Stoltz Michal J, Mullick Maunil, Smith Langan S, Duncan Anna E, Yakkanti Madhusudhan R, Malkani Arthur L
University of Louisville, Department of Orthopedic Surgery, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA.
University of Louisville School of Medicine, 500 S. Preston St, Louisville, KY, 40202, USA.
J Arthroplasty. 2025 Jul 28. doi: 10.1016/j.arth.2025.07.053.
Due to higher failure rates of cemented implants in obese, younger, and active men, along with increasing life span, cementless total knee arthroplasty (TKA) has had a resurgence given the potential of long-term biological fixation. The purpose of this study was to evaluate the clinical and radiographic results of primary TKA using a cementless, highly porous tibial baseplate with a minimum 10-year follow-up.
This was a retrospective review of 300 consecutive, primary cementless TKAs using the same highly porous tibial baseplate. There were 35 patients (38 TKAs) deceased, 40 were lost to follow-up, and 10 patients had revisions, leaving 212 TKAs available for review. Outcome measures included range-of-motion (ROM), Knee Society score (KSS), Knee injury and Osteoarthritis Outcome Score for Joint Replacement score (KOOS JR), Forgotten Joint Score (FJS-12), Patient-Reported Outcomes Measurement Information System score (PROMIS-10), patient satisfaction, revision incidence, and radiographic findings.
Mean KSS function and knee score improved from 45.3 and 40.4 preoperatively to 77.7 and 90.1 postoperatively (P ≤ 0.0001). Mean postoperative KOOS JR and FJS-12 scores were 86.5 and 83.7, respectively. Range of motion improved from a preoperative mean of 104.9 degrees of flexion and 2.3 degrees of extension to 119 degrees of flexion and 0 degrees of extension at 10 years (P ≤ 0.0001). Of the primary TKAs in the cohort, 97.5% were either very satisfied or satisfied. There were 10 revisions: one aseptic tibial loosening, four instabilities, two extensor mechanism ruptures, one chronic patella subluxation/arthrotomy rupture, one infection, and one for unexplained pain. Survivorship with all-cause failure as the endpoint at 10 years was 96.7% and 99.7% for aseptic loosening.
Current-generation cementless TKA using a highly porous tibial baseplate with a keel and four pegs at a minimum 10-year follow-up provided effective pain relief, high patient satisfaction, and 96.7% survivorship.
由于肥胖、年轻且活跃的男性中骨水泥型植入物的失败率较高，以及预期寿命的增加，鉴于长期生物固定的潜力，非骨水泥型全膝关节置换术（TKA）再次兴起。本研究的目的是评估使用非骨水泥、高度多孔胫骨基板的初次TKA的临床和影像学结果，并进行至少10年的随访。
这是一项对连续300例使用相同高度多孔胫骨基板的初次非骨水泥TKA进行的回顾性研究。有35例患者（38例TKA）死亡，40例失访，10例患者进行了翻修，最终有212例TKA可供评估。结果指标包括活动范围（ROM）、膝关节协会评分（KSS）、膝关节损伤和骨关节炎关节置换结局评分（KOOS JR）、遗忘关节评分（FJS-12）、患者报告结局测量信息系统评分（PROMIS-10）、患者满意度、翻修发生率和影像学表现。
平均KSS功能评分和膝关节评分从术前的45.3分和40.4分分别提高到术后的77.7分和90.1分（P≤0.0001）。术后平均KOOS JR和FJS-12评分分别为86.5分和83.7分。活动范围从术前平均屈曲104.9度和伸展2.3度改善到术后10年的屈曲119度和伸展0度（P≤0.0001）。在该队列的初次TKA中，97.5%的患者非常满意或满意。有10例翻修：1例无菌性胫骨松动，4例不稳定，2例伸肌机制断裂，1例慢性髌骨半脱位/关节切开术破裂，1例感染，1例原因不明的疼痛。以全因失败为终点的10年生存率，无菌性松动的生存率为96.7%，总体生存率为99.7%。
采用带有龙骨和四个固定钉的高度多孔胫骨基板的当代非骨水泥TKA，在至少10年的随访中，提供了有效的疼痛缓解、较高的患者满意度和96.7%的生存率。
