{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:15:40Z","timestamp":1791566140149,"version":"4.3.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Evidence supports the use of cementless tibial component fixation in total knee replacement but there is a paucity of literature on posterior stabilized designs. This randomized study of posterior stabilized total knee replacements compared cemented and cementless tibial fixation with regard to component migration, bone remodeling, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective single-center, blinded, randomized clinical trial included 100 patients with a mean age of 68 years (range, 45 to 87 years). Operations were performed by either of 2 experienced arthroplasty surgeons using the Advanced Coated System (ACS) prosthesis (Implantcast). Patients were randomized to cemented or cementless tibial fixation; other variables were standardized. Radiostereometric analysis (RSA) and dual x-ray absorptiometry (DXA) were performed during the inpatient stay and at 3, 12, and 24 months to monitor tibial component migration and periprosthetic bone mineral density (BMD). Clinical scores including the Oxford Knee Score and Short Form-12 were assessed prior to surgery and during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Late and continuing migration was found with cementless fixation. At 24 months, the mean subsidence was significantly greater for the cementless group (1.22 mm) compared with the cemented group (0.06 mm) (p &lt; 0.01). The mean maximum total point motion at 24 months was 2.04 mm for the cementless group and 0.48 mm for the cemented group (p &lt; 0.01). The cemented group had more BMD loss than the cementless group in the medial, lateral, and anterior periprosthetic regions. Two tibial components were revised in the cementless group, including 1 for loosening. Clinical scores improved equally in the 2 groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Late ongoing subsidence and high maximum total point motion in our patients who underwent cementless tibial fixation raise concerns about the fixation stability of ACS cementless posterior stabilized knee replacements. Cemented tibial components were stable. Thus, we advise caution regarding the use of cementless tibial components and recommend tibial fixation with cement for the ACS posterior stabilized total knee replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.01010","type":"journal-article","created":{"date-parts":[[2020,4,14]],"date-time":"2020-04-14T19:27:25Z","timestamp":1586892445000},"page":"1075-1082","source":"Crossref","is-referenced-by-count":40,"title":["Cementless Versus Cemented Tibial Fixation in Posterior Stabilized Total Knee Replacement"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4072-8728","authenticated-orcid":false,"given":"Nils Oscar","family":"Nivbrant","sequence":"first","affiliation":[{"name":"Department of Surgical and Perioperative Sciences, Orthopaedics, Ume\u00e5 University, Ume\u00e5, Sweden"},{"name":"Fiona Stanley Hospital, Murdoch, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0955-7273","authenticated-orcid":false,"given":"Riaz J.K.","family":"Khan","sequence":"additional","affiliation":[{"name":"The Joint Studio, Hollywood Medical Centre, Perth, Western Australia, Australia"},{"name":"Hollywood Private Hospital, Nedlands, Western Australia, Australia"},{"name":"Department of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7744-7976","authenticated-orcid":false,"given":"Daniel P.","family":"Fick","sequence":"additional","affiliation":[{"name":"The Joint Studio, Hollywood Medical Centre, Perth, Western Australia, Australia"},{"name":"Hollywood Private Hospital, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4165-5180","authenticated-orcid":false,"given":"Samantha","family":"Haebich","sequence":"additional","affiliation":[{"name":"The Joint Studio, Hollywood Medical Centre, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5334-4948","authenticated-orcid":false,"given":"Ewan","family":"Smith","sequence":"additional","affiliation":[{"name":"The Joint Studio, Hollywood Medical Centre, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,4,15]]},"reference":[{"issue":"4","key":"bib1-20230812","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib3-20230812","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3109\/17453674.2013.799418","article-title":"Trabecular Metal tibia still stable at 5 years: an RSA study of 36 patients aged less than 60 years","volume":"84","author":"Henricson","year":"2013","journal-title":"Acta Orthop."},{"key":"bib4-20230812","first-page":"CD006193","article-title":"Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases","volume":"10","author":"Nakama","year":"2012","journal-title":"Cochrane Database Syst Rev."},{"issue":"1","key":"bib5-20230812","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s11999-014-3585-y","article-title":"The Mark Coventry Award: Trabecular Metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial","volume":"473","author":"Pulido","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib6-20230812","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00007632-200002010-00004","article-title":"Introducing new technology: a stepwise algorithm","volume":"25","author":"Malchau","year":"2000","journal-title":"Spine (Phila Pa 1976)."},{"issue":"9695","key":"bib7-20230812","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/S0140-6736(09)61116-8","article-title":"No surgical innovation without evaluation: the IDEAL recommendations","volume":"374","author":"McCulloch","year":"2009","journal-title":"Lancet."},{"issue":"4","key":"bib8-20230812","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.2106\/JBJS.H.01532","article-title":"The evidence-based approach in bringing new orthopaedic devices to market","volume":"92","author":"Schemitsch","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"Suppl 232","key":"bib9-20230812","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/17453678909154184","article-title":"Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system","volume":"232","author":"Selvik","year":"1989","journal-title":"Acta Orthop Scand Suppl."},{"issue":"2","key":"bib10-20230812","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1302\/0301-620X.74B2.1544960","article-title":"Early migration of prostheses related to long-term survivorship. Comparison of tibial components in knee replacement","volume":"74","author":"Grewal","year":"1992","journal-title":"J Bone Joint Surg Br."},{"issue":"6","key":"bib11-20230812","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1302\/0301-620X.76B6.7983118","article-title":"Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses","volume":"76","author":"K\u00e4rrholm","year":"1994","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"bib12-20230812","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1302\/0301-620X.77B3.7744919","article-title":"Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses","volume":"77","author":"Ryd","year":"1995","journal-title":"J Bone Joint Surg Br."},{"key":"bib13-20230812","doi-asserted-by":"crossref","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ."},{"issue":"4","key":"bib14-20230812","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1080\/17453670510041574","article-title":"Guidelines for standardization of radiostereometry (RSA) of implants","volume":"76","author":"Valstar","year":"2005","journal-title":"Acta Orthop."},{"issue":"6","key":"bib15-20230812","doi-asserted-by":"crossref","first-page":"614","DOI":"10.3109\/17453674.2012.747052","article-title":"Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties","volume":"83","author":"Pijls","year":"2012","journal-title":"Acta Orthop."},{"issue":"5","key":"bib16-20230812","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1080\/17453674.2016.1205169","article-title":"Trabecular Metal tibial knee component still stable at 10 years","volume":"87","author":"Henricson","year":"2016","journal-title":"Acta Orthop."},{"issue":"Suppl 288","key":"bib17-20230812","first-page":"1","article-title":"Osseointegration in porous coated knee arthroplasty. The influence of component coating type in sheep","volume":"288","author":"Bellemans","year":"1999","journal-title":"Acta Orthop Scand Suppl."},{"issue":"7","key":"bib18-20230812","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1054\/arth.2001.24376","article-title":"No relationship between postoperative changes in bone density at the proximal tibia and the migration of the tibial component 2 years after total knee arthroplasty","volume":"16","author":"Li","year":"2001","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib19-20230812","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1007\/s00402-012-1601-9","article-title":"Osteodensitometry measurements of periprosthetic bone using dual energy x-ray absorptiometry following total knee arthroplasty","volume":"132","author":"Windisch","year":"2012","journal-title":"Arch Orthop Trauma Surg."},{"issue":"3","key":"bib20-20230812","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3109\/17453674.2016.1173982","article-title":"Periprosthetic tibial bone mineral density changes after total knee arthroplasty","volume":"87","author":"Jaroma","year":"2016","journal-title":"Acta Orthop."},{"key":"bib21-20230812","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.anndiagpath.2016.07.006","article-title":"Adverse tissue reactions after total hip arthroplasty","volume":"27","author":"Miller","year":"2017","journal-title":"Ann Diagn Pathol."},{"key":"bib22-20230812","first-page":"485975","article-title":"Titanium-nitride coating of orthopaedic implants: a review of the literature","author":"van Hove","year":"2015","journal-title":"Biomed Res Int."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:41:06Z","timestamp":1787751666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01010"}},"subtitle":["A Randomized Trial"],"short-title":[],"issued":{"date-parts":[[2020,4,15]]},"references-count":21,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.01010","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,15]]}}}