Revision total knee arthroplasty (TKA) is becoming increasingly common in the United States as the population ages and larger numbers of primary TKA are performed in younger individuals. Cemented or uncemented tibial stems are frequently used in revision cases. Decreased clinical outcomes and patient satisfaction have been described for revision TKA. This study aims to determine if the presence of overall pain and tibial pain at the end of the stem differs between cemented and uncemented tibial stems in revision TKA. This was a retrospective cohort study comparing patients who underwent revision TKA utilizing cemented or uncemented tibial stems in a 15-year period at a single institution with at least two-year follow-up. Exclusion criteria included age under 18, isolated revisions of the femoral component or polyethylene exchanges, lack of preoperative or postoperative imaging, insufficient operative or implant records available for electronic chart review, revision procedures performed at outside facilities, patients who were deceased at the time of survey administration, refusal to participate in the study, and failure to return the mailed survey or respond to a telephone follow-up questionnaire. Radiographic analysis included calculation of the percentage of the tibial canal filled with the implant, as well as measurement of the diameter of the tibial stem. Radiographs were also reviewed for evidence of cavitary defects, pedestal formation, radiolucent lines, and periprosthetic fractures. Mailed surveys addressing overall pain, tibial pain, and satisfaction were analyzed using Fisher's exact test and the independent sample t-test. Logistic regression was used to adjust for age, gender, and preoperative bone loss.Introduction
Methods
Long-term follow up after replacement arthroplasty has become established as a “Gold Standard”, providing information that can aid optimisation in future prosthetic design and use. In less mainstream joint replacements however, the evidence for use of prostheses, and in particular long-term outcome, is scarce. A cohort of 71 patients (93 implants) was reviewed in 1997 having had a De la Caffinière prosthesis implanted between 1980 and 1989. The conclusions of the study included the findings that the replacement was generally well regarded by recipients, pain was improved and survivorship was comparable with data from the best hip replacements. Ethical permission was obtained to review the same cohort ten years on (16 – 26 years post-op). Similar outcome measures were employed as in the original study but in addition formal grip strength measurements were taken, along with newer outcome scores including the DASH (Disability of arm, shoulder and hand) and EQ-5D (a European quality of life measure). Radiographs allowed assessment of radiological failure using the criteria from the original study. We found a significant mortality rate in the interim period since the original review (27 patients, 36 implants). A further 8 implants in 8 patients had been removed and were not clinically reviewed as per patients’ wishes. However, 39 implants in 26 patients were available for follow up at a mean 19 years (SD 6.3) leaving a “lost to follow up” rate of 10 patients (10 implants). Survivorship at 26 years was 73.9% (95% CI 61.2, 86.6) with the end-point as revision. Our data also demonstrated continued patient satisfaction without pain, satisfactory power and thumb mobility. Such information may be used to counsel future patients requiring surgery that there is a functional alternative to excision arthroplasty (trapeziectomy).
We found a positive correlation between age and time to union/graft incorporation (R2 = 0.47). The mean time to graft incorporation was 16 weeks. All of the patients treated with iliac crest structural graft progressed to union. Only 2 of the 4 patients treated with HA graft achieved incorporation, while the other 2 have required revision surgery.
