| Background:Osteoarthritis(OA)is the most common bone joint disease in the world,and it is the most frequent causes of pain,loss of functio n and deformity of the joint.It is second only to ischaemic heart disease as a cause of work disability in men over 50 years of age.In addition to affecting people's physical health,osteoarthritis may also negatively impact people's mental health.More than one half of the people have osteoarthritis phenotypes and in about 80% of those aged over 75 years old.With the aging of the population,healthcare resources and costs associated with managing the disease has increased dramatically.OA commonly affects the major joints,such as the knee joint and hip joint.Reducing the daily activities,physical therapy and anti-inflammatory painkillers may control symptoms,but it does not reverse the pathological change.As further cartilage damage,patients eventually need total knee replacement surgery.Total knee arthroplasty(TKA)is one of the most effective treatments for knee joint diseases,such as osteoarthritis,rheumatoid arthritis,traumatic arthritis and other diseases.It generally results in pain relief,improved physical function,and a high level of patient satisfaction.At present,cemented fixation of patellar,femoral,and tibial components have become the gold standard in TKA with excellent clinical outcome and implant survivorship.However,in order to overcome the disadvantages of cemented prosthesis in the clinical application,the research and development of cementless prosthesis has been the hotspot in the field of arthroplasty.The use of cementless fixation in TKA has been available for nearly three decades,it was not widely used due to its complication of early patellar failure,screw track osteolysis,and early loosening of tibial components.In recent years,advances in technology,design,and materials potentially have allowed for more predictable results.As the new generation had shown comparable results in survival rate,clinical outcomes and cost performance in total hip arthroplasty(THA),had gradually replaced cemented total hip arthroplasty;the new generation of cementless prostheses designed with Trabecular Metal,has been reported good early clinical applied effect.But there still exist problems to be solved and the clinical application effect of is still controversial.Objective:The purpose of this study was to investigate the midterm clinical and radiographic results of Cementless Fixation of the Tibial Component in total knee arthroplasty to treat osteoarthritis;to compare the postoperative outcome of the cementless tantalum monoblock tibial component(TMT)with cemented fixation of the tibial component in total knee arthroplasty;to discuss the advantages and disadvantages and feasibility of using cementless knee prosthesis in total knee arthroplasty.Methods:This study was divided into two parts:The first part: This was a retrospective study of a consecutive series of TKA performed at a single institution using the Cementless Fixation of the Tibial Component(TMT)from July 2012 to July 2016.According to the patient selection and exclusion criteria,122 patients(122 knees)underwent primary total knee arthroplasty with a cementless tantalum monoblock tibial component.All patients excepted for 4 lost were followed clinically and radiographically.The results were evaluated according to the range of motion(ROM),Knee Society Score(KSS),visual analogue scale(VAS)and the Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index.Short-form 36 health survey scale(SF-36)was used to evaluate the life quality of patients.These outcomes were compared with the preoperative results.Radiographic evaluation was performed using Knee Society Roentgenographic Evaluation and Scoring System.The rate of postoperative complications related to TKA and the survivorship was evaluated.The second part: This was a retrospective study of a consecutive series of TKA performed at a single institution using the same cemented femoral component from July 2012 to July 2016.During the study period,234 patients(350 knees)underwent primary TKA with cementless tantalum monoblock tibial component,while 206 patients(332 knees)who underwent cemented posterior-stabilized TKA.All patients clinical and radiographic follow-up were reviewed.The results were evaluated according to the range of motion(ROM),Knee Society Score(KSS),vis ual analogue scale(VAS)and the Western Ontario and McMaster Universities(WOMAC)Osteoarthritis Index.Short-form 36 health survey scale(SF-36)was used to evaluate the life quality of patients.Radiographic evaluation was performed using Knee Society Roentgenographic Evaluation and Scoring System.The rate of postoperative complications related to TKA and the survivorship was evaluated.Results:The first part: In this study,118 patients received follow-up on average 29.2 months(range 12 ~ 52 months).Only 1 of the components was revised.The survivorship with reoperation for any reasons as end point was 99.15%.With tibial component revision for aseptic loosening or periprosthetic joint infection as the end point survivorship was 100%.There was no radiographic evidence of tibial component loosening,subsidence,osteolysis,or migration at the time of the latest follow-up.Within the radiographic evaluation,a phenomenon of gap healing was observed.But these gaps had healed at the time of last follow-up.The postoperative clinical evaluation was significantly higher than preoperative results about KSS,VAS,WOMAC and sf-36 score were all significantly difference(P=0.00)before the operation.In the second part: There was no significant difference in ROM,KSS,VAS,WOMAC and SF-36 score(P=0.10-0.90)between two groups.Group TMT was lower than group cemented fixation of the tibial component on Periprosthetic Joint Infection(P=0.03),while other complications and implant survivorship between the two groups was no significant difference(P=0.25-1.00).In addition,no radiolucent line greater than 1 mm in any zone or that progressed over time was seen in both groups;the ? angle(tibial coronal plane alignment)and ? angle(tibial angle in the sagittal plane)were no significant difference(P=0.29-0.51).Conclusions:1.Total knee arthroplasty using tantalum monoblock tibial component results in pain relief,improved physical function,and ahigh level of osteoarthritis patient satisfaction.There was not tibial component revision for aseptic loosening or periprosthetic joint infection as the end point.The use of tantalum monoblock tibial component in total knee arthroplasty has yielded promising clinical and radiographic results.2.Early postoperative joint functional exercise did not increase the failure rate in the group TMT than the group cemented fixation of the tibial component.The application of tantalum monoblock tibial component in total knee arthroplasty showed similar results in survivorship,clinical outcomes and radiographic evaluation compared with the traditional cemented total knee arthroplasty,but it performed lower periprosthetic joint infections and showed good bone ingrowth characteristics.3.Total knee arthroplasty using cementless fixation of the tibial component has yielded promising clinical and radiographic results.We suspect that cementless total knee arthroplasty could obtain the better long-term survivorship rate in theory. |
PDF Full Text Request