深盘活动轴承植入物的5266例患者中，骨水泥型与非骨水泥型全膝关节置换术的5年生存率无差异。
No difference in 5-year survivorship between cemented versus cementless total knee arthroplasty in a cohort of 5266 patients using a deep-dish mobile bearing implant.
作者信息
Manchec Ophélie, Bérard Emilie, Pailhé Regis, Lustig Sébastien, Cavaignac Etienne
机构信息
Service de Chirurgie Orthopédique et Traumatologie, hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France.
Service d'Épidémiologie Clinique et de Santé Publique, CHU de Toulouse, CERPOP, Inserm, Université de Toulouse III Paul Sabatier, Toulouse, France.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3194-3204. doi: 10.1002/ksa.12668. Epub 2025 Apr 8.
PURPOSE
The best fixation method for total knee arthroplasty (TKA) remains controversial. The aim of this study is to compare the effect of cemented and cementless fixation on prosthesis survivorship. Our primary hypothesis is that there is no difference in survivorship between cemented and cementless TKA. Our secondary hypothesis is that there is no difference in aseptic revisions and functional outcomes between cemented and cementless TKA at mid-term follow-up.
METHODS
A multicentre retrospective study was done using data collected prospectively in a large cohort. The same deep-dish mobile bearing design was used for both cemented and cementless TKA. Patients were divided into two groups according to the fixation method. The survival rate between cemented and cementless TKA was compared. Functional outcomes were collected preoperatively and at the 5-year follow-up.
RESULTS
Of the 5266 primary TKA included, 4549 were cementless, and 717 were cemented. At 5 years, there was no significant difference between the survivorship of the cementless (98.7% [95% confidence interval, CI: 98.2-99.1]) and cemented TKA (97.6%, [95% CI: 94.1-99.1]) (p = 0.468). There was no significant difference in the surgery-free survival at 5 years between cementless (95.8% [95% CI: 94.9-96.5]) and cemented TKA (95.5% [95% CI: 92.1-97.5]) (p = 0.508) as well as in aseptic revision: cementless (96.9% [95% CI: 96.2-97.5]) and cemented TKA (97.5 [95% CI: 95.5-98.6]) (p = 0.355). There was no significant difference in the functional outcomes at 5 years.
CONCLUSION
There was no observed difference in survivorship between cemented and cementless TKA at 5 years in this cohort of 5266 patients. Additionally, rates of reoperation and aseptic revision were similar across both fixation methods, and clinical outcomes did not differ significantly. Therefore, it may be suggested that cementless fixation is a safe option for primary TKA.
LEVEL OF EVIDENCE
Level III.
目的
全膝关节置换术（TKA）的最佳固定方法仍存在争议。本研究的目的是比较骨水泥固定和非骨水泥固定对假体生存率的影响。我们的主要假设是骨水泥固定和非骨水泥固定的TKA在生存率上没有差异。我们的次要假设是在中期随访时，骨水泥固定和非骨水泥固定的TKA在无菌翻修和功能结果方面没有差异。
方法
采用在一个大型队列中前瞻性收集的数据进行多中心回顾性研究。骨水泥固定和非骨水泥固定的TKA均采用相同的深盘活动轴承设计。根据固定方法将患者分为两组。比较骨水泥固定和非骨水泥固定的TKA的生存率。在术前和5年随访时收集功能结果。
结果
在纳入的5266例初次TKA中，4549例为非骨水泥固定，717例为骨水泥固定。5年时，非骨水泥固定TKA的生存率（98.7%[95%置信区间，CI：98.2 - 99.1]）与骨水泥固定TKA的生存率（97.6%，[95%CI：94.1 - 99.1]）之间无显著差异（p = 0.468）。非骨水泥固定TKA（95.8%[95%CI：94.9 - 96.5]）与骨水泥固定TKA（95.5%[95%CI：92.1 - 97.5]）在5年时的无手术生存率以及无菌翻修率方面均无显著差异：非骨水泥固定（96.9%[95%CI：96.2 - 97.5]）和骨水泥固定TKA（97.5[95%CI：95.5 - 98.6]）（p = 0.355）。5年时功能结果无显著差异。
结论
在这5266例患者队列中，5年时骨水泥固定和非骨水泥固定的TKA在生存率方面未观察到差异。此外，两种固定方法的再次手术率和无菌翻修率相似，临床结果也无显著差异。因此，对于初次TKA，非骨水泥固定可能是一种安全的选择。
证据水平
三级。
Zotero 插件