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Tag: Geoffrey Westrich

  • Newer Cementless Knee Replacements Could Last Longer

    Newer Cementless Knee Replacements Could Last Longer

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    Newswise — Newer “Cementless” Knee Replacement Could Last Longer

    Knee replacement surgery is considered one of the most effective and predictable procedures in orthopedic surgery today. Hundreds of thousands of patients opt for the procedure each year to relieve arthritis pain and restore function and mobility.

    The standard knee implant used in joint replacement generally lasts a long time—15 years—but it doesn’t last indefinitely. When the implant wears out or loosens, patients generally need a second knee replacement, known as a revision surgery. Now a newer kind of “cementless” knee replacement could change that, according to Dr. Geoffrey Westrich, research director emeritus in the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery.

    CEMENTLESS KNEE REPLACEMENT FOR YOUNGER PATIENTS

    Implant longevity is an important consideration, especially for younger patients with arthritis who opt for joint replacement to maintain their active lifestyle. “Increasing numbers of people in their 50s and even 40s are coming in for joint replacement because they don’t want arthritic knee pain to slow them down. Once they have a knee replacement, these active patients generally put more demands on their joint, causing more wear and tear,” Dr. Westrich explains. “With a conventional cemented prosthesis, chances are they’ll need another surgery down the road. This often has to do with loosening of the implant.”

    In a standard knee replacement, the components of the implant are secured in the joint using bone cement. It’s a tried-and-true technique that has worked well for decades. But eventually, over time, the cement starts to loosen from the bone and/or the implant. “With the new cementless prosthesis, the components are press fit into place for “biologic fixation,” which basically means that the bone will grow into the implant. Perfect positioning of the implant is critical, and we use robotic guidance for pinpoint accuracy,” Dr. Westrich explains.

    ADVANCES IN CEMENTLESS IMPLANT DESIGN AND TECHNOLOGY

    Dr. Westrich believes that with biologic fixation, implant loosening over time will be less likely and a total knee replacement could potentially last much longer, even indefinitely. “Cementless implants have been used in total hip replacement surgery for many years,” he says. “Because of the knee’s particular anatomy, it has been much more challenging to develop a cementless prosthesis that would work well in the knee.”

    Dr. Westrich now believes the time has come. Major advances in design, technology and biomaterials have paved the way for a viable cementless knee implant. The cementless knee system Dr. Westrich utilizes is FDA‐approved for use with the MAKO Robot, combining two of the most recent knee replacement advancements into one high tech procedure that aims to benefit patients.

    Candidates for the cementless procedure are generally patients under 70 with good bone quality to promote biological fixation. In addition to younger patients, Dr. Westrich notes that the cementless implant may also prove to be a good option for very overweight patients who tend to put more stress on their joint replacement.

    To date, Dr. Westrich has seen good results with the cementless prosthesis. However, he says more studies are needed to see how patients with cementless knee replacements do over the long term.

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    Geoffrey Westrich, MD

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  • Study: Novel Imaging Technique Reveals Excellent Biologic Fixation in Cementless Knee Replacement

    Study: Novel Imaging Technique Reveals Excellent Biologic Fixation in Cementless Knee Replacement

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    Newswise — Cementless knee replacement, an alternative approach to the traditional surgery in which bone cement is used, is gaining interest among orthopedic surgeons. Using a novel MRI technique, researchers at Hospital for Special Surgery (HSS) found that a cementless implant demonstrated excellent biologic fixation, and even improved fixation of implant components in some areas in the joint, compared to the standard cemented implant.

    HSS hip and knee surgeon Geoffrey Westrich, MD, and colleagues in the HSS Radiology Department used an advanced imaging technique known as “multi-acquisition variable-resonance image combination selective MRI” to assess fixation in patients who had a cementless knee replacement compared to those whose implant was affixed with bone cement.

    “The purpose of our study was to quantify and compare the fixation of uncemented versus cemented knee replacement components,” said Dr. Westrich, lead investigator. “At an average patient follow-up of 16 months, our study demonstrated robust fixation of the cementless knee replacement components, with results comparable to the cemented total knee replacements. And while there was no clinically significant difference regarding overall fixation in the knee, there were some component areas in which cementless fixation appeared to be superior.” The study was published in the October edition of the journal Arthroplasty Today.  

    The HSS researchers performed MRIs in 20 patients who had a cementless knee replacement. A matched control group of 20 patients with a cemented knee replacement was also evaluated. The images were reviewed by a fellowship-trained musculoskeletal radiologist specializing in the interpretation of joint replacement MRI, including more than 20 years of experience in assessing bony fixation of knee replacement components.

    In a traditional knee replacement, implant components are secured in the joint using bone cement. It’s a tried-and-true technique that has worked well for decades. But eventually, over time, the cement may start to loosen from the bone and/or the implant. This loosening is the leading cause of revision surgery, in which a patient needs a second knee replacement.

    “With the cementless prosthesis, the components are press fit into place for biologic fixation, which basically means that the bone will grow into the implant,” explains Dr. Westrich, who believes a well-designed cementless implant will make loosening over time less likely. This could enable a total knee replacement to last much longer, a particular concern for younger patients.

    “Overall, traditional knee replacement offers excellent outcomes and longevity,” he says. “However, younger patients generally put more demands on their joint, causing more wear and tear and potential loosening. The cemented knee implant used in a traditional joint replacement usually lasts 15 to 20 years.”

    Cementless implants have been used successfully in total hip replacement surgery for many years. It has been much more challenging to develop a cementless prosthesis that would work well in the knee because of its particular anatomy, Dr. Westrich explains.

    “Early generation cementless implants had numerous design flaws resulting in loosening and poor survivorship compared to cemented knee replacements,” he says. “More contemporary cementless knee components such as those used in our study utilize highly porous surfaces to promote biologic fixation of the prosthesis. This should improve outcomes.”

    Candidates for the cementless procedure are generally patients under age 70 with good bone quality to promote biologic fixation. In addition to younger patients, Dr. Westrich notes that the cementless implant may prove to be a good option for very overweight patients who tend to put more stress on their joint replacement.

    “While our study found that early fixation of cementless total knee components are comparable, if not superior, to cemented total knee replacement, further study with a larger number of patients over a lengthier time period is needed to assess long-term durability and fixation.”

    Disclosure: Research support received from Stryker Corporation. 

     

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    Geoffrey Westrich, MD

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