Abstract
Introduction
Revision total knee arthroplasty (TKA) is becoming increasingly common in the United States as the population ages and larger numbers of primary TKA are performed in younger individuals. Cemented or uncemented tibial stems are frequently used in revision cases. Decreased clinical outcomes and patient satisfaction have been described for revision TKA. This study aims to determine if the presence of overall pain and tibial pain at the end of the stem differs between cemented and uncemented tibial stems in revision TKA.
Methods
This was a retrospective cohort study comparing patients who underwent revision TKA utilizing cemented or uncemented tibial stems in a 15-year period at a single institution with at least two-year follow-up. Exclusion criteria included age under 18, isolated revisions of the femoral component or polyethylene exchanges, lack of preoperative or postoperative imaging, insufficient operative or implant records available for electronic chart review, revision procedures performed at outside facilities, patients who were deceased at the time of survey administration, refusal to participate in the study, and failure to return the mailed survey or respond to a telephone follow-up questionnaire. Radiographic analysis included calculation of the percentage of the tibial canal filled with the implant, as well as measurement of the diameter of the tibial stem. Radiographs were also reviewed for evidence of cavitary defects, pedestal formation, radiolucent lines, and periprosthetic fractures. Mailed surveys addressing overall pain, tibial pain, and satisfaction were analyzed using Fisher's exact test and the independent sample t-test. Logistic regression was used to adjust for age, gender, and preoperative bone loss.
Results
A total of 110 patients were included (63 cemented and 47 uncemented stems). No statistically significant differences in stem length, operative side, or indications for revision were found. The uncemented group had a significantly higher percent canal fill (p < 0.0001). Tibial pain at the end of the stem was present in 25.3% of cemented stems and 25.5% of uncemented stems (p = 1.00). There was a trend towards more overall pain in the uncemented cohort, but this did not reach statistical significance. Only 74.6% of cemented patients and 78.7% of uncemented patients were satisfied following revision TKA (p = 0.66).
Conclusion
The data supports our hypothesis that there are no differences in end-of-stem pain or overall pain between cemented and uncemented tibial stems in revision TKA. High rates of dissatisfaction were noted in both cohorts postoperatively, consistent with previous literature. Patient factors likely play a large role in the presence of postoperative pain. These factors should be further evaluated in future studies in an effort to reduce pain and improve patient satisfaction.
