Primary Knee Symposium: Biomechanical Considerations in the Knee
PressFit vs. Cement
Cementless TKA 2009: A Personal View – Steven F. Harwin, MD
Dr. Harwin cited literature with strong survival rates with cemented knees at fifteen years. However, he reviewed some potential advantages with cementless (as well as potential disadvantages). PSlide A
Dr. Harwin's goal is to be able to perform all TKAs in a cementless fashion (similar to his current THA practice). His reasons include:
- Less invasive
- Less time in the OR
- Can do more cases in one day
- Easier revision surgery in the future
Some of the factors that impact his decision to not do cementless knees on all patients at this time include: initial fixation and potential long-term stability issues, implant design features, bone and soft tissue quality, and cost.
He then reviewed the literature on cementless knees and his own personal history. He identified several risk factors. PSlide B
He concluded with his thoughts on how to improve cementless TKA outcomes PSlide C and what he projects for the future. PSlide D
Preference for CEMENT in TKA – Kenneth Krackow, MD
Dr. Krackow argued against the case for cementless knees. He mentioned that there is only an approximate 15 month follow-up (maximum) with cementless knees. In his opinion, there are too many precise requirements. Dr. Krackow does not promote speed and commented that cementless knees are difficult with navigation, in his hands.
He continued by going through his experience with cement, saying that he improved over time and cements using with constant sustained pressurization. In his experience, his best results are with cemented knees.
He understands that biologic fixation should be stronger and more permanent, and that cemented knees can mean more bone loss if removal for infection is necessary. However, he has not seen cement deteriorating with time and has never seen any concerning stress shielding with it—although he has with some uncemented femoral components.
He concluded by stating that he cannot remember a case where he was sorry he used cement.
References
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