Our Summary

This research paper discusses the best method to attach knee implants for long-term durability. The two methods compared are using cement to attach the implant versus allowing the bone to grow into the implant naturally.

This procedure, known as total knee arthroplasty (TKA), is a common orthopedic surgery and the debate about these two methods has been ongoing. However, recent advancements in implant materials and technology have made it possible for the cementless method to be more reliable and efficient, especially for younger, more active patients.

The paper examines the history of the cementless method and its recent popularity. It also provides guidance on choosing the right patients for this procedure and shares surgical techniques that ensure reliable and reproducible results.

Historically, the cemented method has been the standard for TKA but the cementless method is becoming more popular in the US and around the world. It has been found to offer the same or even better results in the right patients.

The conclusion is that the cementless method provides long-lasting and successful results with improved surgical efficiency. This method can be widely used in the right patients, with care taken during surgery to ensure accurate bone cuts for proper contact and biological fixation.

FAQs

  1. What is the debate in orthopaedics about the optimal fixation method for long-term durability in total knee arthroplasty?
  2. How has the use of cementless fixation in total knee arthroplasty evolved over time and what are its benefits?
  3. How does patient selection factor into the decision to use cemented or cementless fixation in total knee arthroplasty?

Doctor’s Tip

One helpful tip a doctor might tell a patient about knee replacement surgery is to follow post-operative rehabilitation exercises as prescribed by the physical therapist. These exercises are crucial for regaining strength, flexibility, and range of motion in the knee joint, ultimately leading to a successful recovery and optimal long-term results. It is important to be consistent and diligent with these exercises to ensure a smooth recovery process.

Suitable For

Patients who are typically recommended for knee replacement surgery are those who have severe knee pain and stiffness that limits daily activities, have failed conservative treatments such as physical therapy and medication, have significant arthritis or joint damage, and have good overall health and are able to tolerate surgery and rehabilitation. Additionally, younger and more active patients may be good candidates for cementless TKA due to its potential for long-term durability and stability. Patient selection is crucial to ensure optimal outcomes, and surgical technique plays a key role in achieving successful results with cementless TKA.

Timeline

Before knee replacement:

  1. Patient experiences chronic knee pain, stiffness, and limited mobility.
  2. Patient consults with an orthopedic surgeon to discuss treatment options.
  3. Patient undergoes pre-operative assessments and tests to determine candidacy for knee replacement surgery.
  4. Patient receives education on the procedure, risks, and recovery process.

After knee replacement:

  1. Patient undergoes knee replacement surgery, either with cemented or cementless fixation.
  2. Patient experiences post-operative pain, swelling, and stiffness.
  3. Patient begins physical therapy and rehabilitation to regain strength and mobility.
  4. Patient gradually improves over time, with reduced pain and improved function.
  5. Patient follows up with the surgeon for regular check-ups and monitoring of the implant.
  6. Patient resumes normal activities and enjoys improved quality of life with their new knee joint.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with cementless knee replacement compared to cemented knee replacement?
  2. How long can I expect the cementless knee replacement to last compared to a cemented knee replacement?
  3. What criteria do you use to determine if I am a suitable candidate for a cementless knee replacement?
  4. What type of implant will be used in the cementless knee replacement and what are the advantages of this specific implant?
  5. What is the recovery process like for a cementless knee replacement compared to a cemented knee replacement?
  6. How long will I need to stay in the hospital after the cementless knee replacement?
  7. What kind of physical therapy and rehabilitation will be necessary after the cementless knee replacement surgery?
  8. Will I be able to resume my normal activities, such as sports or exercise, after a cementless knee replacement?
  9. What kind of follow-up care and monitoring will be needed after the cementless knee replacement surgery?
  10. What are the success rates and outcomes of cementless knee replacement surgeries that you have performed in the past?

Reference

Authors: Mosher ZA, Bolognesi MP, Malkani AL, Meneghini RM, Oni JK, Fricka KB. Journal: J Arthroplasty. 2024 Sep;39(9S2):S45-S53. doi: 10.1016/j.arth.2024.02.078. Epub 2024 Mar 7. PMID: 38458333