Abstract
Introduction
The use of cementless TKA's has been gradually increasing over the past several years given the increasing life expectancy of our patient population. Cementless TKA's have not been rapidly adopted due to the challenges and uncertainty of tibial fixation especially in elderly patients. With the advent of new technologies, the results of cementless TKA's with the potential for long term biologic fixation may now be equivalent or better than cemented TKA's. A highly porous tibial baseplate was developed based on proximal tibial anatomy using CT scans using 3D printing technology with focus on length, location and design of press-fit pegs.
Objectives
The purpose of this study was to review the early results with respect to fixation and complications using a new, highly porous cementless tibial baseplate designed for biologic fixation.
Methods
One hundred primary cementless TKAs were retrospectively reviewed using a highly porous titanium tibial baseplate. The femoral and patella components were also press-fit using peri-apetite beaded technology. Patients were evaluated at 2 weeks, 3 months, 1 and 2 year for clinical and radiographic outcomes along with any early (within 90 day) and 2 year complications. Postoperative protocol consisted of immediate full weightbearing, as tolerated. Radiographs were evaluated for biological fixation and radiolucent lines.
Results
There were 68 females and 32 males with 7 undergoing bilateral TKA. The mean age was 63.8 yrs (range 40–84). The mean BMI was 33.7. Diagnosis in all patients was osteoarthritis. The mean follow up was 24.8 months (range 15 to 33). The mean hospital length of stay was 3.2 days (range 2–7). The mean pre operative flexion was 105.8 degrees which improved to 117.9 degrees at latest follow up. KSS scores improved significantly in all patients. There were no postoperative transfusions in this group. All patients developed good radiographic fixation and stability of the tibial baseplate (Figure 1). There were no cases of loosening of the baseplate or infections in this series. Within 90 days, one patient developed a non fatal DVT and one patient was revised due to instability from a CR to a PS femur with the baseplate intact. At 8 months post-op, one patient had a liner exchange for MPFL rupture with a subluxating patella. At 18 months post-op, one patient had a liner exchange due to instability and extensor mechanism rupture. In both cases the baseplate was not revised.
Conclusions
Study results indicate cementless fixation using this baseplate is a viable option with good short term clinical results and no cases of aseptic loosening at 2 years. Early stability, pain relief and good ROM were shown. Long term data will be required to determine the overall benefits of this highly porous TKA with biologic fixation versus cemented arthroplasty.
