Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2
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KNEE
Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2 years follow‑up Gaspard Fournier1 · Bart Muller1 · Romain Gaillard1 · Cécile Batailler1,2 · Sébastien Lustig1,2 · Elvire Servien1,3 Received: 26 September 2019 / Accepted: 7 January 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The purpose of this study was to compare the clinical results, radiographic loosening and early complications between patients undergoing primary knee arthroplasty (TKA) with tibial short stem extension and those with standard stem for gross varus deformities at minimum two years after surgery. Methods From a prospective TKA database of 4216 patients, patients with a primary TKA with a tibial short stem extension (30 mm) for severe varus deformity (hip-kneeankle angle, HKA 10°, undergoing primary total knee arthroplasty, prophylactic use of a tibial short extension stem may lead to less loosening of the tibial component. In this study, 3% of patient with big varus deformity without stemmed TKA had a tibial implant loosening versus 0% in the stemmed TKA group. Level of evidence Level III, case–control study Keywords Total knee arthroplasty · Gross varus · Tibial stem extension · Tibial component loosening · TKA revision
Introduction
The French advisory committee on health research data processing (CCTIRS) approved this study on 24 January 2012 and 9 March 2015 (approval #11-681).
Reported TKA revision rates in literature are low and range between 4.9 and 7.8% at 10-years [11], with infection and aseptic loosening being the most frequently encountered
* Gaspard Fournier gaspard.fournier@chu‑lyon.fr
Elvire Servien elvire.servien@chu‑lyon.fr
Bart Muller [email protected]
1
Romain Gaillard romain.gaillard@chu‑lyon.fr
Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
2
Cécile Batailler cecile.batailler@chu‑lyon.fr
Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
3
EA 7424 ‑ Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
Sébastien Lustig [email protected]
13
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complications [14]. Preoperative malalignment increases the risk of aseptic loosening of particularly the tibial component [13], with severe varus deformity being the most important risk factor [8, 15]. In order To distribute load transmission and reduce forces in the proximal tibia, prostheses may be equipped with pegs, keels or stems. Tibial stems further increase the mechanical stability of the tibial component by transmitting forces over the metaphysis and thereby reducing micromotion and tibial lift-off [10, 15]. Several studies have underlined the better mechanical stability of the tibial component with the use of stems, but the focus of these studies has either been on revision surgery or on complex primary cases with gross metaphyseal b
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