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.
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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.09/2013; 2013:854871. DOI:10.1155/2013/854871
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ABSTRACT: Poor bone ingrowth into the porous coating of tibial components has been reported. We hypothesized that iliac marrow grafting might be useful to enhance bone ingrowth into a porous-coated implant. The first part of this study was to examine the presence of fibroblast colony-forming units (CFUF) containing osteogenic precursor cells in tibial bone marrow and iliac bone marrow. The second aim was to compare the clinical and radiographic results after bilateral total knee arthroplasty (TKA) with and without autologous bone marrow transplantation to the bone-implant interface. Simultaneous bilateral TKA was performed in 21 patients with osteoarthritis. Aspirated iliac bone marrow was transplanted to the interface of one randomly selected porous-coated tibial component in each patient, and contralateral knees served as controls. All of the 21 patients were followed for 5 years. The average number of CFU-F was significantly lower in tibial marrow than in iliac marrow (p = 0.008). The final fluoroscopically-guided radiographs revealed a decrease in the number of knees with radiolucent lines after marrow grafting compared to those without grafting (p = 0.004). Iliac bone marrow is useful as a bone grafting material to enhance the biological fixation in porous-coated implants.Acta Orthopaedica 03/2007; 78(1):116-22. DOI:10.1080/17453670610013510 · 2.45 Impact Factor
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ABSTRACT: Plusieurs auteurs ont montré que les PTG cimentées et non cimentées pouvaient avoir d’excellents résultats jusqu’à 15 ans de recul, quel que soit le mode de fixation. Les inconvénients potentiels liés à l’usage du PMMA ne se sont pas traduit par des échecs cliniques. La qualité des résultats et la capacité du ciment à pardonner certaines imperfections techniques font que ce mode de fixation reste le « gold standard » pour de nombreux chirurgiens. Une technique chirurgicale méticuleuse est un pré-requis important pour le succès des prothèses non cimentées. Deux autres aspects sont importants : une fixation initiale rigide et la présence de revêtement de surface correct. Les échecs des premières séries de prothèses non cimentées étaient en partie liés à la nonsatisfaction de ces trois critères essentiels. Les chirurgiens utilisant les techniques adéquates pour les prothèses non cimentées avec une prothèse de dessin satisfaisant peuvent obtenir actuellement les mêmes excellents résultats avec des prothèses non cimentées qu’avec des prothèses cimentées en donnant à leur patient le bénéfice d’une fixation biologique et durable.