J Arthroplasty. 2023 Aug 14:S0883-5403(23)00825-2. doi: 10.1016/j.arth.2023.08.028. Online ahead of print.
ABSTRACT
INTRODUCTION: We aimed to determine if the use of augmented tibial fixation with stems in primary total knee arthroplasty (TKA) in obese patients was associated with a difference in the reason for revision, type of revision, or the overall revision rate.
METHODS: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) compared reason for revision, rate, and type of revision between primary TKA using stemmed tibial prostheses to non-stemmed prostheses, stratified by body mass index (BMI) and obesity. The cumulative percent revision (CPR) was obtained using the Kaplan-Meier method, and Cox proportional hazards models estimated hazard ratios (HRs) adjusted for age and sex, with 95% confidence intervals. All tests were two-tailed at 5% statistical significance (P<0.05). P values are capitalized and italicized throughout the manuscript and tables. There were 66,508 procedures were available for analyses.
RESULTS: Obese Class 2 (BMI 35 to 39.99) had higher rates of revision in the stemmed group compared to the no stem group (Hazards Ratio (HR) 1.44, 95% Confidence Interval (CI) 1.00, 2.05, P=0.047). There was no significant difference in revision rates between stemmed and non-stemmed tibial prostheses in any other BMI group. Primary TKA in obese patients (BMI ≥30), with a stem extension had a significantly higher rate of minor revisions compared to no stem extension (HR 1.31 95% CI 1.03, 1.66, P=0.025). There was no significant difference between stemmed and no stem groups for major revision in obese patients, and for minor or major revision in non-obese patients.
CONCLUSION: Using a tibial stem during primary TKA in obese patients is not associated with a lower rate of revision.
PMID:37586598 | DOI:10.1016/j.arth.2023.08.028
