The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age: a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016

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The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age : a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016. / Niemeläinen, Mika J.; Mäkelä, Keijo T.; Robertsson, Otto; W-Dahl, Annette; Furnes, Ove; Fenstad, Anne M.; Pedersen, Alma B.; Schrøder, Henrik M.; Reito, Aleksi; Eskelinen, Antti.

In: Acta Orthopaedica, Vol. 91, No. 2, 2020, p. 184-190.

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Niemeläinen, Mika J. ; Mäkelä, Keijo T. ; Robertsson, Otto ; W-Dahl, Annette ; Furnes, Ove ; Fenstad, Anne M. ; Pedersen, Alma B. ; Schrøder, Henrik M. ; Reito, Aleksi ; Eskelinen, Antti. / The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age : a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016. In: Acta Orthopaedica. 2020 ; Vol. 91, No. 2. pp. 184-190.

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TY - JOUR

T1 - The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age

T2 - a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000–2016

AU - Niemeläinen, Mika J.

AU - Mäkelä, Keijo T.

AU - Robertsson, Otto

AU - W-Dahl, Annette

AU - Furnes, Ove

AU - Fenstad, Anne M.

AU - Pedersen, Alma B.

AU - Schrøder, Henrik M.

AU - Reito, Aleksi

AU - Eskelinen, Antti

PY - 2020

Y1 - 2020

N2 - Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years. Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason. Results — The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4–93.8), uncemented 91.2% (CI 90.1–92.2), hybrid 93.0% (Cl 92.2–93.8), and inverse hybrid 96.0% (CI 94.1–98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years’ follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4–0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1–1.7]) and > 6 years’ (HR 1.3 [1.0–1.7]) follow-up compared to the reference. Interpretation — Both cemented and hybrid TKAs had 10-year survival rates exceeding 92–>93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.

AB - Background and purpose — Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years. Patients and methods — We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000–2016. Kaplan–Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason. Results — The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4–93.8), uncemented 91.2% (CI 90.1–92.2), hybrid 93.0% (Cl 92.2–93.8), and inverse hybrid 96.0% (CI 94.1–98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years’ follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4–0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1–1.7]) and > 6 years’ (HR 1.3 [1.0–1.7]) follow-up compared to the reference. Interpretation — Both cemented and hybrid TKAs had 10-year survival rates exceeding 92–>93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.

U2 - 10.1080/17453674.2019.1710373

DO - 10.1080/17453674.2019.1710373

M3 - Article

C2 - 31928097

AN - SCOPUS:85078597864

VL - 91

SP - 184

EP - 190

JO - Acta Orthopaedica

JF - Acta Orthopaedica

SN - 1745-3682

IS - 2

ER -