Cemented and ingrowth fixation of the Miller-Galante prosthesis. Clinical and roentgenographic comparison after three- to six-year follow-up studies.
ABSTRACT One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were followed between three and six years (average, 43-44 months). The fixation technique was based on patient age, bone quality, and ability to delay full-weight bearing. Clinical follow-up studies were possible on 116 cemented knees. Fifteen knees were lost because of death before the three-year follow-up study, and eight knees required component removal. One hundred twenty-three cementless knees were available for clinical follow-up studies; there were three deaths, and six failures required component removal. No cemented failure was due to fixation, and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one. Preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points. A similar significant difference was maintained at the final follow-up study. No significant differences were noted for pain, limp, or support scores. Average range of motion was similar in the two groups. Radiolucent lines about the femoral component were rare. Cementless tibial radiolucencies were partial in up to 20% of examined zones, and complete tibial tray radiolucency was seen in only three patients. No correlation between radiolucency and knee scores was seen.
- SourceAvailable from: jbjs.org.ukJournal of Bone and Joint Surgery-british Volume - J BONE JOINT SURG-BRIT VOL. 01/2003; 85(8):1123-1127.
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ABSTRACT: The optimal method of fixation in total knee arthroplasty is still debated. Hybrid total knee arthroplasty (TKA), with cemented tibial and cementless femoral components, is a proposed method of fixation to improve outcomes. Although several studies have shown favorable outcomes, there is still lack of consensus in the literature. We hypothesized that hybrid TKA yields similar clinical, radiographic, and survivorship results compared to fully cemented TKA. The clinical and radiographic outcomes of 304 cruciate retaining TKAs with minimum two-year followup, including 193 hybrid (mean followup of 4.1 years) and fully cemented TKAs (mean followup of 3.2 years) were evaluated. Knee society scores were similar between the two groups. The total number of femoral radiolucencies was also similar between the two groups, while a greater number of femoral Zone 4 radiolucencies were seen in the cemented group (9% versus 1.6%, P = 0.005). The hybrid group demonstrated a 99.2% survival rate of the femoral component out to seven years for aseptic loosening. No significant difference in survivorship was seen between the groups for all cause or aseptic failure at seven years. We conclude that hybrid fixation leads to similar intermediate-term outcomes as fully cemented components and remains a viable option in total knee arthroplasty.BioMed research international. 01/2013; 2013:854871.
Chapter: Cementless Total Knee Arthroplasty[Show abstract] [Hide abstract]
ABSTRACT: Recent reports with up to 10-year clinical follow-up have demonstrated that cementless total knee arthroplasty can yield excellent results in young, active patients when sound implant design principles and surgical techniques are followed. Intimate apposition of the prosthesis to host bone is achieved with instrumentation that allows precise bone resection, and by the routine application of morselized autogenous bone chips to the cut surfaces. Revision of cementless total knee components without porous-coated pegs, keels, or stems has proven to be bone-sparing, which is an important consideration in the younger patient who may outlive their prosthesis. The authors believe that cementless fixation is a superior alternative to cemented fixation for primary total knee arthroplasty in younger patients with higher functional demands and good bone stock.06/2006: pages 80-103;