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  • The effect of surgeon's preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

    Author(s)
    Vertullo, Christopher J
    Graves, Stephen E
    Peng, Yi
    Lewis, Peter L
    Griffith University Author(s)
    Vertullo, Christopher J.
    Year published
    2018
    Metadata
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    Abstract
    Background and purpose: Recent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation. Methods: Registry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation ...
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    Background and purpose: Recent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation. Methods: Registry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation preferring surgeons, designated routinely hybrid (RH), and those treated by high-volume cemented fixation preferring surgeons, designated routinely cemented (RC). Results: At 13 years, the cumulative percentage revision of the RC cohort was 4.8% (CI 4.1–5.7) compared with 5.5% (CI 3.5–8.7) for the RH cohort. The revision risk for each cohort was the same for all causes (HR =1.0 (CI (0.84–1.20)), non-infective causes, and for infection. This finding was irrespective of patient age or sex, patella resurfacing, and with non-cross-linked polyethylene (NXLPE). The RH cohort who received cross-linked polyethylene (XLPE) had a lower revision risk than the RC cohort with XLPE (HR =0.57 (0.37–0.88), p = 0.01). Interpretation: The risk of revision for the patients of surgeons who prefer cemented fixation in minimally stabilized TKR is the same as for the patients of surgeons who prefer hybrid fixation, except when used with XLPE, where hybrid fixation has a lower revision risk.
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    Journal Title
    Acta Orthopaedica
    Volume
    89
    Issue
    3
    DOI
    https://doi.org/10.1080/17453674.2018.1449466
    Subject
    Biomedical engineering
    Clinical sciences
    Clinical sciences not elsewhere classified
    Publication URI
    http://hdl.handle.net/10072/378704
    Collection
    • Journal articles

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