title: Fixation of stem in revision of total knee arthroplasty: cemented versus cementless-a meta-analysis.
abstract: OBJECTIVE
  Revision of total knee arthroplasty (TKA) is growing rapidly all over the world. The introduction of intramedullary stems for additional stability in revision is well accepted by most of the surgeons, while the philosophy of stem fixation is still under controversy. A meta-analysis was performed to compare the survivorship of revised implants with regard to a cemented or cementless stem fixation.
  
  
  METHODS
  Publications with patients who underwent revision TKA with minimum 24-month follow-up were systematically reviewed. Type of intramedullary stem fixation, failure rate for any reason, incidence of aseptic loosening and infection were extracted with follow-up interval specified. Random-effects meta-analysis was used to aggregate incidence data, which was compared between different fixation groups by fitting of logistic regression model.
  
  
  RESULTS
  Seventeen observational studies were included in this meta-analysis. There was a similar likelihood of failure for any reason (risk ratio, RR 0.97), general reoperation (RR 1.02), aseptic loosening (RR 1.0) and infection (RR 1.0) in cemented stem fixation group compared to cementless stem fixation group with follow-up <60 months. When follow-up period extend to more than 60 months, the same likelihood was observed as 0.98, 0.96, 0.97 and 0.98, respectively. There was no significant difference in any of these comparisons of survival-related indices.
  
  
  CONCLUSIONS
  There was no significant difference in failure for any reason, reoperation, aseptic loosening and infection between revision TKA with cemented or cementless stem fixation. Based on the available literature, no superiority of any type of stem fixation was found. If follow-up period was neglected, aseptic loosening would be the leading reason for pain and dysfunction of patient undertaken revision TKA.
  
  
  METHODS
  Systematic review of Level IV, Therapeutic studies, Level IV.
authors.affiliation: Department of Joint Surgery, Hospital of Qingdao University, Qingdao, China.
authors.forename: Changyao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Pfitzner
authors.affiliation: Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: von Roth
authors.affiliation: Orthopädische Chirurgie München, Steinerstraβe 6, 81369, Munich, Germany.
authors.forename: Hermann O
authors.initials: HO
authors.lastname: Mayr
authors.affiliation: Orthopädische Chirurgie München, Steinerstraβe 6, 81369, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sostheim
authors.affiliation: Orthopädische Chirurgie München, Steinerstraβe 6, 81369, Munich, Germany. robert.hube@ocm-muenchen.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Hube
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001843:Bone Cements; D006801:Humans; D007720:Knee Prosthesis; D011475:Prosthesis Failure; D012086:Reoperation
chemical_list: D001843:Bone Cements
keywords: Cementing; Knee prosthesis; Prosthesis failure; Stem revision; Total knee arthroplasty