{"product_id":"hybrid-vs-cemented-stems-in-revision-knee-replacement-which-method-works-better","title":"Hybrid vs. Cemented Stems in Revision Knee Replacement: Which Method Works Better?","description":"\u003cp\u003eThis systematic review and meta-analysis compared two ways of fixing the stem of a knee replacement during revision surgery: fully cemented stems and hybrid stems. The researchers pooled eight studies with a total of 1,555 revision total knee arthroplasty (TKA) cases, of which 577 used cemented stems and 978 used hybrid stems. They found no statistically significant difference between the two methods in radiological failure and loosening, all-cause re-revision, or aseptic re-revision, although results trended slightly in favor of hybrid stems. Functional and pain outcomes were largely similar between the two groups.\u003c\/p\u003e\n\n\u003ch1\u003eHybrid vs. Cemented Stems in Revision Knee Replacement: Which Method Works Better?\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#study-summary\"\u003eSummary of the Studies Included\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#radiological\"\u003eKey Finding 1: Radiological Failure and Loosening\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#revision\"\u003eKey Finding 2: All-Cause Re-Revision Rates\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#aseptic\"\u003eKey Finding 3: Aseptic Re-Revision Rates\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#functional\"\u003eKey Finding 4: Functional and Pain Outcomes\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#discussion\"\u003eWhat These Findings Mean\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of the Study\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eA meta-analysis of 8 studies with 1,555 revision knee replacement cases found no significant difference between cemented and hybrid stems in radiological loosening, all-cause re-revision, or aseptic re-revision.\u003c\/li\u003e\n\u003cli\u003eFunctional and pain outcomes were largely similar between cemented and hybrid stems in most studies, though individual results varied.\u003c\/li\u003e\n\u003cli\u003eHybrid stems may cause end-of-stem pain, while cemented stems may be harder to remove in a later revision and can cause additional bone loss.\u003c\/li\u003e\n\u003cli\u003eThe choice between cemented and hybrid stems should be made by the surgeon based on the patient's bone quality, reason for revision, and surgeon's experience.\u003c\/li\u003e\n\u003cli\u003eLimitations include a small number of studies, varied definitions of loosening, different revision indications, and no studies from Asian countries.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eThe number of primary total knee arthroplasty (TKA, or knee replacement) and revision TKA cases is expected to increase around the world by 2050. In America alone, the number of patients younger than 65 years old requiring a primary TKA is expected to exceed 50% of the total American population in the future. The number of primary TKAs is projected to increase by more than six times from 2005 to 2030. As a result, the number of revision TKAs is expected to increase correspondingly as well.\u003c\/p\u003e\n\n\u003cp\u003eThe economic cost of a revision TKA is exceedingly substantial. Revision surgery commonly results in decreased function and satisfaction for patients after the operation. Bone deficiency, osteopenia (reduced bone density), and deformity after removing primary implants make revision cases challenging for surgeons. These factors can affect the stability of revision implants.\u003c\/p\u003e\n\n\u003cp\u003eTo achieve a higher level of implant stability, intramedullary stems (metal rods placed inside the hollow center of the bone) are routinely used in revision surgery. These stems achieve diaphyseal fixation (fixation in the shaft of the bone) for adequate stability. This improves the survival and clinical outcomes of revision TKA.\u003c\/p\u003e\n\n\u003cp\u003eStems can be placed using either a fully cemented construct or a press-fit, hybrid technique. In the hybrid technique, the femoral and tibial components are usually cemented, but the stem portion is press-fit into the bone without cement. There are existing studies that have described excellent results for both hybrid and cemented stems for revision TKA. However, there is a lack of information and controversy in the existing literature about the optimal method of fixation for these stems. There are very few studies that make direct comparisons between the two techniques.\u003c\/p\u003e\n\n\u003cp\u003eA meta-analysis done by Wang et al. in 2015 pooled non-comparative studies describing outcomes from each individual technique. That analysis concluded that both techniques were similar in total failures, incidence of aseptic loosening (loosening not caused by infection), and infection rate in both the mid to long term.\u003c\/p\u003e\n\n\u003cp\u003eOn the contrary, a recent systematic review and meta-analysis done by Sheridan et al. in 2020 pooled studies that only made a direct comparison between cemented and hybrid stems. That study found that hybrid stems had a significantly lower all-cause failure rate than cemented stems. However, rates of aseptic loosening and radiographic failure were found to be statistically similar, although results generally trended more favorably toward hybrid stems. Thus, it is evident that even attempts at higher levels of evidence are controversial in this regard.\u003c\/p\u003e\n\n\u003cp\u003eThe aim of this study was to provide an updated insight and combine existing studies in the literature. The researchers explored and evaluated the optimal fixation method for stems in revision TKA. They aimed to provide clinical guidance based on the existing literature. The authors compared outcomes between hybrid and cemented stems in terms of three main areas:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eRadiological failure and loosening (problems seen on X-rays)\u003c\/li\u003e\n\u003cli\u003eTotal re-revision rates for any cause\u003c\/li\u003e\n\u003cli\u003eIncidence of aseptic re-revision\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines strictly throughout the study. They searched the PubMed, Cochrane Library, Embase, and Web of Science databases. The search used Medical Subject Headings (MeSH) terms in different combinations, including \"cemented,\" \"uncemented,\" \"revision total knee,\" \"total knee arthroplasty,\" \"total knee replacement,\" and \"outcomes.\"\u003c\/p\u003e\n\n\u003cp\u003eThe authors assessed studies for inclusion on two separate occasions to ensure accuracy. Any ambiguity about whether to include studies was resolved by further discussion among the authors. Final papers were also reviewed in entirety by the authors.\u003c\/p\u003e\n\n\u003cp\u003eThe authors included studies in the English language published from the year 2010. These studies explicitly compared outcomes between cemented and cementless stems directly in revision TKA. Studies describing surgical techniques, review articles, case reports, and studies describing outcomes of a single technique (either cemented or cementless stems only) without comparison were excluded. Other inclusion criteria included a minimum follow-up period of 2 years. Studies also had to describe criteria surrounding the aims they were looking into, as well as indications for subsequent re-revision.\u003c\/p\u003e\n\n\u003cp\u003eA total of 758 papers were identified for the initial screening and title screening process. Of these, 690 papers were excluded because they were not relevant to the study aims. The remaining 68 were screened again based on abstract. Thirty-four were excluded subsequently. The remaining 34 were reviewed based on full text. Eight papers were eventually selected to be included in the review. These papers were compared against the inclusion and exclusion criteria again.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers extracted important information and variables relevant to the study aims. These variables included:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eStudy title, authors, journal, year, and country\u003c\/li\u003e\n\u003cli\u003eType of study and inclusion criteria of each respective study\u003c\/li\u003e\n\u003cli\u003eTotal number of stems, and total number of cemented and hybrid stems respectively\u003c\/li\u003e\n\u003cli\u003eImplants used (if reported)\u003c\/li\u003e\n\u003cli\u003eGender and mean age\u003c\/li\u003e\n\u003cli\u003eTotal number of re-revisions\u003c\/li\u003e\n\u003cli\u003eTotal number of radiological failure or loosening\u003c\/li\u003e\n\u003cli\u003eTotal number of aseptic re-revision cases\u003c\/li\u003e\n\u003cli\u003ePost-operative care regime\u003c\/li\u003e\n\u003cli\u003eFunctional outcome\u003c\/li\u003e\n\u003cli\u003eFollow-up period\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eTo address heterogeneity (differences) between studies, the authors paid particular attention to the definition of each outcome measure. This ensured that results could be pooled and compared.\u003c\/p\u003e\n\n\u003cp\u003eThe meta-analysis was performed using R meta package (R version 4.2.2), which is an open-source statistical software. Demographic data was pooled and analyzed using descriptive statistics. The authors used a random-effects model for the meta-analysis. In this model, the odds ratio (OR) for each outcome was calculated based on a percentage weight assigned to each study. The odds ratio was calculated with a 95% confidence interval. A p-value of less than 0.05 was taken to be statistically significant. Inter-study heterogeneity was assessed with the I2 statistic. A p-value of less than 0.05 was taken to be statistically significant for heterogeneity impacting the results.\u003c\/p\u003e\n\n\u003cp\u003ePublication bias was ruled out through visual inspection of a funnel plot and by carrying out Egger's test. The visual inspection of the funnel plot did not reveal any significant asymmetry. The Egger's regression test confirmed that the studies were indeed unbiased in nature. Hence, publication bias minimally impacted the validity of the results in this study.\u003c\/p\u003e\n\n\u003ch2 id=\"study-summary\"\u003eSummary of the Studies Included\u003c\/h2\u003e\n\n\u003cp\u003eEight studies met the inclusion criteria and were included in this study. There were a total of 1,555 revision TKA cases collectively used for the comparison. Of these, 577 were cemented stems and 978 consisted of hybrid stems.\u003c\/p\u003e\n\n\u003cp\u003eThe mean age of patients who received a cemented stem was 67.9 years. The mean age of patients who received a hybrid stem was 66.9 years. Females were the majority in both groups. Females made up 65.7% of patients in the cemented group and 64.7% in the hybrid group.\u003c\/p\u003e\n\n\u003cp\u003eAll studies followed up on their patients for at least 24 months. All studies reported indications for revising their primary TKAs.\u003c\/p\u003e\n\n\u003cp\u003eIn terms of indications for revision TKAs, Edwards et al. solely included only infected TKAs. On the contrary, studies by Gomez et al., Gililland et al., and Jacquet et al. studied all aseptic causes of primary TKA failure. The rest of the studies included all indications of revision TKAs. These indications included loosening, infection, instability, osteolysis (bone loss around the implant), polywear (plastic liner wear), stiffness, malposition, arthrofibrosis (scar tissue formation in the joint), and patellar subluxation (kneecap displacement).\u003c\/p\u003e\n\n\u003cp\u003eMajority of the studies included in this systematic review were from the United States of America (USA). There were also studies from Spain, the Netherlands, and France. Of note, there were no studies from Asian countries.\u003c\/p\u003e\n\n\u003cp\u003eMajority of the studies reported the implants that they opted for, apart from four studies that did not specify. Most studies explicitly detailed their post-operative care for their patients.\u003c\/p\u003e\n\n\u003cp\u003eLachiewicz et al. inserted drains for all the revision TKA cases done in that study. The drains were subsequently removed from the first post-operative day. Patients were allowed to ambulate under the supervision of a physiotherapist twice a day.\u003c\/p\u003e\n\n\u003cp\u003eGomez et al. and Jacquet et al. administered low molecular weight heparin (a blood thinner) for all cases. This started from the evening before surgery, up to one month post-operatively. Patients in those two studies, as well as the study carried out by Mills et al., started ambulating immediately post-operatively.\u003c\/p\u003e\n\n\u003ch2 id=\"radiological\"\u003eKey Finding 1: Radiological Failure and Loosening\u003c\/h2\u003e\n\n\u003cp\u003eRadiological failure and loosening were defined differently among the studies. Out of the ten studies, four defined radiological loosening using the modified Knee Society Radiographic Scoring System described by Fehring et al. This involved dividing the tibia into 6–7 zones on the anterior-posterior and lateral radiographs respectively. The femur was evaluated in three zones on the anterior-posterior and 6–8 zones on the lateral films. Radiolucent lines (areas that appear dark on X-ray) were graded either partial or complete depending on the extent relative to the area in each zone.\u003c\/p\u003e\n\n\u003cp\u003eApart from the four studies, Lachiewicz et al. defined radiological loosening using the conventional Knee Society Scoring System. Mills et al. defined loosening based on radiostereometric analysis scans. These scans looked for implant micromotion of more than 1 mm translation or 1 degree rotation. The remaining studies did not define radiological loosening explicitly.\u003c\/p\u003e\n\n\u003cp\u003eOut of the 6 studies that investigated radiological failure and loosening, none found a statistically significant difference between cemented and hybrid stems. Cumulatively, there were 49 cemented stems and 46 hybrid stems that were deemed radiologically loose from the total study sample.\u003c\/p\u003e\n\n\u003cp\u003eThe random effects meta-analysis revealed that there was no difference between the respective fixation methods. However, the results trended favorably toward the hybrid method. The odds ratio was 0.79 with a confidence interval of 0.37–1.66. There was no significant heterogeneity between the studies cumulatively either (I2 = 29%, p = 0.22).\u003c\/p\u003e\n\n\u003cp\u003eIn plain language, an odds ratio of 0.79 means that the hybrid group had a slightly lower odds of radiological loosening compared to the cemented group. However, because the confidence interval crosses 1.0 and the p-value is greater than 0.05, this difference is not statistically significant. This means the difference could be due to chance rather than a true effect of the fixation method.\u003c\/p\u003e\n\n\u003ch2 id=\"revision\"\u003eKey Finding 2: All-Cause Re-Revision Rates\u003c\/h2\u003e\n\n\u003cp\u003eAll studies reported cases of re-revisions and indications for re-revision. These indications included infection, periprosthetic fractures (fractures around the implant), implant breakage or loosening, instability, loosening, insert exchange, secondary placement of patella prosthesis, and medial patellofemoral ligament reconstruction.\u003c\/p\u003e\n\n\u003cp\u003eThe random effects meta-analysis revealed that there was no difference between cemented and hybrid fixation methods in subsequent re-revision. The odds ratio was 1.03 with a confidence interval of 0.73–1.44. There was also no significant heterogeneity (I2 = 0%, p = 0.56).\u003c\/p\u003e\n\n\u003cp\u003eAn odds ratio of 1.03 is very close to 1.0, which indicates that the odds of re-revision were nearly identical between the two groups. The confidence interval includes 1.0, and the p-value is greater than 0.05, confirming that this difference is not statistically significant.\u003c\/p\u003e\n\n\u003ch2 id=\"aseptic\"\u003eKey Finding 3: Aseptic Re-Revision Rates\u003c\/h2\u003e\n\n\u003cp\u003eFive out of the eight papers reported cases of aseptic re-revision. Aseptic re-revision means a repeat surgery that is not caused by infection. The random effects meta-analysis once again revealed that there was largely no difference between cemented and hybrid fixation. The results very slightly favored hybrid fixation. The odds ratio was 0.74 with a confidence interval of 0.27–2.02. There was no significant heterogeneity (I2 = 0%, p = 0.41).\u003c\/p\u003e\n\n\u003cp\u003eSimilar to the other findings, the confidence interval crosses 1.0 and the p-value is greater than 0.05. This means the difference in aseptic re-revision rates between the two methods is not statistically significant.\u003c\/p\u003e\n\n\u003ch2 id=\"functional\"\u003eKey Finding 4: Functional and Pain Outcomes\u003c\/h2\u003e\n\n\u003cp\u003eThe authors were keen to explore how the type of stem fixation affected radiological outcomes and the incidence of re-revision. However, there were a few studies that went beyond just looking at these outcomes and looked at functional outcomes post-operatively.\u003c\/p\u003e\n\n\u003cp\u003eThe Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used by Gomez et al. This study revealed that cemented stems had a poorer score compared to hybrid stems (64.9 ± 16.8 vs. 78.9 ± 9, p = 0.001). This means patients with cemented stems reported worse function and pain scores than those with hybrid stems, and this difference was statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eThe Knee Society Score (KSS) was used in all studies except for the study carried out by Fleischman et al. and Edwards et al., which did not assess functional scores. Kemker et al. also did not look into functional scores but looked more into comparing survivorship and predictors.\u003c\/p\u003e\n\n\u003cp\u003eAmong the seven studies that used the KSS, the score was found to be similar between the two types of revision TKA techniques, except for two studies. Gililland et al. found that the overall KSS was similar between the two groups. However, looking at specific KSS components, patients who received cemented revision TKAs had more improvement in clinical scores (46 ± 26 vs. 23 ± 19, p = 0.02) but less improvement in functional scores (10 ± 15 vs. 22 ± 18, p = 0.04) compared to those who received hybrid fixation.\u003c\/p\u003e\n\n\u003cp\u003eJacquet et al. also found that cemented stems had a more significant change in KSS scores compared to cementless stems. In terms of measuring pain, three of the eight studies investigated and reported no difference between the two groups.\u003c\/p\u003e\n\n\u003ch2 id=\"discussion\"\u003eWhat These Findings Mean\u003c\/h2\u003e\n\n\u003cp\u003eIn this systematic review and meta-analysis, the authors pooled together existing literature that made a direct comparison between different stem fixation methods for revision TKAs. In the revision setting with compromised periarticular bone (bone around the joint), it is important to achieve stable implant fixation. This stability contributes to the durability of revised components.\u003c\/p\u003e\n\n\u003cp\u003eTo enhance stability, implants with extended stems have been used to transfer stress from the deficient plateau to the shaft of the bone. Other studies have proven the success of using intramedullary stems for revision TKAs. However, there is a lack of information in the literature and controversy about the type of fixation for these stems.\u003c\/p\u003e\n\n\u003cp\u003eThe most important finding of this study is that the type of stem fixation used did not affect final clinical and radiological outcomes. Both the cementless and cemented intramedullary stem fixation achieved similar stability and durability.\u003c\/p\u003e\n\n\u003cp\u003eDiaphyseal engaging cementless stems have proven to have better alignment within the intramedullary axis and better chances of bone preservation. However, studies have also shown that using hybrid stem fixation may potentially cause end-of-stem pain. The authors recognize that other studies have shown that end-of-stem pain can be reduced with slotted stems.\u003c\/p\u003e\n\n\u003cp\u003eOn the other hand, cemented stems may be easier to implant. They achieve excellent initial stability, less micromotion, and have additional benefits of mixing antibiotics into the cement for prolonged release. However, during subsequent re-revisions, it may potentially be more difficult to remove cemented stems without causing additional bone loss.\u003c\/p\u003e\n\n\u003cp\u003eComparing between the two methods, the current literature has yet to come to a consensus about which method is more ideal. Both methods have been proven to be effective. As most studies have reported and described outcomes from each individual method, there is a lack of studies directly comparing between the two.\u003c\/p\u003e\n\n\u003cp\u003eA recent systematic review and meta-analysis carried out by Sheridan et al. also explored this controversial topic. That study carried out a random-effects meta-analysis on comparative studies on outcomes between hybrid and cemented stem fixation. In that study, the primary aim was to look at a combined outcome measure of \"all-cause failure.\" This was defined as the summation of incidence of re-revision. This was also defined as radiological loosening.\u003c\/p\u003e\n\n\u003cp\u003eThe Sheridan et al. team postulated that by doing that, there could have been a more sensitive and accurate representation of outcomes between the fixation techniques. Even though the authors recognize that definition may encompass all factors affecting outcomes from the respective techniques, in this study, the authors opted to use a different approach. It is unclear whether there may be potential confounders or cases being counted twice where radiologically loose cases eventually required re-revision. It is also unclear how these cases may be accounted for.\u003c\/p\u003e\n\n\u003cp\u003eIn that previous study, there was a statistically significant reflection that hybrid stems have lower all-cause failure than cement fixation. That was not found in this study. The respective random-effects meta-analysis for both outcome measures (radiological loosening and total re-revisions) were not significant in this study, although there was a shift favoring hybrid stems.\u003c\/p\u003e\n\n\u003cp\u003eThe focus of this study was to look at issues caused by each fixation technique. The endpoint was either being deemed radiologically loose or requiring total removal of implants or any form of surgery. The authors recognize that the difference in the definitions of the outcomes may contribute to the differing results as well.\u003c\/p\u003e\n\n\u003cp\u003eIn addition, the study carried out by Mills et al. was included in this study. The study by Mills et al. also served as a follow-on study on outcomes after ten years of follow-up from prior studies. In the study carried out by Sheridan et al., both prior studies carried out by Heesterbeek et al. and Kosse et al. were included in the analysis. However, for this study, the authors intentionally omitted results from the prior two studies. Repeat analysis from the same population would be done, in hopes of producing more accurate results.\u003c\/p\u003e\n\n\u003cp\u003eIn this study, the authors found that there is no significant difference in radiological loosening between hybrid and cemented stems, despite results trending in favor of hybrid stems. These results were echoed in a recent study on diaphyseal impaction grafting.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of the Study\u003c\/h2\u003e\n\n\u003cp\u003eThe authors acknowledge several limitations in this study. First, the number of studies directly comparing cemented and hybrid stems in revision TKA is small. Only eight studies met the inclusion criteria, which limits the statistical power of the analysis.\u003c\/p\u003e\n\n\u003cp\u003eSecond, the definitions of radiological loosening and failure varied among the included studies. Four studies used the modified Knee Society Radiographic Scoring System, one used the conventional Knee Society Scoring System, one used radiostereometric analysis, and two did not define radiological loosening explicitly. This variation in definitions may have affected the pooled results.\u003c\/p\u003e\n\n\u003cp\u003eThird, the studies included different indications for revision TKA. Some studies included only infected cases, some included only aseptic cases, and others included all indications. This clinical heterogeneity may influence the outcomes.\u003c\/p\u003e\n\n\u003cp\u003eFourth, the majority of studies were from Western countries (USA, Spain, Netherlands, France), with no studies from Asian countries. This limits the generalizability of the findings to other populations.\u003c\/p\u003e\n\n\u003cp\u003eFifth, the follow-up periods varied among studies, although all had a minimum of 24 months. Longer-term outcomes beyond the follow-up periods of the included studies are not known.\u003c\/p\u003e\n\n\u003cp\u003eSixth, the authors intentionally omitted results from prior studies by Heesterbeek et al. and Kosse et al. to avoid repeat analysis from the same population. While this was done to produce more accurate results, it also reduced the number of studies available for analysis.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on the findings of this study, patients considering revision total knee arthroplasty can be reassured that both cemented and hybrid stem fixation methods achieve similar outcomes in terms of:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eRadiological failure and loosening (problems seen on X-rays)\u003c\/li\u003e\n\u003cli\u003eAll-cause re-revision rates (need for repeat surgery for any reason)\u003c\/li\u003e\n\u003cli\u003eAseptic re-revision rates (need for repeat surgery not caused by infection)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe choice between cemented and hybrid stems should be made by the surgeon based on the individual patient's bone quality, the reason for revision, and the surgeon's experience and preference. Both methods have advantages and disadvantages.\u003c\/p\u003e\n\n\u003cp\u003eCemented stems may be easier to implant and provide excellent initial stability. They also allow antibiotics to be mixed into the cement for prolonged release, which can help prevent infection. However, removing cemented stems during a subsequent revision may be more difficult and may cause additional bone loss.\u003c\/p\u003e\n\n\u003cp\u003eHybrid stems may provide better alignment within the bone canal and better preservation of bone. However, they may potentially cause end-of-stem pain, although this can be reduced with slotted stems.\u003c\/p\u003e\n\n\u003cp\u003ePatients should discuss with their surgeon which method is most appropriate for their individual situation. Factors to consider include:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eThe reason for the revision surgery (infection, loosening, instability, etc.)\u003c\/li\u003e\n\u003cli\u003eThe quality of the bone around the knee joint\u003c\/li\u003e\n\u003cli\u003eThe surgeon's experience and preference\u003c\/li\u003e\n\u003cli\u003eThe potential need for future revision surgery\u003c\/li\u003e\n\u003cli\u003eThe patient's overall health and activity level\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003ePatients should also be aware that functional outcomes and pain relief were largely similar between the two methods in most studies. One study found that cemented stems had poorer WOMAC scores compared to hybrid stems. But another study found that cemented stems had more improvement in clinical scores but less improvement in functional scores. These mixed results suggest that individual patient factors may play a more important role in functional outcomes than the type of stem fixation alone.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is the difference between cemented and hybrid stems in revision knee replacement?\u003c\/h3\u003e\n\u003cp\u003eIn cemented stems, the entire stem is fixed with bone cement. In hybrid fixation, the femoral and tibial components are usually cemented, but the stem portion is press-fit into the bone without cement. Both methods aim to stabilize the implant in the bone shaft during revision knee replacement surgery.\u003c\/p\u003e\n\u003ch3\u003eDoes one stem fixation method lead to fewer re-revisions?\u003c\/h3\u003e\n\u003cp\u003eA meta-analysis of eight studies with 1,555 revision knee replacement cases found no statistically significant difference between cemented and hybrid stems in all-cause re-revision rates. The odds ratio was 1.03, meaning the odds of needing another surgery were nearly identical between the two groups.\u003c\/p\u003e\n\u003ch3\u003eAre X-ray problems like loosening more common with one type of stem?\u003c\/h3\u003e\n\u003cp\u003eIn the pooled analysis of six studies, there was no statistically significant difference in radiological failure or loosening between cemented and hybrid stems. The results trended slightly in favor of hybrid stems, but this difference could be due to chance rather than a true effect of the fixation method.\u003c\/p\u003e\n\u003ch3\u003eWill my knee function and pain be better with hybrid or cemented stems?\u003c\/h3\u003e\n\u003cp\u003eFunctional and pain outcomes were largely similar between the two groups in most studies. One study found cemented stems had poorer WOMAC scores, while another found cemented stems had more improvement in clinical scores but less in functional scores. Individual patient factors may play a more important role than stem type.\u003c\/p\u003e\n\u003ch3\u003eWhat are the potential risks or disadvantages of each stem type?\u003c\/h3\u003e\n\u003cp\u003eHybrid stems may cause end-of-stem pain, though this can be reduced with slotted stems. Cemented stems may be harder to remove during a later revision and can cause additional bone loss. Cemented stems also allow antibiotics to be mixed into the cement for prolonged release, which can help prevent infection.\u003c\/p\u003e\n\u003ch3\u003eHow does the surgeon decide which stem fixation to use?\u003c\/h3\u003e\n\u003cp\u003eThe choice should be made by the surgeon based on the individual patient's bone quality, the reason for revision, and the surgeon's experience and preference. Patients should discuss factors such as the reason for surgery, bone quality, potential need for future revision, and overall health and activity level with their surgeon.\u003c\/p\u003e\n\u003ch3\u003eWhat does an odds ratio of 0.79 mean for radiological loosening?\u003c\/h3\u003e\n\u003cp\u003eAn odds ratio of 0.79 means the hybrid group had a slightly lower odds of radiological loosening compared to the cemented group. However, because the confidence interval crosses 1.0 and the p-value is greater than 0.05, this difference is not statistically significant and could be due to chance.\u003c\/p\u003e\n\u003ch3\u003eMy surgeon recommends cemented stems for my revision knee replacement, but I've read hybrid stems might be better — should I get a second opinion before surgery?\u003c\/h3\u003e\n\u003cp\u003eA second opinion can help when the choice between cemented and hybrid stems for revision knee replacement is uncertain. Pooled results from eight studies covering 1,555 revision cases show no statistically significant difference between the two methods in radiological loosening, all-cause re-revision, or aseptic re-revision, though results trended slightly toward hybrid stems. Functional and pain outcomes were largely similar. Because the choice depends on bone quality, the reason for revision, and surgeon experience, an independent review of your imaging and records can clarify which fixation approach fits your situation. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e A systematic review and meta-analysis of hybrid vs. cemented stems - which method is more optimal for revision total knee arthroplasty?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eLicense:\u003c\/strong\u003e CC BY (open access)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Thever Y, James Loh SY, Raghavan R, Toh RC, Moo IH.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAffiliation:\u003c\/strong\u003e Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, Simei 529889, Singapore\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e BMC Musculoskeletal Disorders (2024) 25:277\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1186\/s12891-024-07389-y\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication Type:\u003c\/strong\u003e Systematic Review and Meta-Analysis\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. The original article is available as open access under a Creative Commons Attribution 4.0 International License.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47876013326492,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/sv\/products\/hybrid-vs-cemented-stems-in-revision-knee-replacement-which-method-works-better","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}