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Comparable mid-term revision rates of primary cemented and cementless total knee arthroplasties in 201,211 cases in the Dutch Arthroplasty Register (2007–2017)

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Long-term failure of total knee arthroplasty (TKA) is mostly due to loosening of the prosthesis. In this study, the short- and mid-term revision rates of cemented vs cementless TKAs were investigated. Comparable short- and mid-term survival rates of both fixation methods were expected.

Methods

Data on all cemented and cementless TKAs performed between 2007 and 2017 were retrieved from the Dutch Arthroplasty Register. The cumulative crude incidence of revision of cemented and cementless TKA was calculated. Death was considered a competing risk. Revision rates were compared using multivariable Cox proportional hazard regression analysis. The associations between fixation method and type of revision or reason for revision were tested using logistic regression analyses.

Results

In total, 190,651 (94.8%) cemented and 10,560 (5.3%) cementless TKAs were evaluated. Both groups had comparable case characteristics. Cemented TKAs were inserted more often in cases with previous knee surgery compared to cementless TKAs (32% vs 27%). The cumulative incidence of revision after 9 years was 5.5% (CI 5.3–5.6%) for cemented and 5.8% (CI 5.2–6.4%) for cementless TKAs (p = 0.2). Cementless TKAs were more often revised due to loosening of the tibial (27% vs 18%; p < 0.001) or the femoral component (7% vs 5%; p = 0.005) than cemented TKAs. Cemented TKAs were more often revised due to infection (17% vs 9%; p = 0.004) than cementless TKAs.

Conclusion

In conclusion, cemented and cementless TKAs have comparable short- and mid-term revision rates based on a nationwide register study.

Level of evidence

III.

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Fig. 1

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, HagaZiekenhuis, Sportlaan 600, 2566, The Hague, The Netherlands

    Casper R. Quispel, Stefan R. Beekhuizen & Jantsje H. Pasma

  2. Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands

    Tijs Duivenvoorden & Hennie Verburg

  3. Department of Orthopedic Surgery, Langeland Ziekenhuis, Zoetermeer, The Netherlands

    Casper R. Quispel & Ruud De Ridder

  4. Dutch Arthroplasty Register (LROI), ‘s-Hertogenbosch, The Netherlands

    Anneke Spekenbrink-Spooren & Liza N. Van Steenbergen

Authors
  1. Casper R. Quispel
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  2. Tijs Duivenvoorden
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  3. Stefan R. Beekhuizen
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  4. Hennie Verburg
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  5. Anneke Spekenbrink-Spooren
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  6. Liza N. Van Steenbergen
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  7. Jantsje H. Pasma
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  8. Ruud De Ridder
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Contributions

All authors contributed substantially to the manuscript. CQ, TD, HV and RD contributed to the design of the study. CQ, AS and LS collected the data. CQ, AS, LS and JP performed the data analysis and statistical analysis. CQ, SB, JP and RD interpreted and discussed the results. CQ, SB, TD, JP and HV drafted the manuscript. All authors critically revised the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Casper R. Quispel.

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Ethical approval has been evaluated by the LROI.

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Quispel, C.R., Duivenvoorden, T., Beekhuizen, S.R. et al. Comparable mid-term revision rates of primary cemented and cementless total knee arthroplasties in 201,211 cases in the Dutch Arthroplasty Register (2007–2017). Knee Surg Sports Traumatol Arthrosc 29, 3400–3408 (2021). https://doi.org/10.1007/s00167-020-06183-2

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  • DOI: https://doi.org/10.1007/s00167-020-06183-2

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