"Primary Total Knee Arthroplasty Using a Cementless Highly Porous Titanium Tibial Baseplate: A Minimum 10-year Follow-Up".

Abstract

Due to higher failure rates of cemented implants in obese, younger, and active men, along with increasing life span, cementless total knee arthroplasty (TKA) has had a resurgence given the potential of long-term biological fixation. The purpose of this study was to evaluate the clinical and radiographic results of primary TKA using a cementless, highly porous tibial baseplate with a minimum 10-year follow-up. This was a retrospective review of 300 consecutive, primary cementless TKAs using the same highly porous tibial baseplate. There were 35 patients (38 TKAs) deceased, 40 were lost to follow-up, and 10 patients had revisions, leaving 212 TKAs available for review. Outcome measures included range-of-motion (ROM), Knee Society score (KSS), Knee injury and Osteoarthritis Outcome Score for Joint Replacement score (KOOS JR), Forgotten Joint Score (FJS-12), Patient-Reported Outcomes Measurement Information System score (PROMIS-10), patient satisfaction, revision incidence, and radiographic findings. Mean KSS function and knee score improved from 45.3 and 40.4 preoperatively to 77.7 and 90.1 postoperatively (P ≤ 0.0001). Mean postoperative KOOS JR and FJS-12 scores were 86.5 and 83.7, respectively. Range of motion improved from a preoperative mean of 104.9 degrees of flexion and 2.3 degrees of extension to 119 degrees of flexion and 0 degrees of extension at 10 years (P ≤ 0.0001). Of the primary TKAs in the cohort, 97.5% were either very satisfied or satisfied. There were 10 revisions: one aseptic tibial loosening, four instabilities, two extensor mechanism ruptures, one chronic patella subluxation/arthrotomy rupture, one infection, and one for unexplained pain. Survivorship with all-cause failure as the endpoint at 10 years was 96.7% and 99.7% for aseptic loosening. Current-generation cementless TKA using a highly porous tibial baseplate with a keel and four pegs at a minimum 10-year follow-up provided effective pain relief, high patient satisfaction, and 96.7% survivorship.