Reduced Aseptic Loosening With Fully Cemented Short-Stemmed Tibial Components in Primary Cemented Total Knee Arthroplasty

• Published in: The Journal of arthroplasty Vol. 35; no. 6; pp. 1591 - 1594.e3
• Main Authors: Garceau, Simon P., Harris, Nathan H., Felberbaum, Dvorah L., Teo, Greg M., Weinblatt, Aaron I., Long, William J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: Arthroplasty, Replacement, Knee - adverse effects; aseptic loosening; Humans; implant design; Knee Joint - surgery; Knee Prosthesis; obesity; Prosthesis Design; Prosthesis Failure; Tibia - surgery; tibial stems; total knee arthroplasty; total knee arthroplasty; tibial stems; implant design; obesity; aseptic loosening
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.01.084

Recently, the use of short tibial stems in the obese population undergoing total knee arthroplasty (TKA) has been proposed. Thus, we designed a study to assess tibial component survivorship after primary TKA using a single implant both with and without a fully cemented stem extension performed by a single surgeon. A search of our institutional research database was performed. A minimum 2-year follow-up was selected. Cohorts were created according to patient body mass index (BMI; >40 kg/m2 and <40 kg/m2) and the presence (stemmed tibia [ST]) or absence (non-stemmed tibia [NST]) of a short tibial stem extension. Kaplan-Meier survival analyses for aseptic loosening and log-rank tests were performed. A total of 236 patients were identified (ST = 162, NST = 74). Baseline patient characteristics were statistically similar between cohorts with the exception of BMI which was greater in the ST cohort (32.9 kg/m2, 30.6 kg/m2; P = .01). Kaplan-Meier survival analysis at 5 years was superior for the BMI < 40 kg/m2 cohort (98.9%, 93.1%; P = .045), the ST cohort (100%, 94.5%; P = .006), and the BMI > 40 kg/m2 with ST cohort at 4 years (71.4%, 100%; P = .008). Morbid obesity and a short native tibial stem design appear to be associated with aseptic loosening in primary TKA. This appears to be mitigated through the use of an ST. As such, the use of ST may be considered in at-risk patients. Alternatively, implants with longer native stem designs can be employed. Modern short-stemmed tibial components may need to be redesigned.