Download PDF
J Knee Surg 2023; 36(05): 530-539
DOI: 10.1055/s-0041-1739201
Original Article

Similar Healthcare Utilization and 1-Year Patient-Reported Outcomes between Cemented and Cementless Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Michael P. Erossy
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Ahmed K. Emara
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Christopher A. Rothfusz
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Alison K. Klika
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Michael R. Bloomfield   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Carlos A. Higuera   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Yuxuan Jin   *
2   Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
,
Viktor E. Krebs   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Nathan W. Mesko   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Robert M. Molloy   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Trevor G. Murray   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Preetesh D. Patel   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Kim L. Stearns   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Jonathan L. Schaffer   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Gregory J. Strnad   *
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
,
Nicolas S. Piuzzi 
1   Cleveland Clinic Foundation, Orthopedic & Rheumatologic Institute, Cleveland, Ohio
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Cementless fixation for total knee arthroplasty (TKA) has gained traction with the advent of newer fixation technologies. This study assessed (1) healthcare utilization (length of stay (LOS), nonhome discharge, 90-day readmission, and 1-year reoperation); (2) 1-year mortality; and (3) 1-year joint-specific and global health-related patient-reported outcome measures (PROMs) among patients who received cementless versus cemented TKA. Patients who underwent cementless and cemented TKA at a single institution (July 2015–August 2018) were prospectively enrolled. A total of 424 cementless and 5,274 cemented TKAs were included. The cementless cohort was propensity score-matched to a group cemented TKAs (1:3-cementless: n = 424; cemented: n = 1,272). Within the matched cohorts, 76.9% (n = 326) cementless and 75.9% (n = 966) cementless TKAs completed 1-year PROMs. Healthcare utilization measures, mortality and the median 1-year change in knee injury and osteoarthritis outcome score (KOOS)-pain, KOOS-physical function short form (PS), KOOS-knee related quality of life (KRQOL), Veteran Rand (VR)-12 mental composite (MCS), and physical composite (PCS) scores were compared. The minimal clinically important difference (MCID) for PROMs was calculated. Cementless TKA exhibited similar rates of median LOS (p = 0.109), nonhome discharge disposition (p = 0.056), all-cause 90-day readmission (p = 0.226), 1-year reoperation (p = 0.597), and 1-year mortality (p = 0.861) when compared with cemented TKA. There was no significant difference in the median 1-year improvement in KOOS-pain (p = 0.370), KOOS-PS (p = 0.417), KOOS-KRQOL (p = 0.101), VR-12-PCS (p = 0.269), and VR-12-MCS (p = 0.191) between the cementless and cemented TKA cohorts. Rates of attaining MCID were similar in both cohorts for assessed PROMs (p > 0.05, each) except KOOS-KRQOL (cementless: n = 313 (96.0%) vs. cemented: n = 895 [92.7%]; p = 0.036). Cementless TKA provides similar healthcare-utilization, mortality, and 1-year PROM improvement versus cemented TKA. Cementless fixation in TKA may provide value through higher MCID improvement in quality of life. Future episode-of-care cost-analyses and longer-term survivorship investigations are warranted.

Keywords

cemented - cementless - fixation - total knee arthroplasty (TKA) - healthcare utilization - patient-reported outcomes

Note

The investigation was performed at the Cleveland Clinic Foundation Cleveland, Ohio.


* These authors are the members of the Cleveland Clinic Arthroplasty Group.




Publication History

Received: 10 June 2021

Accepted: 21 September 2021

Article published online:
15 November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Maggs J, Wilson M. The relative merits of cemented and uncemented prostheses in total hip arthroplasty. Indian J Orthop 2017; 51 (04) 377-385
    CrossrefPubMedGoogle Scholar
  • 2 Moskal JT, Capps SG, Scanelli JA. Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty. Arthroplast Today 2016; 2 (04) 211-218
    CrossrefPubMedGoogle Scholar
  • 3 Harwin SF, Levin JM, Khlopas A. et al. Cementless posteriorly stabilized total knee arthroplasty: seven-year minimum follow-up report. J Arthroplasty 2018; 33 (05) 1399-1403
    CrossrefPubMedGoogle Scholar
  • 4 Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented versus cementless total knee arthroplasty of the same modern design: a prospective, randomized trial. J Bone Joint Surg Am 2019; 101 (13) 1185-1192
    CrossrefPubMedGoogle Scholar
  • 5 Newman JM, Sodhi N, Dekis JC. et al. Survivorship and functional outcomes of cementless versus cemented total knee arthroplasty: a meta-analysis. J Knee Surg 2020; 33 (03) 270-278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Parker DA, Rorabeck CH, Bourne RB. Long-term followup of cementless versus hybrid fixation for total knee arthroplasty. Clin Orthop Relat Res 2001; (388) 68-76
    CrossrefPubMedGoogle Scholar
  • 7 Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 2003; 85 (02) 259-265
    CrossrefPubMedGoogle Scholar
  • 8 Robertsson O, Bizjajeva S, Fenstad AM. et al. Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association. Acta Orthop 2010; 81 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 9 Illgen R, Tueting J, Enright T, Schreibman K, McBeath A, Heiner J. Hybrid total knee arthroplasty: a retrospective analysis of clinical and radiographic outcomes at average 10 years follow-up. J Arthroplasty 2004; 19 (7, Suppl 2): 95-100
    CrossrefPubMedGoogle Scholar
  • 10 Lombardi Jr AVJ, Berasi CC, Berend KR. Evolution of tibial fixation in total knee arthroplasty. J Arthroplasty 2007; 22 (4, Suppl 1): 25-29
    CrossrefPubMedGoogle Scholar
  • 11 Carr AJ, Robertsson O, Graves S. et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
    CrossrefPubMedGoogle Scholar
  • 12 Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 2010; 81 (04) 413-419
    CrossrefPubMedGoogle Scholar
  • 13 Mont MA, Gwam C, Newman JM. et al. Outcomes of a newer-generation cementless total knee arthroplasty design in patients less than 50 years of age. Ann Transl Med 2017; 5 (Suppl. 03) S24
    CrossrefPubMedGoogle Scholar
  • 14 Fernandez-Fairen M, Hernández-Vaquero D, Murcia A, Torres A, Llopis R. Trabecular metal in total knee arthroplasty associated with higher knee scores: a randomized controlled trial. Clin Orthop Relat Res 2013; 471 (11) 3543-3553
    CrossrefPubMedGoogle Scholar
  • 15 Hayakawa K, Date H, Tsujimura S, Nojiri S, Yamada H, Nakagawa K. Mid-term results of total knee arthroplasty with a porous tantalum monoblock tibial component. Knee 2014; 21 (01) 199-203 https://doi.org/https://doi.org/10.1016/j.knee.2013.06.004
    CrossrefPubMedGoogle Scholar
  • 16 Harwin SF, Patel NK, Chughtai M. et al. Outcomes of newer generation cementless total knee arthroplasty: beaded periapatite-coated vs highly porous titanium-coated implants. J Arthroplasty 2017; 32 (07) 2156-2160
    CrossrefPubMedGoogle Scholar
  • 17 Aprato A, Risitano S, Sabatini L, Giachino M, Agati G, Massè A. Cementless total knee arthroplasty. Ann Transl Med 2016; 4 (07) 129 DOI: 10.21037/atm.2016.01.34.
    CrossrefPubMedGoogle Scholar
  • 18 Graves SE, Davidson D, Ingerson L. et al. The Australian Orthopaedic Association National Joint Replacement Registry. Med J Aust 2004; 180 (S5): S31-S34
    CrossrefPubMedGoogle Scholar
  • 19 Mckie J, Devane P, Young S, Coleman V, Muir D, Turner P. et al. The New Zealand Joint Registry: Twenty Year Report. 2019: 184
    PubMedGoogle Scholar
  • 20 Boyle KK, Nodzo SR, Ferraro JT, Augenblick DJ, Pavlesen S, Phillips MJ. Uncemented vs cemented cruciate retaining total knee arthroplasty in patients with body mass index greater than 30. J Arthroplasty 2018; 33 (04) 1082-1088
    CrossrefPubMedGoogle Scholar
  • 21 Fricka KB, McAsey CJ, Sritulanondha S. To cement or not? Five-year results of a prospective, randomized study comparing cemented vs cementless total knee arthroplasty. J Arthroplasty 2019; 34 (7S): S183-S187
    CrossrefPubMedGoogle Scholar
  • 22 OME Cleveland Clinic Orthopaedics. Value in research: achieving validated outcome measurements while mitigating follow-up cost. J Bone Joint Surg Am 2020; 102 (05) 419-427
    CrossrefPubMedGoogle Scholar
  • 23 Piuzzi NS, Strnad G, Brooks P. et al; OME Cleveland Clinic Orthopaedics. Implementing a scientifically valid, cost-effective, and scalable data collection system at point of care: the Cleveland Clinic OME cohort. J Bone Joint Surg Am 2019; 101 (05) 458-464
    CrossrefPubMedGoogle Scholar
  • 24 Gandek B, Ware Jr JE. Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients. Arthritis Care Res (Hoboken) 2017; 69 (06) 817-825
    CrossrefPubMedGoogle Scholar
  • 25 Lyman S, Lee Y-Y, Franklin PD, Li W, Cross MB, Padgett DE. Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res 2016; 474 (06) 1461-1471
    CrossrefPubMedGoogle Scholar
  • 26 Selim AJ, Rogers W, Fleishman JA. et al. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res 2009; 18 (01) 43-52
    CrossrefPubMedGoogle Scholar
  • 27 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
    CrossrefPubMedGoogle Scholar
  • 28 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
    Google Scholar
  • 29 Copay AG, Eyberg B, Chung AS, Zurcher KS, Chutkan N, Spangehl MJ. Minimum clinically important difference: current trends in the orthopaedic literature, part II: lower extremity: a systematic review. JBJS Rev 2018; 6 (09) e2
    CrossrefPubMedGoogle Scholar
  • 30 Karas V, Calkins TE, Bryan AJ. et al. Total knee arthroplasty in patients less than 50 years of age: results at a mean of 13 years. J Arthroplasty 2019; 34 (10) 2392-2397
    CrossrefPubMedGoogle Scholar
  • 31 Lawrie CM, Schwabe M, Pierce A, Nunley RM, Barrack RL. The cost of implanting a cemented versus cementless total knee arthroplasty. Bone Joint J 2019; 101-B (7_Supple_C): 61-63
    CrossrefPubMedGoogle Scholar
  • 32 Maheshwari AV, Argawal M, Naziri Q, Pivec R, Mont MA, Rasquinha VJ. Can cementing technique reduce the cost of a primary total knee arthroplasty?. J Knee Surg 2015; 28 (03) 183-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153 (04) e176233 DOI: 10.1001/jamasurg.2017.6233.
    CrossrefPubMedGoogle Scholar
  • 34 Anis HK, Strnad GJ, Klika AK. et al; Cleveland Clinic OME Arthroplasty Group. Developing a personalized outcome prediction tool for knee arthroplasty. Bone Joint J 2020; 102-B (09) 1183-1193
    CrossrefPubMedGoogle Scholar