nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

03.08.2024 | Original Article

The use of a tibial stem in primary total knee arthroplasty for patients with a frontal deformity of more than ten degrees reduces the rate of postoperative pain

verfasst von: Jean-Arthur Bourdier, Pierre-Alban Bouché, Jules Descamps, Pascal Bizot, Rémy Nizard, Guillaume-A. Odri

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

The use of a tibial stem for large deformities (> 10°) would reduce the incidence of pain. The aim of this study was to compare the effect of tibial stem on postoperative pain and aseptic loosening at the tibia in patients with a preoperative deformity > 10° in the frontal plane at 2 years follow-up.

Methods

This was a retrospective single-center case–control study. Ninety-eight patients with deformities greater than 10° in the frontal plane and a BMI > 30 kg/m² who had undergone posterior-stabilized (PS) total knee arthroplasty (TKA) with a tibial stem were matched using a propensity score to 98 patients who had undergone PS TKA without a tibial stem. The primary endpoint was the pain rate at 2 years. The secondary endpoints were the rate of aseptic loosening of the tibia at 2 years post-operatively.

Results

A significant difference was found in the rate of postoperative pain at 2 years. It was higher in the group without tibial stem compared with the group with tibial stem (41.8% vs 17.3%, p = 0.0003). In the group without tibial stem, 24.4% of pain was mild, 61% moderate and no severe pain. In the tibial stem group, 47.1% of pain was mild, 41.2% moderate and no severe pain. A radiolucent line (RLL) was present at 2 years in 26.5% of prostheses in the without tibial stem group and in 9.2% of prostheses in the tibial stem group (p = 0.002).

There was no difference between the two groups in terms of aseptic loosening.

Conclusion

The use of a tibial stem in primary TKA in patients with frontal deformities greater than 10° reduces postoperative pain and the presence of radiolucent lines.

Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222CrossRefPubMed

Erivan R, Tardieu A, Villatte G et al (2020) Knee surgery trends and projections in France from 2008 to 2070. Orthop Traumatol Surg Res 106:893–902. https://doi.org/10.1016/j.otsr.2020.02.018CrossRefPubMed

World Health Organization (2016) World health statistics 2016: monitoring health for the SDGs, sustainable development goals. World Health Organization, Geneva

Lange T, Schmitt J, Kopkow C et al (2017) What do patients expect from total knee arthroplasty? a delphi consensus study on patient treatment goals. J Arthroplast 32:2093-2099.e1. https://doi.org/10.1016/j.arth.2017.01.053CrossRef

Wylde V, Beswick A, Bruce J et al (2018) Chronic pain after total knee arthroplasty. EFORT Open Rev 3:461–470. https://doi.org/10.1302/2058-5241.3.180004CrossRefPubMedPubMedCentral

Sadoghi P, Liebensteiner M, Agreiter M et al (2013) Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplast 28:1329–1332. https://doi.org/10.1016/j.arth.2013.01.012CrossRef

Petersen KK, Arendt-Nielsen L (2016) Chronic postoperative pain after joint replacement. Pain 24:1–6

Lewis GN, Rice DA, McNair PJ, Kluger M (2015) Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 114:551–561. https://doi.org/10.1093/bja/aeu441CrossRefPubMed

Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82:1189–1195. https://doi.org/10.1302/0301-620x.82b8.10717CrossRefPubMed

10.

Teeny SM, Krackow KA, Hungerford DS, Jones M (1991) Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res 273:19–31CrossRef

11.

Lee B-S, Lee S-J, Kim J-M et al (2011) No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:960–966. https://doi.org/10.1007/s00167-010-1316-9CrossRefPubMed

12.

Gililland JM, Gaffney CJ, Odum SM et al (2014) Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA. J Arthroplasty 29:224–228. https://doi.org/10.1016/j.arth.2014.03.049CrossRefPubMed

13.

Fournier G, Muller B, Gaillard R et al (2020) Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 28:3780–3786. https://doi.org/10.1007/s00167-020-05848-2CrossRefPubMed

14.

Druel J, Gelin N, Ollivier M et al (2024) Outcomes of short and long tibial stems for primary total knee arthroplasty in a population of obese patients at two-year follow-up: a clinical and biomechanical study. J Arthroplast S0883–5403(24):00146–00153. https://doi.org/10.1016/j.arth.2024.02.047CrossRef

15.

Fehring TK, Odum S, Olekson C et al (2003) Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000093032.56370.4bCrossRefPubMed

16.

Walsh CP, Han S, Canham CD et al (2019) Total knee arthroplasty in the osteoporotic tibia: a biomechanical evaluation of the role of stem extensions and cementing techniques. J Am Acad Orthop Surg 27:370–374. https://doi.org/10.5435/JAAOS-D-17-00736CrossRefPubMed

17.

Osan JK, Harris IA, Harries D et al (2024) Utilizing stems in primary total knee arthroplasty: analysis of the Australian orthopaedic association national joint replacement registry data. J Arthroplast 39:1692–1698. https://doi.org/10.1016/j.arth.2024.01.031CrossRef

18.

Filip AC, Cuculici SA, Cristea S et al (2022) Tibial stem extension versus standard configuration in total knee arthroplasty: a biomechanical assessment according to bone properties. Medicina 58:634. https://doi.org/10.3390/medicina58050634CrossRefPubMedPubMedCentral

19.

Kwon HM, Hong H-T, Kim I et al (2024) Biomechanical effects of stem extension of tibial components for medial tibial bone defects in total knee arthroplasty: a finite element study. J Knee Surg. https://doi.org/10.1055/a-2344-5084CrossRefPubMed

20.

Scott CEH, Biant LC (2012) The role of the design of tibial components and stems in knee replacement. J Bone Joint Surg Br 94:1009–1015. https://doi.org/10.1302/0301-620X.94B8.28289CrossRefPubMed

21.

Ritter MA, Faris GW, Faris PM, Davis KE (2004) Total knee arthroplasty in patients with angular varus or valgus deformities of > or = 20 degrees. J Arthroplasty 19:862–866. https://doi.org/10.1016/j.arth.2004.03.009CrossRefPubMed

22.

Ritter MA, Davis KE, Davis P et al (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg Am 95:126–131. https://doi.org/10.2106/JBJS.K.00607CrossRefPubMed

23.

Chalmers BP, Sculco PK, Fehring KA et al (2017) A novel percentage-based system for determining aseptic loosening of total knee arthroplasty tibial components. J Arthroplast 32:2274–2278. https://doi.org/10.1016/j.arth.2017.02.020CrossRef

24.

Bach CM, Steingruber IE, Peer S et al (2001) Radiographic assessment in total knee arthroplasty. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200104000-00022CrossRefPubMed

25.

Meneghini RM, Mont MA, Backstein DB et al (2015) Development of a modern knee society radiographic evaluation system and methodology for total knee arthroplasty. J Arthroplast 30:2311–2314. https://doi.org/10.1016/j.arth.2015.05.049CrossRef

26.

Ahn JH, Back YW (2013) Comparative study of two techniques for ligament balancing in total knee arthroplasty for severe varus knee: medial soft tissue release vs. bony resection of proximal medial tibia. Knee Surg Relat Res 25:13–18. https://doi.org/10.5792/ksrr.2013.25.1.13CrossRefPubMedPubMedCentral

27.

Piedade SR, Pinaroli A, Servien E, Neyret P (2009) Revision after early aseptic failures in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:248–253. https://doi.org/10.1007/s00167-008-0667-yCrossRefPubMed

28.

Hinman AD, Prentice HA, Paxton EW, Kelly MP (2021) Modular tibial stem use and risk of revision for aseptic loosening in cemented primary total knee arthroplasty. J Arthroplast 36:1577–1583. https://doi.org/10.1016/j.arth.2020.11.003CrossRef

29.

Sharkey PF, Lichstein PM, Shen C et al (2014) Why are total knee arthroplasties failing today–has anything changed after 10 years? J Arthroplast 29:1774–1778. https://doi.org/10.1016/j.arth.2013.07.024CrossRef

30.

Completo et al (2008) The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA. Knee 15(3):227–32CrossRefPubMed

31.

Completo A, Simões JA, Fonseca F, Oliveira M (2008) The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA. Knee 15:227–232. https://doi.org/10.1016/j.knee.2008.01.008CrossRefPubMed

32.

Rawlinson JJ, Peters LE, Campbell DA et al (2005) Cancellous bone strains indicate efficacy of stem augmentation in constrained condylar knees. Clin Orthop Relat Res 440:107–116. https://doi.org/10.1097/01.blo.0000187340.10003.68CrossRefPubMed

33.

Murase K, Crowninshield RD, Pedersen DR, Chang TS (1983) An analysis of tibial component design in total knee arthroplasty. J Biomech 16:13–22. https://doi.org/10.1016/0021-9290(83)90042-8CrossRefPubMed

34.

Patel AR, Barlow B, Ranawat AS (2015) Stem length in revision total knee arthroplasty. Curr Rev Musculoskelet Med 8:407–412. https://doi.org/10.1007/s12178-015-9297-4CrossRefPubMedPubMedCentral

35.

Oh S-M, Bin S-I, Kim J-Y et al (2019) Impact of preoperative varus deformity on postoperative mechanical alignment and long-term results of “mechanical” aligned total knee arthroplasty. Orthop Traumatol Surg Res 105:1061–1066. https://doi.org/10.1016/j.otsr.2019.04.016CrossRefPubMed

36.

Parratte S, Ollivier M, Lunebourg A et al (2017) Do stemmed tibial components in total knee arthroplasty improve outcomes in patients with obesity? Clin Orthop Relat Res 475:137–145. https://doi.org/10.1007/s11999-016-4791-6CrossRefPubMed

37.

Kajetanek C, Bouyer B, Ollivier M et al (2016) Mid-term survivorship of Mini-keel™ versus Standard keel in total knee replacements: differences in the rate of revision for aseptic loosening. Orthop Traumatol Surg Res 102:611–617. https://doi.org/10.1016/j.otsr.2016.05.007CrossRefPubMed

38.

Boeckstyns MEH, Backer M (1989) Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 38:29–33. https://doi.org/10.1016/0304-3959(89)90069-9CrossRefPubMed

39.

Park M-H, Bin S-I, Kim J-M et al (2018) Using a tibial short extension stem reduces tibial component loosening after primary total knee arthroplasty in severely varus knees: long-term survival analysis with propensity score matching. J Arthroplast 33:2512–2517. https://doi.org/10.1016/j.arth.2018.03.058CrossRef

40.

Abdel MP, Bonadurer GF, Jennings MT, Hanssen AD (2015) Increased aseptic tibial failures in patients with a bmi ≥35 and well-aligned total knee arthroplasties. J Arthroplast 30:2181–2184. https://doi.org/10.1016/j.arth.2015.06.057CrossRef

41.

Lachiewicz PF, Soileau ES (2015) A 30-mm cemented stem extension provides adequate fixation of the tibial component in revision knee arthroplasty. Clin Orthop Relat Res 473:185–189. https://doi.org/10.1007/s11999-014-3529-6CrossRefPubMed

42.

Angers-Goulet M, Bédard M (2017) Up to seven years’ follow-up of short cemented stems in complex primary total knee arthroplasty: a prospective study. Knee 24:1166–1174. https://doi.org/10.1016/j.knee.2017.05.010CrossRefPubMed

43.

Barrack RL, Stanley T, Burt M, Hopkins S (2004) The effect of stem design on end-of-stem pain in revision total knee arthroplasty. J Arthroplast 19:119–124. https://doi.org/10.1016/j.arth.2004.06.009CrossRef

44.

McLean AJ (2007) Effect of modular stems and cement fixation techniques on the initial stability of the tibial prosthesis and the strain distribution within the proximal tibia in primary and revision total knee arthroplasty

45.

Completo A, Talaia P, Fonseca F, Simões JA (2009) Relationship of design features of stemmed tibial knee prosthesis with stress shielding and end-of-stem pain. Mater Des 30:1391–1397. https://doi.org/10.1016/j.matdes.2008.06.071CrossRef

Titel: The use of a tibial stem in primary total knee arthroplasty for patients with a frontal deformity of more than ten degrees reduces the rate of postoperative pain
verfasst von: Jean-Arthur Bourdier
Pierre-Alban Bouché
Jules Descamps
Pascal Bizot
Rémy Nizard
Guillaume-A. Odri
Publikationsdatum: 03.08.2024
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2024
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-04052-z

Do preoperative glucose levels predict risk of complications in orthopaedic surgery?

Original Article

Establishing the diagnosis of radial tunnel syndrome: a systematic review of published clinical series

General Review

Preoperative chronic steroid use as a risk factor for complications following open reduction internal fixation for proximal humerus fracture

Original Article

Postoperative 3D computed tomographic evaluation of 92 calcaneal fracture reduction using the sinus tarsi technique and fixation with 3.5 mm cortical screws

Original Article

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series

Original Article

The “foothill” entry for cephalomedullary nailing in unstable proximal femoral fractures: a technical note with a review of the literature

Technical Note

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Viele Versäumnisse bei Psoriasis-Arthritis

17.04.2025
Psoriasis-Arthritis
Nachrichten

Menschen mit Psoriasis-Arthritis (PsA) müssen länger auf die Diagnose warten und werden zögerlicher behandelt als an rheumatoider Arthritis (RA) Erkrankte. Diese Defizite hat eine Untersuchung in Großbritannien aufgedeckt.

Yoga gegen Kniearthrose nicht schlechter als Krafttraining

15.04.2025
Gonarthrose
Nachrichten

Menschen mit Gonarthrose profitieren von Yogaübungen nicht weniger als von gezielten Kräftigungsübungen für die lädierten Knie. In einer Vergleichsstudie haben sich für Yogis und Yoginis sogar einige Vorteile ergeben.

Muskelrelaxanzien wohl nur bei akuten Kreuzschmerzen hilfreich

14.04.2025
Rückenschmerzen
Nachrichten

Bei akuten Rückenschmerzen können Muskelrelaxanzien, eventuell in Kombination mit NSAR, zur Schmerzlinderung beitragen. Wegen der Nebenwirkungen wird jedoch empfohlen, die Medikamente nur über wenige Tage einzusetzen.

Thoracic-Outlet-Syndrom nur in Ausnahmefällen operieren!

08.04.2025
DCK 2025
Nachrichten

Das Thoracic-Outlet-Syndrom erfordert nur in ganz bestimmten Fällen ein operatives Vorgehen. Beim DCK wurde vor schwerwiegenden Komplikationen des anspruchsvollen Eingriffs gewarnt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

The use of a tibial stem in primary total knee arthroplasty for patients with a frontal deformity of more than ten degrees reduces the rate of postoperative pain