Nwankwo Tobenna, Olson Nicholas, Crowley Brandon, Ho Henry, Fricka Kevin, Sershon Robert
Anderson Orthopaedic Research Institute, Alexandria, VA.
Anderson Orthopaedic Research Institute, Alexandria, VA.
J Arthroplasty. 2025 Sep 15. doi: 10.1016/j.arth.2025.09.010.
Patients who had a body mass index (BMI) ≥ 40 pose challenges in total knee arthroplasty (TKA), particularly aseptic tibial loosening. This study compared survivorship, clinical outcomes, and patient-reported outcome measures (PROMs) of TKA using cemented tibiae with stems, cemented tibiae without stems, and cementless tibial designs in this high BMI population.
This retrospective cohort included 1,359 patients who had a BMI ≥ 40 undergoing primary TKA between 2010 and 2024. Patients were divided into three groups based on tibial design: cemented tibiae with stems, cemented tibiae without stems, and cementless tibiae. The primary outcome was implant survivorship. The secondary outcomes included revision for aseptic tibial loosening, revision for any reason, complications, PROMs, including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Patient-Reported Outcomes Measurement Information System (PROMIS), and Knee Society Score (KS), as well as range of motion (ROM) and Tibio-femoral Angle (TFA).
Survivorship at one, two, and five years was highest in the cementless group; however, the differences were not statistically significant. There were no cases of aseptic tibial loosening observed in the cemented tibiae with stems group, while three cases (0.38%) occurred in the cemented tibiae without stems group, and one (0.36%) in the cementless group. Revision for any reason occurred in 2.33% of cases in the cemented tibiae with stems group, 2.17% in the cemented tibiae without stems group, and 0.36% in the cementless tibiae group. The PROMS improved in all groups with no significant postoperative differences.
In morbidly obese patients undergoing primary TKA, all three tibial component designs demonstrated high survivorship with low rates of aseptic tibial loosening. While cementless designs showed promising early survivorship, cemented tibial stems had the lowest incidence of aseptic loosening. Our findings suggest that all fixation methods are viable options, with implant selection best guided by patient-specific factors and surgeon preference.
体重指数（BMI）≥40的患者在全膝关节置换术（TKA）中面临挑战，尤其是无菌性胫骨松动。本研究比较了在这一高BMI人群中，使用带柄骨水泥胫骨、不带柄骨水泥胫骨和非骨水泥胫骨设计的TKA的生存率、临床结果和患者报告结局指标（PROMs）。
这项回顾性队列研究纳入了1359例2010年至2024年间接受初次TKA且BMI≥40的患者。根据胫骨设计将患者分为三组：带柄骨水泥胫骨组、不带柄骨水泥胫骨组和非骨水泥胫骨组。主要结局是植入物生存率。次要结局包括因无菌性胫骨松动进行的翻修、因任何原因进行的翻修、并发症、PROMs，包括关节置换的膝关节损伤和骨关节炎结局评分（KOOS，JR）、患者报告结局测量信息系统（PROMIS）和膝关节协会评分（KS），以及活动范围（ROM）和胫股角（TFA）。
非骨水泥组1年、2年和5年的生存率最高；然而，差异无统计学意义。带柄骨水泥胫骨组未观察到无菌性胫骨松动病例，不带柄骨水泥胫骨组有3例（0.38%）发生，非骨水泥组有1例（0.36%）发生。带柄骨水泥胫骨组2.33%的病例因任何原因进行了翻修，不带柄骨水泥胫骨组为2.17%，非骨水泥胫骨组为0.36%。所有组的PROMs均有所改善，术后无显著差异。
在接受初次TKA的病态肥胖患者中，所有三种胫骨组件设计均显示出高生存率和低无菌性胫骨松动率。虽然非骨水泥设计显示出良好的早期生存率，但带柄骨水泥胫骨的无菌性松动发生率最低。我们的研究结果表明，所有固定方法都是可行的选择，植入物的选择最好根据患者的具体因素和外科医生的偏好来指导。
