Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry
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 r...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2023-12-01
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| Series: | Acta Orthopaedica |
| Subjects: | |
| Online Access: | https://actaorthop.org/actao/article/view/33283 |
| _version_ | 1797391548602646528 |
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| author | Raymond Puijk Inger N Sierevelt Bart G C W Pijls Anneke Spekenbrink-Spooren Peter A Nolte |
| author_facet | Raymond Puijk Inger N Sierevelt Bart G C W Pijls Anneke Spekenbrink-Spooren Peter A Nolte |
| author_sort | Raymond Puijk |
| collection | DOAJ |
| description |
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 arthroplasty 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 adjustment 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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| first_indexed | 2024-03-08T23:34:24Z |
| format | Article |
| id | doaj.art-f54a71cfa596453e96376c930358ec79 |
| institution | Directory Open Access Journal |
| issn | 1745-3674 1745-3682 |
| language | English |
| last_indexed | 2024-03-08T23:34:24Z |
| publishDate | 2023-12-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj.art-f54a71cfa596453e96376c930358ec792023-12-14T08:12:09ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822023-12-019410.2340/17453674.2023.33283Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty RegistryRaymond Puijk0Inger N Sierevelt1Bart G C W Pijls2Anneke Spekenbrink-Spooren3Peter A Nolte4Department of Orthopaedic Surgery, Spaarne Gasthuis, HoofddorpDepartment of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp; Department of Orthopaedic Surgery, Xpert Clinics Orthopedic Amsterdam/Specialized Center of Orthopedic Research and Education, AmsterdamLandelijke Registratie Orthopedische Interventies (LROI; Dutch Arthroplasty Register), Bruistensingel 230, 5232 AD, ’s Hertogenbosch; Department of Orthopaedics, Leiden University Medical Center (LUMC), LeidenLandelijke Registratie Orthopedische Interventies (LROI; Dutch Arthroplasty Register), Bruistensingel 230, 5232 AD, ’s HertogenboschDepartment of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands 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 arthroplasty 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 adjustment 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. https://actaorthop.org/actao/article/view/33283CementlessCruciate-retainingPosterior stabilizedRegistry studyRevisionTotal Knee Replacement |
| spellingShingle | Raymond Puijk Inger N Sierevelt Bart G C W Pijls Anneke Spekenbrink-Spooren Peter A Nolte Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry Acta Orthopaedica Cementless Cruciate-retaining Posterior stabilized Registry study Revision Total Knee Replacement |
| title | Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry |
| title_full | Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry |
| title_fullStr | Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry |
| title_full_unstemmed | Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry |
| title_short | Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry |
| title_sort | increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate retaining uncemented total knee replacements a cohort study of 13 667 knees from the dutch arthroplasty registry |
| topic | Cementless Cruciate-retaining Posterior stabilized Registry study Revision Total Knee Replacement |
| url | https://actaorthop.org/actao/article/view/33283 |
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