title: Fixation of revision TKA: a review of the literature.
abstract: OBJECTIVE
  Early aseptic loosening is a major complication in revision total knee arthroplasty (TKA). It is well accepted that intramedullary stems improve the anchoring of the prosthetic components; however, controversy still exists about the optimal fixation technique of the stems (cementless, hybrid, cemented).
  
  
  METHODS
  A literature review was carried out in the main medical databases from 1980 to 04/2010 to evaluate the available literature by evidence-based criteria and to analyse the results of the single studies regarding fixation technique in knee revision arthroplasty.
  
  
  RESULTS
  There are four studies regarding the cementless fixation. Eight studies reported the hybrid technique and five studies the cemented technique. Hybrid and cemented techniques are comparable regarding the survival of arthroplasties, the rate of aseptic loosening and the clinical outcome. However, most studies just show a low level of evidence (LoE III and IV), a small to medium number of cases and a short follow-up.
  
  
  CONCLUSIONS
  Based on the current literature, no final statement can be drawn regarding the optimal fixation technique in revision TKA. Future RCTs are needed to enable conclusive statements about the possible advantages and disadvantages of the single fixation techniques, although the clinical implementation often is critical.
authors.affiliation: Orthopaedic Department, University of Regensburg, Kaiser-Karl V-Allee 3, Bad Abbach, 93077, Regensburg, Germany. drjbeckmann@gmx.de
authors.forename: J
authors.initials: J
authors.lastname: Beckmann
authors.forename: C
authors.initials: C
authors.lastname: Lüring
authors.forename: R
authors.initials: R
authors.lastname: Springorum
authors.forename: F X
authors.initials: FX
authors.lastname: Köck
authors.forename: J
authors.initials: J
authors.lastname: Grifka
authors.forename: M
authors.initials: M
authors.lastname: Tingart
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery; D010147:Pain Measurement; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
references.citation: Clin Orthop Relat Res. 2006 May;446:140-8
references.pmid: 16672883
references.citation: J Arthroplasty. 2009 Sep;24(6 Suppl):48-53
references.pmid: 19553076
references.citation: Knee. 2008 Jun;15(3):227-32
references.pmid: 18420415
references.citation: Clin Orthop Relat Res. 1999 Oct;(367):216-25
references.pmid: 10546618
references.citation: J Arthroplasty. 2001 Sep;16(6):759-67
references.pmid: 11547375
references.citation: J Bone Joint Surg Am. 1995 Nov;77(11):1700-7
references.pmid: 7593080
references.citation: J Arthroplasty. 2003 Aug;18(5):592-9
references.pmid: 12934211
references.citation: J Biomech. 2008;41(3):560-6
references.pmid: 18036530
references.citation: Clin Orthop Relat Res. 1994 Dec;(309):116-23
references.pmid: 7994949
references.citation: J Bone Joint Surg Am. 2003 Jan;85(1):1-3
references.pmid: 12533564
references.citation: J Arthroplasty. 2004 Oct;19(7 Suppl 2):119-24
references.pmid: 15457430
references.citation: J Bone Joint Surg Am. 2009 Jun;91(6):1440-7
references.pmid: 19487523
references.citation: Knee. 2009 Aug;16(4):275-9
references.pmid: 19299144
references.citation: Clin Orthop Relat Res. 2002 Nov;(404):158-68
references.pmid: 12439256
references.citation: Clin Orthop Relat Res. 2006 May;446:29-33
references.pmid: 16672868
references.citation: J Arthroplasty. 2003 Oct;18(7 Suppl 1):27-32
references.pmid: 14560407
references.citation: J Arthroplasty. 2007 Sep;22(6 Suppl 2):100-5
references.pmid: 17823026
references.citation: Clin Orthop Relat Res. 2010 Jan;468(1):45-51
references.pmid: 19554385
references.citation: J Arthroplasty. 1997 Dec;12(8):896-903
references.pmid: 9458255
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 Jul;18(7):945-8
references.pmid: 20148322
references.citation: Clin Orthop Relat Res. 2009 Mar;467(3):810-7
references.pmid: 19034597
references.citation: J Bone Joint Surg Br. 1985 Mar;67(2):242-8
references.pmid: 3980534
references.citation: J Bone Joint Surg Am. 2009 Aug;91 Suppl 5:72-4
references.pmid: 19648632
references.citation: Surg Technol Int. 2004;12:214-20
references.pmid: 15455329
references.citation: J Bone Joint Surg Am. 2009 Dec;91(12):2838-45
references.pmid: 19952245
references.citation: Clin Orthop Relat Res. 1994 Dec;(309):110-5
references.pmid: 7994948
references.citation: J Arthroplasty. 2005 Apr;20(3):302-8
references.pmid: 15809946
references.citation: Clin Orthop Relat Res. 2006 May;446:127-31
references.pmid: 16568004
references.citation: Clin Orthop Relat Res. 2003 Apr;(409):158-68
references.pmid: 12671498
references.citation: J Arthroplasty. 2001 Jan;16(1):107-11
references.pmid: 11172279
references.citation: Clin Orthop Relat Res. 1995 Aug;(317):172-7
references.pmid: 7671473
references.citation: J Bone Joint Surg Am. 2007 Apr;89(4):780-5
references.pmid: 17403800
references.citation: Clin Orthop Relat Res. 1993 Jan;(286):160-7
references.pmid: 8425339
references.citation: Clin Biomech (Bristol, Avon). 2010 Feb;25(2):159-65
references.pmid: 19944503
references.citation: Clin Biomech (Bristol, Avon). 2008 Aug;23(7):853-8
references.pmid: 18321621
references.citation: Knee Surg Sports Traumatol Arthrosc. 2009 Oct;17(10):1199-205
references.pmid: 19572121
references.citation: Acta Orthop. 2010 Jun;81(3):337-43
references.pmid: 20450422
references.citation: J Arthroplasty. 2007 Jun;22(4 Suppl 1):56-60
references.pmid: 17570279
references.citation: J Arthroplasty. 1998 Sep;13(6):681-6
references.pmid: 9741446
references.citation: Clin Orthop Relat Res. 2010 Jan;468(1):82-9
references.pmid: 19727993
references.citation: Clin Orthop Relat Res. 1994 Dec;(309):156-62
references.pmid: 7994955
references.citation: J Arthroplasty. 2003 Oct;18(7 Suppl 1):33-6
references.pmid: 14560408
references.citation: Iowa Orthop J. 2009;29:28-37
references.pmid: 19742082
references.citation: Clin Orthop Relat Res. 2003 Nov;(416):217-24
references.pmid: 14646764