Hybrid fixation modular tibial prosthesis. Early clinical and radiographic results and retrieval analysis.

Abstract

A prosthetic tibial component has been designed with features for fixation to bone using a combination of acrylic cement and ingrowth interfaces. This hybrid concept affords the component the immediate stability of cement fixation and the potential long-term stability of biologic fixation. The ingrowth interfaces (coupled with the central stem) are intended to shield the cement interface beneath the tibial tray from the tensile liftoff forces that result from eccentric loading, while avoiding the fretting and osteolysis associated with screw fixation. A disassembly capability allows the tray to be removed from the stemmed anchorage assembly, facilitating component extraction and limiting bone loss. A clinical and radiographic review of 50 consecutive primary total knee arthroplasties with a mean follow-up period of 35 months revealed stable interfaces with no progressive radiolucencies and minimal remodeling changes. The mean Knee Society knee score was 92.2. At final follow-up evaluation, 88.6% of patients noted no or mild (occasional) pain. Retrieval of three prosthetic knees with chronic sepsis showed extensive ingrowth into the porous interfaces and an osteointegrated bony sleave around the smooth central stem.