No effect of fixation type on early and late mortality after total knee arthroplasty: a Dutch arthroplasty register study

Abstract

Purpose: Postoperative mortality is commonly reported as outcome measurement after total knee arthroplasty (TKA). Mortality might be influenced by multiple factors including cementation of the prosthesis. Until now, the influence of cementation on early and late mortality after TKA is unknown. The aim of the present study was to determine the effect of fixation on early and late mortality after primary TKA.

Methods: All patients in the Dutch Arthroplasty Register (LROI) with a primary TKA for osteoarthritis were eligible for inclusion. Data collected from 2007 to 2014 with follow-up until January 2020 were used. Survival analysis was performed by using Kaplan-Meier and Cox survival analysis to determine the mortality rate according to fixation. Adjustments were made for age at time of surgery, gender, American Society of Anaesthesiologists class, and year of surgery.

Results: In total 108,687 TKA were included for analysis, which comprised 95,857 cemented, 6,140 cementless and 6,690 hybrid TKA. The early and late mortality rate in cemented TKA was statistically not different compared to cementless or hybrid TKA at 30 days, 31-90 days, 91 days-1 year and 1-5 years. The hazard ratio at 30 days was 1.05 (CI 0.49-2.25) for hybrid fixation, and 1.46 (CI 0.74-2.90) for cementless fixation compared to cemented fixation. The 1-5 years hazard ratio was 1.06 (CI 0.96-1.17) and 0.97 (CI 0.87-1.08), respectively.

Conclusion: Based on register data, method of fixation does not influence early mortality after primary TKA. This suggests that there is no preferred fixation technique for primary TKA based on the mortality rates.

Level of evidence: IV.

Keywords: Cementation; Fixation; Mortality rate; Survival; Total knee arthroplasty.