Purpose: The indications, incidence, outcomes, and survivorship of stems in primary total knee arthroplasty (TKA) are lacking in the contemporary literature. Our hypothesis is stems in primary TKA would result in worse outcomes and survivorship.
Methods: All primary TKAs between 2007 and 2011 with 2-year follow-up were identified. Revision TKA or UKA conversion was excluded. Demographic information (age, sex, race, BMI, primary diagnosis, and Charlson-Deyo comorbidity index), outcome measures including KOOS and WOMAC, and any revisions were identified from the registry. A 2:1 matched cohort of non-stemmed/stemmed primary TKA patients was created to compare revision rates and outcomes at baseline and 2 years post-TKA. Subgroup analyses of long versus short stems, 1 versus 2 stems, and cemented versus hybrid stem fixation were completed. Two-sample t tests and Chi-square tests were used to compare conventional and stemmed TKA groups.
Results: The registry review included 13,507 conventional TKA and 318 stemmed TKA resulting in an incidence of 2.3 % in primary TKA. The mean follow-up was approximately 49 months in both groups. No difference was found in revision rates between stemmed TKA (2.5 %) and conventional TKA (2.2 %). Patients with post-traumatic arthritis had an odds ratio of 10.5 (95 % CI 1.2-15.3) of receiving stems. Stem length did not affect revision rates. Patients with two stems had worse KOOS and WOMAC scores at baseline which equalized to single-stem patients at 2 years.
Conclusions: The use of stems may provide a survival benefit in complex primary TKA over the short term and no adverse effect on patient outcomes or satisfaction.
Level of evidence: III.
Keywords: KOOS; Outcomes; Primary total knee arthroplasty; Stems incidence; Stems indications; Survivorship; WOMAC.