J Knee Surg 2022; 35(01): 015-020
DOI: 10.1055/s-0040-1712085
Original Article

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

1   Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
,
Wael Azzam
1   Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
› Author Affiliations
Funding None.

Abstract

Over many decades, total knee replacement (TKR) has become the ideal treatment option for advanced arthritis. Many designs were introduced to increase the stability of the tibial tray, hence the longevity of the prosthesis. This retrospective study was performed on 168 patients who received NexGen cemented primary total knee either with standard tibial tray (group A) or tibial tray with an intramedullary stem (group B) between May 2008 and May 2017. We reviewed all preoperative and postoperative clinical and radiological data retrospectively. In addition, a prospective clinical and radiological reassessment was done. Our aim was to answer the following questions: (1) Is there any difference between both groups in regard to clinical and radiological results? (2) Is there any difference in the revision rate? (3) Is there a role of using stemmed tibial tray in primary TKR? Better results were recorded in obese and severely obese patients having stemmed cemented tibial tray and so for patients with marked and severe preoperative varus angle. Our recommendations are to use cemented tibial tray with a stem in complicated primary surgery without fear of adverse effects on short and intermediate terms of follow-up.

Note

All procedures performed in the study were in accordance with the ethical standards of our department and with the 1964 Helsinki declaration and its later amendments.




Publication History

Received: 02 November 2019

Accepted: 31 March 2020

Article published online:
22 May 2020

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  • References

  • 1 Vanlommel J, Luyckx JP, Labey L, Innocenti B, De Corte R, Bellemans J. Cementing the tibial component in total knee arthroplasty: which technique is the best?. J Arthroplasty 2011; 26 (03) 492-496
  • 2 Li MG, Nilsson KG. The effect of the preoperative bone quality on the fixation of the tibial component in total knee arthroplasty. J Arthroplasty 2000; 15 (06) 744-753
  • 3 Lachiewicz PF, Soileau ES. A 30-mm cemented stem extension provides adequate fixation of the tibial component in revision knee arthroplasty. Clin Orthop Relat Res 2015; 473 (01) 185-189
  • 4 Rawlinson JJ, Closkey Jr RF, Davis N, Wright TM, Windsor R. Stemmed implants improve stability in augmented constrained condylar knees. Clin Orthop Relat Res 2008; 466 (11) 2639-2643
  • 5 Pérez-Blanca A, Prado M, Ezquerro F, Montañéz E, Espejo A. Addition of a short central extension to surface cemented tibial trays in primary TKA: an in vitro study of the effect on initial fixation stability and its relationship to supporting bone density. Clin Biomech (Bristol, Avon) 2008; 23 (04) 483-492
  • 6 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
  • 7 Siu D, Cooke TD, Broekhoven LD. et al. A standardized technique for lower limb radiography. Practice, applications, and error analysis. Invest Radiol 1991; 26 (01) 71-77
  • 8 Chalmers BP, Sculco PK, Fehring KA, Trousdale RT, Taunton MJ. A novel percentage based system for determining aseptic loosening of total knee arthroplasty tibial components. J Arthroplasty 2017; 32 (07) 2274-2278
  • 9 Inc Zimmer. Zimmer Tibial Component Pocket Guide, United States Version. Warsaw, IN: Zimmer Inc; 2009
  • 10 Kolisek FR, Mont MA, Seyler TM. et al. Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results. Int Orthop 2009; 33 (01) 117-121
  • 11 Stern SH, Wills RD, Gilbert JL. The effect of tibial stem design on component micromotion in knee arthroplasty. Clin Orthop Relat Res 1997; (345) 44-52
  • 12 Barlow BT, Oi KK, Lee YY, Joseph AD, Alexiades MM. Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3611-3619
  • 13 Au AG, James Raso V, Liggins AB, Amirfazli A. Contribution of loading conditions and material properties to stress shielding near the tibial component of total knee replacements. J Biomech 2007; 40 (06) 1410-1416
  • 14 Lonner JH, Klotz M, Levitz C, Lotke PA. Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty 2001; 16 (01) 107-111
  • 15 Gobba MS, Chan N, Patel R, Noble PC, Incavo SJ. Tibial stems in revision total knee arthroplasty: is there an anatomic conflict?. J Arthroplasty 2015; 30 (9, Suppl): 86-89
  • 16 Bae DK, Song SJ, Heo DB, Tak DH. Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2248-2254
  • 17 Rawlinson JJ, Peters LE, Campbell DA, Windsor R, Wright TM, Bartel DL. Cancellous bone strains indicate efficacy of stem augmentation in constrained condylar knees. Clin Orthop Relat Res 2005; 440 (440) 107-116
  • 18 Fehring TK, Fehring KA, Anderson LA, Otero JE, Springer BD. Catastrophic varus collapse of the tibia in obese total knee arthroplasty. J Arthroplasty 2017; 32 (05) 1625-1629
  • 19 Berend ME, Ritter MA, Hyldahl HC, Meding JB, Redelman R. Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size. J Arthroplasty 2008; 23 (06, Suppl 1): 104-109
  • 20 Parratte S, Ollivier M, Lunebourg A, Verdier N, Argenson JN. Do stemmed tibial components in total knee arthroplasty improve outcomes in patients with obesity?. Clin Orthop Relat Res 2017; 475 (01) 137-145
  • 21 Hakkalamani S, Prasanna VK, Wood EV, Acharya A, Parkinson RW. Tibial-stem dissociation in a modular revision total knee arthroplasty system: a comparative clinical outcome study. J Arthroplasty 2008; 23 (08) 1140-1145
  • 22 Steere JT, Sobieraj MC, DeFrancesco CJ, Israelite CL, Nelson CL, Kamath AF. Prophylactic tibial stem fixation in the obese: comparative early results in primary total knee arthroplasty. Knee Surg Relat Res 2018; 30 (03) 227-233
  • 23 Baker P, Muthumayandi K, Gerrand C, Kleim B, Bettinson K, Deehan D. Influence of body mass index (BMI) on functional improvements at 3 years following total knee replacement: a retrospective cohort study. PLoS One 2013; 8 (03) e59079
  • 24 Barrack RL, Stanley T, Burt M, Hopkins S. The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplasty 2004; 19 (07, Suppl 2): 119-124
  • 25 Sah AP, Shukla S, Della Valle CJ, Rosenberg AG, Paprosky WG. Modified hybrid stem fixation in revision TKA is durable at 2 to 10 years. Clin Orthop Relat Res 2011; 469 (03) 839-846