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The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age : a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016

Niemeläinen, Mika J. ; Mäkelä, Keijo T. ; Robertsson, Otto LU ; W-Dahl, Annette LU ; Furnes, Ove ; Fenstad, Anne M. ; Pedersen, Alma B. ; Schrøder, Henrik M. ; Reito, Aleksi and Eskelinen, Antti (2020) In Acta Orthopaedica 91(2). p.184-190
Abstract

Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years. Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to... (More)

Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years. Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason. Results — The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4–93.8), uncemented 91.2% (CI 90.1–92.2), hybrid 93.0% (Cl 92.2–93.8), and inverse hybrid 96.0% (CI 94.1–98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years’ follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4–0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1–1.7]) and > 6 years’ (HR 1.3 [1.0–1.7]) follow-up compared to the reference. Interpretation — Both cemented and hybrid TKAs had 10-year survival rates exceeding 92–>93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
91
issue
2
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • pmid:31928097
  • scopus:85078597864
ISSN
1745-3674
DOI
10.1080/17453674.2019.1710373
language
English
LU publication?
yes
id
36bb6c4c-a228-46c8-b98d-61b871925c0d
date added to LUP
2020-02-10 13:27:23
date last changed
2021-06-17 02:03:47
@article{36bb6c4c-a228-46c8-b98d-61b871925c0d,
  abstract     = {<p>Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged &lt; 65 years. Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged &lt; 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason. Results — The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4–93.8), uncemented 91.2% (CI 90.1–92.2), hybrid 93.0% (Cl 92.2–93.8), and inverse hybrid 96.0% (CI 94.1–98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years’ follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4–0.8]), while uncemented TKAs showed increased risk of revision both &lt; 1 year (HR 1.4 [1.1–1.7]) and &gt; 6 years’ (HR 1.3 [1.0–1.7]) follow-up compared to the reference. Interpretation — Both cemented and hybrid TKAs had 10-year survival rates exceeding 92–&gt;93% in patients aged &lt; 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.</p>},
  author       = {Niemeläinen, Mika J. and Mäkelä, Keijo T. and Robertsson, Otto and W-Dahl, Annette and Furnes, Ove and Fenstad, Anne M. and Pedersen, Alma B. and Schrøder, Henrik M. and Reito, Aleksi and Eskelinen, Antti},
  issn         = {1745-3674},
  language     = {eng},
  number       = {2},
  pages        = {184--190},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age : a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016},
  url          = {http://dx.doi.org/10.1080/17453674.2019.1710373},
  doi          = {10.1080/17453674.2019.1710373},
  volume       = {91},
  year         = {2020},
}