J Knee Surg 2017; 30(09): 930-935
DOI: 10.1055/s-0037-1599253
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cementless Total Knee Arthroplasty in Patients Older Than 75 Years

Jared M. Newman
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Anton Khlopas
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Morad Chughtai
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Chukwuweike U. Gwam
2   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Jaydev B. Mistry
2   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
George A. Yakubek
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Steven F. Harwin
3   Center for Reconstructive Joint Surgery, Mount Sinai Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

20 December 2016

14 January 2017

Publication Date:
11 April 2017 (online)

Abstract

Some surgeons have been hesitant to use cementless fixation for total knee arthroplasty (TKA) in elderly patients due to concerns regarding successful bone biological fixation. Therefore, this study evaluated: (1) implant survivorship, (2) functional outcomes, (3) radiographic outcomes, and (4) complications in patients over 75 years of age who underwent cementless total knee arthroplasty. A total of 134 patients (142 TKAs) older than 75 years at a single institution between June 2008 and June 2014 were retrospectively reviewed. Their mean follow-up was 4 years (range: 2–8 years). The cohort consisted of 91 women and 43 men who had a mean age of 80 years (range: 76 to 88 years). The preoperative diagnoses were osteoarthritis (n = 107 patients), rheumatoid arthritis (n = 21 patients), and osteonecrosis (n = 6 patients). Descriptive statistics were used to calculate the means and ranges and a Kaplan-Meier analysis was performed to determine the aseptic and all cause implant survivorship. Radiographic evaluation was performed using the new Knee Society Radiographic Evaluation and Scoring System. Functional outcomes at the final follow-up as well as all medical and surgical complications were recorded for each patient. The aseptic implant survivorship was 99.3% (95% CI: 7.9–8.1), and the all cause implant survivorship was 98.6% (95% CI: 7.9–8.1). There was one aseptic revision and one septic revision. At the latest follow-up the mean Knee Society pain score was 93 points (range, 80–100 points), and the mean Knee Society function score was 84 points (range, 70–90 points). On radiographic evaluation, there were no progressive radiolucencies, subsidence, and loosening of prostheses at the latest follow-up. The use of cementless TKA demonstrated excellent survivorship, mid-term clinical and functional outcomes, as well as no progressive radiolucencies or subsidence in patients older than 75 years. In addition, there was a low rate of surgical and medical complications. Therefore, cementless TKA may be a good option for patients older than 75 years.

 
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