Functional outcomes comparative analysis of cemented and uncemented total knee arthroplasty

Abstract

Introduction: Cementless knee arthroplasty becomes more and more popular worldwide. At the beginning of endoprosthetics era, cementless implants showed unsatisfactory results. However, surgical technologies develop rapidly and nowadays the cementless fixation shows better outcomes.

Objectives: To analyze the experience of total knee arthroplasty using cementless fixation for the treatment of advanced arthritis of the knee.

Methods: We operated on 130 patients. The mean follow-up duration was 36 months. In 70 patients we used cementless fixation and in 60 patients we used implants with cemented fixation. To evaluate the results, we used KOOS scale and WOMAC scale. We also evaluated the mean duration of surgical intervention and blood loss.

Results: In the cementless group WOMAC and KOOS scales scores before the operation were 198,2 (±35.7) and 23,1 (±3.4), respectively, and in the cemented group it was 199.3(±36.8) and 24.9 (±2.1), respectively(p > 0,05). One year after the operation, KOOS and WOMAC scores were 54.5(±12.6) and 83.6(±8,.2) in the cementless group and 78.9(±4.6) and 66.9(±5.7) in the cemented group(p < 0,05)., respectively. Intraoperative blood loss was 255(±89,3) in the cemented group and 315(±52,1) in cementless group(p < 0,05). Postoperative blood loss was 515(±119, 5) and 440(±129,3)) (p < 0,05), respectively. Mean duration of intervention was 78 min (±6,8) in cemented group and 64 min (±8,7) in cementless group(p < 0,05).

Conclusions: 1We have better functional results using implants with cementless fixation.2There was a greater intraoperative and postoperative blood loss in cementless group.3Cementless knee arthroplasty associated with shorter duration of intervention than cemented.

Keywords: Cemented total knee arthroplasty; Cementless fixation; Cementless knee arthroplasty; Primary TKA.

Fig. 1

Results for KOOS scale. The presented figure illustrates the dynamics on the KOOS scale over the year after TKA in two groups. Further results did not have significant dynamics.

Fig. 2

Results for WOMAC scale. The presented figure illustrates the dynamics on the WOMAC scale over the year after TKA in two groups. Further results did not have significant dynamics.

Fig. 3

Change of Hb level. The presented figure illustrates Hb dynamics before surgery and 2 days after the surgery.

Pic 1

Group 1 (cementless fixation). F. 62 y. o.: A-before surgery, B – 2 days after surgery. Female patient 62 years old underwent total knee replacement due to gonarthrosis. Cementless implant were used. Patient is dedicated to Group 1. KOOS result before 22p. a fter 51p. WOMAC results before operation 192 and 142 6 month after.

Pic 2

Group 2 (cemented fixation). F. 63 y. o.: A-before surgery, B – 2 days after surgery. Female patient 63 years old underwent total knee replacement due to rheumatoid arthritis. Cemented implant were used. Patient is dedicated to Group 2. KOOS result before 25 p. 6 month after 61p. WOMAC results before operation 196p and 140p 6 month after.

Pic 3

Group 1 (cementless fixation):A - 2 days after surgery. B - 47 month after surgery. Male patient 67 years old underwent total knee replacement using cementless implant. Presented results after 47 months. KOOS result before operation 20 p. a fter 47 months 59 p. WOMAC results before operation 189p and 132p 47 months after.

Pic 4

Group 2 (cemented fixation):A - 2 days after surgery, B - 42 month after surgery. Female patient 69 years old underwent total knee replacement using cemented implant. «B » picture shows X-ray result after 42 month. KOOS result before operation 26 p. after 47 months - 69 p. WOMAC results before operation 179p and 129 p 42 months after surgery.

Pic 5

Group 1 (cementless fixation) (complication). Patient H. 59 y. o. A- 2 days after surgery. B −7 months after surgery (deep periprosthetic infection).