A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

Hasan R Mohammad; Andrew Judge; David Murray

doi:10.2340/17453674.2021.896

A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

Hasan R Mohammad^*, Andrew Judge, David Murray

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

2 Citations (Scopus)

26 Downloads (Pure)

Abstract

Background and purpose — Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods.

Patients and methods — We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55–64 years; (3) 65–74 years; (4) ≥ 75 years.

Results — The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55–64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. There
were no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1).

Interpretation — Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this is
appropriate.

Original language	English
Pages (from-to)	164-170
Number of pages	7
Journal	Acta Orthopaedica
Volume	93
DOIs	https://doi.org/10.2340/17453674.2021.896
Publication status	Published - 3 Jan 2022

Bibliographical note

Funding Information:
This study was approved by the NJR Research subcommit tee and had ethical approval from the South Central Oxford B Research Ethics Committee (19/SC/0292). The linkage of the datasets was approved by the Confidentiality Advisory Group (19/CAG/0054). Finan cial support has been received from Zimmer Biomet. HRM was supported by the Henni Mester Scholarship at Univer sity College, Oxford Univer sity and the Royal College of Surgeons’ Research Fellow ship. AJ was supported by the NIHR Biomedical Research Centre at the University Hos pitals Bristol NHS Foundation Trust and the University of Bristol.

Publisher Copyright:
© 2021 The Author(s). Published by Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation.

Keywords

Cemented
Cementless
Fixation
Patient reported outcome measures
Total Knee Replacement

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Mohammad, H. R., Judge, A., & Murray, D. (2022). A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme. Acta Orthopaedica, 93, 164-170. https://doi.org/10.2340/17453674.2021.896

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abstract = "Background and purpose — Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods.Patients and methods — We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55–64 years; (3) 65–74 years; (4) ≥ 75 years.Results — The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55–64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. Therewere no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1).Interpretation — Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this isappropriate.",

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author = "Mohammad, {Hasan R} and Andrew Judge and David Murray",

note = "Funding Information: This study was approved by the NJR Research subcommit tee and had ethical approval from the South Central Oxford B Research Ethics Committee (19/SC/0292). The linkage of the datasets was approved by the Confidentiality Advisory Group (19/CAG/0054). Finan cial support has been received from Zimmer Biomet. HRM was supported by the Henni Mester Scholarship at Univer sity College, Oxford Univer sity and the Royal College of Surgeons{\textquoteright} Research Fellow ship. AJ was supported by the NIHR Biomedical Research Centre at the University Hos pitals Bristol NHS Foundation Trust and the University of Bristol. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation.",

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Mohammad, HR, Judge, A & Murray, D 2022, 'A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme', Acta Orthopaedica, vol. 93, pp. 164-170. https://doi.org/10.2340/17453674.2021.896

A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme. / Mohammad, Hasan R; Judge, Andrew; Murray, David.
In: Acta Orthopaedica, Vol. 93, 03.01.2022, p. 164-170.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

AU - Mohammad, Hasan R

AU - Judge, Andrew

AU - Murray, David

N1 - Funding Information: This study was approved by the NJR Research subcommit tee and had ethical approval from the South Central Oxford B Research Ethics Committee (19/SC/0292). The linkage of the datasets was approved by the Confidentiality Advisory Group (19/CAG/0054). Finan cial support has been received from Zimmer Biomet. HRM was supported by the Henni Mester Scholarship at Univer sity College, Oxford Univer sity and the Royal College of Surgeons’ Research Fellow ship. AJ was supported by the NIHR Biomedical Research Centre at the University Hos pitals Bristol NHS Foundation Trust and the University of Bristol. Publisher Copyright: © 2021 The Author(s). Published by Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation.

PY - 2022/1/3

Y1 - 2022/1/3

N2 - Background and purpose — Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods.Patients and methods — We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55–64 years; (3) 65–74 years; (4) ≥ 75 years.Results — The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55–64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. Therewere no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1).Interpretation — Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this isappropriate.

AB - Background and purpose — Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods.Patients and methods — We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55–64 years; (3) 65–74 years; (4) ≥ 75 years.Results — The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55–64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. Therewere no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1).Interpretation — Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this isappropriate.

KW - Cemented

KW - Cementless

KW - Fixation

KW - Patient reported outcome measures

KW - Total Knee Replacement

U2 - 10.2340/17453674.2021.896

DO - 10.2340/17453674.2021.896

M3 - Article (Academic Journal)

C2 - 34981127

SN - 1745-3674

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JO - Acta Orthopaedica

JF - Acta Orthopaedica

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