Superior Survivorship of Cementless vs Cemented Diaphyseal Fixed Modular Rotating-Hinged Knee Megaprosthesis at 7 Years’ Follow-Up

Total knee arthroplasty in the presence of a huge bone and soft-tissue defect is always a challenge. A rotating-hinged (RH) megaprosthesis is indicated for extensive soft-tissue loss with a huge bone defect such as a primary or metastatic neoplasm of the bone, repeat periprosthetic joint infection, or extensive trauma of the knee. However, the reported survivorship of RH megaprostheses is unsatisfactory. The aim of this study was to evaluate the survivorship of megaprostheses and the factors that contribute to implant survival.

A total of 103 RH knee megaprostheses were implanted in 85 patients between January 2001 and June 2013. Each prosthesis was a modular custom-made (CM) cemented or cementless fixed total knee system (United USTAR system). Clinical results and prosthesis survivorship were evaluated between the 2 groups.

The overall survivorship of this CM knee megaprosthesis was 91% at 2 years, 83% at 5 years, and 68% at 10 years. The cumulative component survivorship was 87% in the cemented group and 96% in the cementless group at 2 years compared with 75% in the cemented group and 94% in the cementless group at 5 years. The failure mechanism included loosening in 5 and breakage in 6 patients in the cemented stem group. The survivorship of the cementless fixed component was significantly superior to that of the cemented fixed component.

Our data suggest that modular RHCM knee megaprosthesis provides an acceptable clinical result. A diaphyseal long stem with cementless fixation was more reliable and durable than its cemented counterpart.