Beverland D. Cemented Or Non Cemented Fixation, An Issue

Cemented or non-cemented fixation: an issue? ,[object Object],[object Object],[object Object],[object Object]

I have used cemented and cementless LCS Rotating Platforms extensively ,[object Object]

First of all Ten year results of cemented LCS rotating platforms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Revisions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Other re-operations or visits to the operating room ,[object Object],[object Object]

Survivorship ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Then in January 1998 I moved to all cementless ,[object Object],[object Object],[object Object]

Date of surgery 1: 06/01/98 2: 10/06/98 3: 12/08/98 4: 08/09/98 5: 10/09/98 6: 10/10/98 7: 19/01/01 Fractures of the proximal tibia First Last Jan 1998

Day 2 Day 5 So what had changed? Was anyone else seeing this? What were the risk factors?

So what had changed? Was anyone else seeing this? ,[object Object],[object Object],[object Object]

Published Journal of Arthroplasty 2001; 16: 984-990

Case Reports ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DEXA Results ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Then in 2001 the LCS complete was launched ,[object Object],[object Object],[object Object],[object Object]

No change in femoral geometry but dimensions changed Condylar width reduced - less over hang Big Improvement Patello-femoral flange 5mm longer

Initially one new tibia and femur now the Duofix option has a full range of half sizes in the Tibia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Femoral Components Tibial Components

LCS complete study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

LCS complete study ,[object Object],[object Object],[object Object],[object Object],[object Object]

LCS complete study ,[object Object],[object Object],[object Object],[object Object]

LCS complete study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

500 1000 0 1500 2000 2500 3000 3500 4000 93 94 95 96 97 98 99 00 01 02 03 04 05 Years Number of procedures First 575 10 Spinouts out of 900 Cases - 1.1% Change in practice 3 Spinouts out of 3025 cases 0.1% My experience with Rotating Platform Spinouts Summary - Rotating Platform spinouts CORR 425: 207-211; Aug 2004 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why is spinout more common in valgus knees LATERAL SIDE Slack in flexion Popliteus LCL Gastrocnemius Flexion gap Normal ligament tension

What about patellar resurfacing? ,[object Object],[object Object],[object Object],[object Object]

Results of 13 resurfaced patients At 3 month review ,[object Object],[object Object],[object Object],[object Object]

In April 2003 we reviewed the thirteen resurfaced patients One patient died at 3 months ,[object Object],[object Object],[object Object],[object Object],Has lost 4 stone in weight Back to original symptoms

Category 1- 4 1 - Very happy 2 - Happy 3 - OK (not perfect) 4 - Never Happy So l have patients with anterior knee pain on whom I don’t re-operate!

Further developments in fixation LCS complete - DUOFIX ,[object Object],[object Object],[object Object]

LCS Complete - DUOFIX ,[object Object],[object Object],[object Object],[object Object],[object Object]

So cemented or cementless – why are the results so good in terms of loosening and wear? ,[object Object],[object Object],[object Object],[object Object]

Mean Wear Rates Transactions of 50 th Annual Meeting of the Orthopaedic Research Society, Vol. 29, San Francisco, California, March 7-10 2004. Linear wear is much less than multi-directional!

Fixed bearing Multidirectional motion of femoral component relative to bearing RP Mobile bearing Bearing rotation decoupled: Linear rotation at tibial counterface with reduced rotation at femoral counterface Wear in Fixed vs Rotating Platform The LCS Rotating Platform reduces wear and cross shear by decoupling multidirectional motions to more linear motions at two interfaces

Cemented or non-cemented fixation: an issue ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Beverland D. Cemented Or Non Cemented Fixation, An Issue

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