Objective To investigate the difference of total knee arthroplasty (TKA) with tantalum monoblock tibial component (TMT) and cemented tibial plateau prosthesis in patients of different ages. Methods The clinical data of 248 patients (392 knees) who underwent primary TKA between May 2014 and May 2019 and met the selection criteria were retrospectively analyzed. There were 54 males (98 knees) and 194 females (294 knees). Of the 122 patients (183 knees), less than 65 years old, 52 (75 knees, group A1) were treated with TMT and 70 (108 knees, group B1) were treated with cemented tibial plateau prosthesis; of the 126 patients (209 knees), more than 65 years old, 57 (82 knees, group A2) were treated with TMT and 69 (127 knees, group B2) were treated with cemented tibial plateau prosthesis. The baseline data of patients, perioperative indicators [hemoglobin (Hb), hematocrit (Hct), total blood loss, unilateral operation time], effectiveness evaluation indicators [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score, Knee Society Scoring System (KSS) score, active flexion and extension range of motion (ROM) of the knee joint], complications, and imaging indicators [tibial prosthesis varus angle (β angle), tibial prosthesis posterior slope angle (δ angle), tibio-femoral angle, occurrence of radiolucent line, prosthesis survival rate] were recorded and compared. Results There was no significant difference in gender, age, height, weight, body mass index, Kellgren-Lawrence grading, the length of hospital stay, and follow-up time between groups A1, B1 and groups A2, B2 (P>0.05). The unilateral operation time in groups A1 and A2 was significantly shorter than that in the corresponding groups B1 and B2 (P<0.05). There was no significant difference in differences of pre- and post-operative Hb and Hct and total blood loss between groups A1, B1 and groups A2, B2 (P>0.05). There was no significant difference in preoperative effectiveness evaluation indicators between groups A1, B1 and groups A2, B2 (P>0.05). There were significant differences in the differences of pre- and post-operative WOMAC activity and pain scores, KSS function and pain scores, and VAS scores between groups A1 and B1 (P<0.05); there was no significant difference in WOMAC stiffness score and ROM (P>0.05). There was no significant difference in the above indicators between groups A2 and B2 (P>0.05). There was no significant difference in the incidence of complications (2.7% vs 6.5%, 3.7% vs 3.1%) and prosthesis survival rate (100% vs 97.2%, 100% vs 99.2%) between groups A1, B1 and groups A2, B2 (P>0.05). During follow-up, there was no significant difference in β angle, δ angle, and tibio-femoral angle between groups A1, B1 and groups A2, B2 (P>0.05). In the evaluation of knee X-ray radiolucent line, 2 knees of group A1 and 2 knees of group A2 had radiolucent line at prosthesis-bone interface immediately after operation, and the radiolucent line was gradually filled by new bone, without new radiolucent line. During follow-up, 1 knee of group B1 and 1 knee of group B2 had prosthesis-bone interface radiolucent line, without radiolucent line widening or prosthesis loosening. Conclusion TMT is recommended in patients less than 65 years old, and the two types of prostheses are available for patients nore than 65 years old. However, the long-term effectiveness of the two types of prosthesis in patients of different ages needs further follow-up.
Objective To investigate the short- and mid-term effectiveness and prosthesis survival rate in patients undergoing total knee arthroplasty (TKA) using domestic cementless knee prostheses with three-dimensional (3D)-printed trabecular metal interface. Methods A retrospective analysis was performed on the clinical data of 79 patients who underwent primary TKA for end-stage knee disorders, met the selection criteria and were treated between December 2021 and March 2022. There were 39 patients in the cementless group receiving cementless knee prostheses with 3D-printed trabecular metal interface, and 40 patients in the cemented group adopting posterior-stabilized cement-fixed knee prostheses. Baseline data including age, gender, body weight, disease type, disease duration, and preoperative Knee Society Score (KSS) (clinical score and function score) showed no significant differences between the two groups (P>0.05). Operation time, intraoperative blood loss, and complications were recorded and compared between groups. KSS clinical and function scores before operation and at last follow-up were used to evaluate knee functional recovery. Radiographic assessment was conducted to detect prosthesis loosening, osteolysis, prosthesis subsidence, joint dislocation, and other abnormalities. Prosthesis survival rate was calculated with complete or partial prosthesis removal defined as the endpoint event, and Kaplan-Meier method was adopted to plot prosthesis survival curves. Results All patients successfully completed surgery. No significant intergroup differences were found in operation time and intraoperative blood loss (P>0.05). All patients in the cementless group and cemented group were followed up for (28.4±2.4) months and (28.2±2.8) months respectively, without significant difference (t=?0.274, P=0.785). At last follow-up, both KSS clinical and function scores were significantly higher than preoperative values in both groups (P<0.05), while no significant intergroup differences were observed in the changes of each score (P>0.05). X-ray films at last follow-up revealed no prosthesis loosening, osteolysis, prosthesis subsidence, or joint dislocation in any patient. During follow-up, 5 cases of intermuscular venous thrombosis occurred in the cementless group; in the cemented group, there were 6 cases of intermuscular venous thrombosis, 1 case of poor wound healing, 1 case of periprosthetic joint infection, 1 case of periprosthetic fracture, and 1 case of all-cause death. The complication rates of the two groups (12.8% vs 25.0%) were not different (P>0.05). One revision surgery was performed for periprosthetic joint infection and 1 for periprosthetic fracture in the cemented group, corresponding to a prosthesis survival rate of 95.0%; no endpoint events occurred in the cementless group, with a prosthesis survival rate of 100.0%. Kaplan-Meier survival curve analysis demonstrated no significant difference in prosthesis survival rates between the two groups (Log-rank test: χ2=2.028, P=0.154). Conclusion TKA performed with domestic cementless knee prostheses featuring 3D-printed trabecular metal interface shows no obvious disadvantages compared with cemented prostheses in terms of postoperative function, complication rate, and prosthesis survival rate, which represents a safe and viable prosthesis option.