TY - JOUR
T1 - Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements
T2 - a cohort study of 13,667 knees from the Dutch Arthroplasty Registry
AU - Puijk, Raymond
AU - Sierevelt, Inger N.
AU - Pijls, Bart G. C. W.
AU - Spekenbrink-Spooren, Anneke
AU - Nolte, Peter A.
N1 - Publisher Copyright: © 2023 The Author(s).
PY - 2023
Y1 - 2023
N2 - Background and purpose — While registry studies have suggested a higher risk of revision for posterior-stabilized (PS) compared with posterior cruciate-retaining (CR) total knee replacements (TKR) using cement, it is unknown whether this is also the case for uncemented TKR. We aimed to compare the revision rates of PS and CR designs in patients receiving primary uncemented TKR. Patients and methods — Data from the Dutch arthro-plasty register (LROI) was analyzed, comprising 12,226 uncemented primary CR TKRs and 750 uncemented PS TKRs registered between 2007 and 2022. Competing risk and multivariable Cox regression analyses were used to compare revision rates, risks of revision, and reasons for revision between groups. Sensitivity analyses were performed to analyze the risk, concerning the 5 most commonly used implants and performing hospitals for each group. Results — Uncemented PS TKRs had higher 10-year revision rates for any reason and aseptic loosening (6.5%, 95% confidence interval [CI] 4.6–9.2 and 3.9%, CI 2.6–6.7) compared with uncemented CR TKRs (4.2%, CI 3.8–4.7 and 1.4%, CI 1.2–1.7). PS TKRs were 1.4 and 2.5 times more likely to be revised for any reason and aseptic loosening, respectively. These results remained consistent after adjust-ment for age, sex, BMI, previous surgeries, bearing mobility, and surface modification, with sensitivity analyses. Conclusion — We found that uncemented PS implants have a higher rate of revision than uncemented CR implants, mainly due to a higher risk of aseptic loosening.
AB - Background and purpose — While registry studies have suggested a higher risk of revision for posterior-stabilized (PS) compared with posterior cruciate-retaining (CR) total knee replacements (TKR) using cement, it is unknown whether this is also the case for uncemented TKR. We aimed to compare the revision rates of PS and CR designs in patients receiving primary uncemented TKR. Patients and methods — Data from the Dutch arthro-plasty register (LROI) was analyzed, comprising 12,226 uncemented primary CR TKRs and 750 uncemented PS TKRs registered between 2007 and 2022. Competing risk and multivariable Cox regression analyses were used to compare revision rates, risks of revision, and reasons for revision between groups. Sensitivity analyses were performed to analyze the risk, concerning the 5 most commonly used implants and performing hospitals for each group. Results — Uncemented PS TKRs had higher 10-year revision rates for any reason and aseptic loosening (6.5%, 95% confidence interval [CI] 4.6–9.2 and 3.9%, CI 2.6–6.7) compared with uncemented CR TKRs (4.2%, CI 3.8–4.7 and 1.4%, CI 1.2–1.7). PS TKRs were 1.4 and 2.5 times more likely to be revised for any reason and aseptic loosening, respectively. These results remained consistent after adjust-ment for age, sex, BMI, previous surgeries, bearing mobility, and surface modification, with sensitivity analyses. Conclusion — We found that uncemented PS implants have a higher rate of revision than uncemented CR implants, mainly due to a higher risk of aseptic loosening.
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U2 - https://doi.org/10.2340/17453674.2023.33283
DO - https://doi.org/10.2340/17453674.2023.33283
M3 - Article
C2 - 38093649
SN - 1745-3674
VL - 94
SP - 600
EP - 606
JO - Acta Orthopaedica
JF - Acta Orthopaedica
ER -