Comparison between uncemented and cemented fixation for the tibial component in distal femoral replacement: a clinical and radiological study

Abstract

Purposes: We performed a retrospective, cohort study to compare uncemented tibial fixation with cemented tibial fixation in distal femoral replacement (DFR).

Methods: Sixty-two cases with uncemented tibial fixation and 58 cases with cemented tibial fixation were included. Inter-group comparisons were performed for baseline data, oncological and prosthetic outcomes, and changes of cortical thickness of tibial diaphysis. Radiological signs of bone adaptations around the uncemented tibial stem were identified through evaluation of plain films during follow-up.

Results: Uncemented tibial fixation shortened operative duration by 26 minutes, achieved equivalent oncological and prosthetic outcomes, and helped preserve anterior cortical thickness of tibia compared with the cemented counterpart after a mean follow-up of over 40 months. Radiological signs of osseointegration and reactive line were observed in 64.3 and 17.9% cases with uncemented tibial fixation. The two signs had different patterns of distribution and no significant predisposing factors could be identified.

Conclusions: For DFR, the uncemented tibial fixation was safe and effective in functional reconstruction and in preservation of anterior cortex of tibial diaphysis. It could achieve osseointegration and might permit adaptive micromotion of the tibial stem post-operatively.

Level of evidence: level III Therapeutic.

Keywords: Distal femoral replacement; Micromotion; Osseointegration; Tumor; Uncemented tibial fixation.