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    ICJR DEBATES: Cemented vs. Cementless Stem Fixation in Revision TKA

    What is the optimum method of stem fixation in a revision total knee arthroplasty (TKA) procedure? Is cemented fixation necessary, or is a cementless technique adequate?

    As it turns out, either one is acceptable: The literature does not unequivocally favor one over the other, with both fixation methods having been found to be effective. [1]

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    The choice of fixation technique come down to surgeon preference and quality of the patient’s bone. Cemented and cementless fixation (or a hybrid cemented/cementless fixation) have their advantages and disadvantages. [2] In general, surgeons tend to select cemented fixation in patients with large bone defects and/or poor bone quality to ensure metaphyseal engagement, while cementless or hybrid fixation is appropriate for most routine revision procedures. [2]

    At ICJR’s inaugural course for senior residents and fellows, Advanced Techniques in Total Hip & Knee Arthroplasty, Matthew P. Abdel, MD, and H. John Cooper, MD, addressed the question of cemented versus cementless fixation. Dr. Abdel described the 5 reasons he prefers to cement the stem in revision TKA, including the ability to achieve immediate fixation, while Dr. Cooper elaborated on the hybrid technique he uses in most revision scenarios to add strength and stability to the fixation and prevent aseptic loosening.

    Click the images below to watch their presentations.

    Why I Use Cemented Stems in Revision TKA
    Matthew P. Abdel, MD

    Why I Use Cementless Stems in Revision TKA
    H. John Cooper, MD

    Disclosures: Dr. Abdel has disclosed that he receives royalties from Stryker. Dr. Cooper has no disclosures relevant to this presentation.

    References

    1. Wang C, Pfitzner T, von Roth P, Mayr HO, Sostheim M, Hube R. Fixation of stem in revision of total knee arthroplasty: cemented versus cementless-a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24:3200–11. doi: 10.1007/s00167-015-3820-4.
    2. Kang SG, Park CH, Song SJ. Stem fixation in revision total knee arthroplasty: indications, stem dimensions, and fixation methods. Knee Surg Relat Res. 2018 Sep; 30(3): 187–192. [EPub 2018 Sept 1]. doi: 10.5792/ksrr.18.019.