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Hall TAG, Cegla F, van Arkel RJ. Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants. SENSORS (BASEL, SWITZERLAND) 2024; 24:1696. [PMID: 38475232 DOI: 10.3390/s24051696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Saini MK, Reddy CD, Reddy NR, Reddy PJ, Singh M, Bhati M. Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design. Arch Orthop Trauma Surg 2023; 143:7139-7146. [PMID: 37530846 DOI: 10.1007/s00402-023-05000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND New total knee prostheses are being designed to improve clinical outcome, survivorship and patient satisfaction following total knee arthroplasty (TKA). A new knee system was developed with improvements in patellofemoral joint, trochlear geometry, polyethylene formulation and tibial baseplate. Aim of this study was to compare the newer kinematic knee system with its existing predecessor knee system in terms of clinical outcome, revision rates, radiographic outcomes specifically medial tibial bone resorption. METHODS The prospective matched-pair study included 88 TKA surgeries using newer kinematic design knee prostheses, performed between January 2015 and December 2016, out of which 82 patients were available for final follow-up. The control cohort of 82 traditional TKA prosthesis was matched in terms of age, gender and body mass index. All surgeries were performed by the single surgeon using medial parapatellar arthrotomy and posterior stabilized implants were used. Clinical outcomes were assessed using knee society score, range of motion (ROM), anterior knee pain and crepitation. Radiological examinations included recording of radiolucent lines and medial tibial bone resorption. RESULTS At the 5-year follow-up, no significant differences were noted in terms of mean knee society score (93.3 ± 6.6 vs 94.2 ± 8.1), knee function score (88.5 ± 10.5 vs 89.1 ± 11.2) and ROM. The incidences of anterior knee pain and crepitation were lower in the newer group (8.5% vs 21.9% and 14.6% vs 32.9%, respectively) compared to the traditional prosthesis group. No cases of aseptic loosening were observed in either cohort. No significant difference was seen in terms of radiolucent lines (29.3% vs 26.8%) and medial tibial resorption (2.43% in each group) incidences. CONCLUSIONS At the 5 years follow-up no significant differences were noted between the two groups in terms of clinical and radiological outcomes, except the former proved to be better for anterior knee pain and crepitation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mukesh Kumar Saini
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India.
| | - Challa Dinesh Reddy
- Department of Orthopaedics, Star Hospitals, B Block, Banjara Hills, Hyderabad, India
| | - Neelam Ramana Reddy
- Department of Orthopaedics, Star Hospitals, B Block, Banjara Hills, Hyderabad, India
| | | | - Mahendra Singh
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India
| | - Mahesh Bhati
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India
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Galas A, Banci L, Innocenti B. The Effects of Different Femoral Component Materials on Bone and Implant Response in Total Knee Arthroplasty: A Finite Element Analysis. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5605. [PMID: 37629896 PMCID: PMC10456576 DOI: 10.3390/ma16165605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Due to the high stiffness of the biomaterials used in total knee arthroplasty, stress shielding can lead to decreased periprosthetic bone mineral density and bone resorption. As different materials and 3D-printed highly porous surfaces are available for knee femoral components from the industry nowadays, this study aimed to compare the effects of two same-design cruciate-retaining femoral components, made with CoCr and titanium alloy, respectively, on periprosthetic bone stresses through a finite element model of the implanted knee in order to evaluate the induced stress shielding. Moreover, the effect of the cementless highly porous surface of the titanium implant was analyzed in comparison to the cemented interface of the CoCr implant. The von Mises stresses were analyzed in different periprosthetic regions of interest of the femur with different configurations and knee flexion angles. The titanium component induced higher bone stresses in comparison with the CoCr component, mostly in the medial compartment at higher knee flexion angles; therefore, the CoCr component led to more stress shielding. The model was revealed to be effective in describing the effects of different femoral component materials on bone stress, highlighting how a cementless, highly porous titanium femoral component might lead to less stress shielding in comparison to a cemented CoCr implant with significant clinical relevance and reduced bone resorption after total knee arthroplasty.
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Affiliation(s)
- Allegra Galas
- LaBS, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, Politecnico di Milano, 20133 Milan, Italy
| | - Lorenzo Banci
- Clinical Department, Permedica Orthopaedics, 23807 Merate, Italy;
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
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Prodromidis AD, Chloros GD, Thivaios GC, Sutton PM, Pandit H, Giannoudis PV, Charalambous CP. High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty. Bone Joint J 2023; 105-B:610-621. [PMID: 37259548 DOI: 10.1302/0301-620x.105b6.bjj-2022-0675.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening. Methods A systematic search was undertaken using the Cochrane methodology in three online databases: MEDLINE, Embase, and CINAHL. Studies were screened against predetermined criteria, and data were extracted. Available National Joint Registries in the Network of Orthopaedic Registries of Europe were also screened. A random effects model meta-analysis was undertaken. Results Of 263 studies, 12 were included with a total of 3,861 TKAs. Meta-analysis of ten studies showed high rates of overall tibial or femoral RLLs for the cemented original design of the ATTUNE TKA. The overall rate was 21.4% (95% confidence interval (CI) 12.7% to 33.7%) for all types of design but was higher for certain subgroups: 27.4% (95% CI 13.4% to 47.9%) for the cruciate-retaining type, and 29.9% (95% CI 15.6% to 49.6%) for the fixed-bearing type. Meta-analysis of five studies comparing the ATTUNE TKA with other implants showed a significantly higher risk of overall tibial or femoral RLLs (odds ratio (OR) 2.841 (95% CI 1.219 to 6.623); p = 0.016) for the ATTUNE. The rates of loosening or revision for loosening were lower, at 1.2% and 0.9% respectively, but the rates varied from 0% to 16.3%. The registry data did not report specifically on the original ATTUNE TKA or on revision due to loosening, but 'all-cause' five-year revision rates for the cemented ATTUNE varied from 2.6% to 5.9%. Conclusion The original cemented ATTUNE TKA has high rates of RLLs, but their clinical significance is uncertain given the overall low associated rates of loosening and revision. However, in view of the high rates of RLLs and the variation in the rates of loosening and revision between studies and registries, close surveillance of patients who have undergone TKA with the original ATTUNE system is recommended.
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Affiliation(s)
- Apostolos D Prodromidis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - George D Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | | | - Paul M Sutton
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hemant Pandit
- Department of Orthopaedics, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
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Han HS, Song SJ, Chang CB, Park CH, Won S, Lee MC. Comparison of Clinical Outcomes for Patients Treated With Gradually Reducing Radius Versus Single-Radius Total Knee Arthroplasty Systems. Orthopedics 2022; 45:367-372. [PMID: 35858180 DOI: 10.3928/01477447-20220706-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The choice of implant used for primary total knee arthroplasty (TKA) may have an impact on clinical outcomes. Clinical outcomes after TKA with gradually reducing radius implants (group G) vs single-radius implants (group S) were evaluated among Asian patients. This study included 541 patients (754 knees) in group G and 187 patients (275 knees) in group S. Range of motion (ROM), flexion contracture, American Knee Society Knee and American Knee Society Function scores (KSKS and KSFS, respectively), and mechanical and anatomic tibiofemoral angles (MTFA and ATFA, respectively) were evaluated with electronic medical records. In univariate analysis, improvements in ROM, KSKS, and KSFS were significantly better in group G compared with group S at 1-year follow-up. Multivariable analyses showed greater ROM (4.52°, P=.002), decreased flexion contracture (-2.80°, P=.011), and improved KSKS (15.57, P<.001) at 1 year for group G vs group S. No significant differences in KSFS, MTFA, or ATFA were observed. Implant-related complications and radiologic loosening were not identified in either group at 2-year follow-up. The TKA implants with a gradually reducing radius showed greater 1-year improvements in ROM, flexion contracture, KSKS, and similar implant-related safety outcomes compared with a single-radius system. [Orthopedics. 2022;45(6):367-372.].
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Garabano G, Rodriguez J, Perez Alamino L, Pesciallo CA, del Sel H, Lopreite F. Stress shielding in total knee replacements: Comparative analysis between titanium and all-polyethylene bases at 10 years follow-up. J Orthop 2022; 34:276-281. [PMID: 36158038 PMCID: PMC9493296 DOI: 10.1016/j.jor.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this retrospective study was to assess bone resorption due to stress shielding in total knee replacement (TKR), comparing titanium bases (TiB) versus all polyethylene bases (APB), analyzing its incidence, progression and mechanical consequences after 10 years of follow-up. Methods We evaluated two groups of patients undergoing TKR, one treated with TiB and the other with APB, operated consecutively between 2004 and 2009 with a diagnosis of idiopathic gonarthrosis and a minimum of 10 years of follow-up. Deen's radiographical method was used to assess tibial bone resorption. We assessed its incidence, progression, relationship with the femoro-tibial and prosthetic alignment, clinical outcomes and mechanical loosening. Results Eighty-six patients were treated with TiB and 80 with APB with a median follow-up of 11 (range 10-15) years. The bone resorption rate in TiB was 24.41% and in APB was 1.25% (p < 0.0001). The type 2 of Deen's classification was the most frequently observed. Bone resorption was strongly correlated with preoperative varus femoro-tibial alignment and varus placement of the tibial component, also showing a significant association with postoperative femoro-tibial alignment correction (p 0.009). We observed no significant differences in functional scores or revision rates due to mechanical loosening after 10 years of follow-up between the groups. Conclusion Titanium tibial bases in TKR showed a significantly higher incidence of medial tibia resorption compared to all-polyethylene bases. Our results suggest that bone resorption does not influence long-term mechanical loosening.
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Affiliation(s)
- Germán Garabano
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Joaquín Rodriguez
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Leonel Perez Alamino
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Hernán del Sel
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Lopreite
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
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Medial proximal tibial resorption after total knee arthroplasty according to the design of the cobalt chrome tibial baseplate. Arch Orthop Trauma Surg 2022; 143:3401-3407. [PMID: 36209439 DOI: 10.1007/s00402-022-04642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/29/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE A new tibial baseplate of the cobalt-chrome (CoCr) prosthesis has an enhanced design with additional cement pockets and undersurface with increased roughness compared with the original baseplate. This study aimed to compare the incidence of medial proximal tibial resorption (MPTR) in total knee arthroplasties (TKAs) with the original and new CoCr tibial baseplates. METHODS Each of 200 posterior stabilized TKAs with the original (Group O) and new (Group N) CoCr tibial baseplates with a minimum follow-up period of 2 years were retrospectively reviewed. The matches were made according to age, sex, body mass index, and severity of varus deformity. The occurrence of MPTR was investigated with a radiograph at 2 years postoperatively. MPTR was categorized as type U (resorption under the tibial baseplate; associated with stress shielding), C (resorption around the penetrated cement under the baseplate; associated with thermal necrosis), and M (resorption on the medial tibial cortex without extension to the baseplate; associated with bony devascularization). RESULTS The incidence of MPTR was 35% in group O and 24% in group N (p = 0.021) at postoperative 2 years. The U type of MPTR occurred more frequently in group O (26 vs. 15%, p = 0.009). There were no significant differences in the incidence of types C and M MPTR. CONCLUSION The modified design of the CoCr tibial baseplate affected the incidence of MTPR. The new tibial baseplate was more advantageous in preventing MPTR than the original baseplate in TKAs using the CoCr prosthesis. LEVEL OF EVIDENCE III.
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Bendich I, Lawrie CM, Riegler V, Barrack RL, Nunley RM. The Impact of Component Design and Fixation on Stress Shielding After Modern Total Knee Arthroplasty. J Arthroplasty 2022; 37:S221-S225. [PMID: 35249788 DOI: 10.1016/j.arth.2022.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) tibial baseplate thickness, metallurgy, and implant fixation with cement may influence stress shielding. The purpose of the present study is to compare bone mineral density of 2 cemented and press-fit TKA designs with differing tibial baseplate thicknesses and metallurgy over a 2-year period to assess for changes in stress shielding. METHODS One-hundred one TKAs were performed in this Institutional Review Board-approved, prospective study. There were 4 cohorts: DePuy Attune cemented and press-fit, and Stryker Triathlon cemented and press-fit. The Attune tibial baseplate was thicker; both cemented tibial and femoral components were cobalt-chromium. The DePuy Attune press-fit had a cobalt-chromium sintered bead porous coating while the Stryker Triathlon was 3-dimensional printed highly porous titanium alloy. All patients had quantitative dual-energy X-ray absorptiometry scans performed at baseline (4-6 weeks postoperatively) and at 1 and 2 years postoperatively. Stress shielding was evaluated by comparing percent change in bone mineral density in 11 radiographic zones over 2 years. RESULTS Over a 2-year period, there were no differences in stress shielding on the tibial side in either cemented or press-fit between Stryker Triathlon and DePuy Attune; however, there were differences on the femoral side. The press-fit tibial components of the Stryker Triathlon and DePuy Attune had either similar or less stress shielding over a 2-year period compared to their cemented counterparts. CONCLUSION This study comparing 2 TKA implants with differing tibial tray thickness did not find significant differences in tibial stress shielding between designs. There was a difference in stress shielding on the femoral side between designs, suggesting that longer term follow-up is warranted.
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Affiliation(s)
- Ilya Bendich
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Charles M Lawrie
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Venessa Riegler
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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Mathis DT, Schmidli J, Amsler F, Henckel J, Hothi H, Hart A, Hirschmann MT. Comparative retrieval analysis of a novel anatomic tibial tray backside: alterations in tibial component design and surface coating can increase cement adhesions and surface roughness. BMC Musculoskelet Disord 2022; 23:474. [PMID: 35590296 PMCID: PMC9118733 DOI: 10.1186/s12891-022-05446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the Persona® knee system a novel anatomic total knee design was developed, which has no pre-coating, whereas the predecessor knee system is pre-coated with polymethylmethacrylate (PMMA). Joint registry data have shown no decrease in risk of aseptic revision of PMMA pre-coated tibial components compared with non-pre-coated implants. The aim of this retrieval study was to compare the amount of cement adhesions, geometry and surface features between the two knee designs and to correlate them with the underlying reason for revision surgery. METHODS Retrieval analysis was performed of 15 NexGen® and 8 Persona® fixed-bearing knee implants from the same manufacturer retrieved from two knee revision centres. A photogrammetric method was used to grade the amount of cement attached to the tibial tray backside. The geometry and dimensions of the tibial trays, tray projections and peripheral lips were measured using digital callipers and compared between the two different designs. To measure the surface roughness on the backside of the tibial tray, a contact profilometer was used. To investigate differences between the two designs statistical analyses (t-test) were performed. RESULTS All Persona® trays showed evidence of cement adhesion with a % area of 75.4%; half of the NexGen® trays had cement adhesions, with a mean value of 20%. There was a significant difference in the percentage of area covered by cement between the two designs (p < 0.001). Results from the contact profilometer revealed that Persona® and NexGen® tray backsides showed a similar lateral (1.36 μm and 1.10 μm) and medial (1.39 μm and 1.12 μm) mean surface roughness with significant differentiation (p < 0.05) of the lateral and medial roughness values between the two designs. Persona® stems showed a significantly higher mean surface roughness (1.26) compared to NexGen® stems (0.89; p < 0.05). CONCLUSION The novel anatomic knee system showed significantly more cements adhesions and a higher surface roughness which was most likely attributed to the most obvious design and coating alteration of the tibial tray. This study provides first retrieval findings of a novel TKA design recently introduced to the market.
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Affiliation(s)
- Dominic T Mathis
- University of Basel, Basel, Switzerland. .,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland.
| | | | | | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Harry Hothi
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Alister Hart
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Michael T Hirschmann
- University of Basel, Basel, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
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Cho BW, Kang KT, Kwon HM, Lee WS, Yang IH, Nam JH, Koh YG, Park KK. Biomechanical effect of anatomical tibial component design on load distribution of medial proximal tibial bone in total knee arthroplasty : finite element analysis indicating anatomical design prevents stress-shielding. Bone Joint Res 2022; 11:252-259. [PMID: 35491552 PMCID: PMC9130674 DOI: 10.1302/2046-3758.115.bjr-2021-0537.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims This study aimed to identify the effect of anatomical tibial component (ATC) design on load distribution in the periprosthetic tibial bone of Koreans using finite element analysis (FEA). Methods 3D finite element models of 30 tibiae in Korean women were created. A symmetric tibial component (STC, NexGen LPS-Flex) and an ATC (Persona) were used in surgical simulation. We compared the FEA measurements (von Mises stress and principal strains) around the stem tip and in the medial half of the proximal tibial bone, as well as the distance from the distal stem tip to the shortest anteromedial cortical bone. Correlations between this distance and FEA measurements were then analyzed. Results The distance from the distal stem tip to the shortest cortical bone showed no statistically significant difference between implants. However, the peak von Mises stress around the distal stem tip was higher with STC than with ATC. In the medial half of the proximal tibial bone: 1) the mean von Mises stress, maximum principal strain, and minimum principal strain were higher with ATC; 2) ATC showed a positive correlation between the distance and mean von Mises stress; 3) ATC showed a negative correlation between the distance and mean minimum principal strain; and 4) STC showed no correlation between the distance and mean measurements. Conclusion Implant design affects the load distribution on the periprosthetic tibial bone, and ATC can be more advantageous in preventing stress-shielding than STC. However, under certain circumstances with short distances, the advantage of ATC may be offset. Cite this article: Bone Joint Res 2022;11(5):252–259.
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Affiliation(s)
- Byung W Cho
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Hyuck M Kwon
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ick H Yang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji H Nam
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Kwan K Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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11
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Song SJ, Lee HW, Kang SG, Bae DK, Park CH. Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate. J Knee Surg 2022; 35:434-442. [PMID: 32838461 DOI: 10.1055/s-0040-1715085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent literature has implicated a thick cobalt chromium baseplate as a potential source of stress shielding and medial tibial bone resorption after total knee arthroplasty (TKA) in a Western population. The purpose was to calculate the incidence of various types and severity of medial tibial bone resorption utilizing a novel classification system after TKA with a thick cobalt chromium baseplate in Asian patients. Five hundred TKAs using Attune prostheses with mean follow-up of 3.4 years were evaluated, using the prospective radiographic data. The mean age was 71.3 years. The preoperative mechanical axis was varus, 11.2 degrees. The type and severity of medial tibial bone resorption were categorized as type U (resorption under the tibial baseplate up to 50% [U1] or beyond 50% [U2] of medial tibial tray width), C (resorption around the penetrated cement under the baseplate), and M (resorption on the medial tibial cortex without extension to the baseplate). Bone resorption of medial proximal tibia was observed in 96 knees (19.2%). Types U1 and U2 were seen in 46 and 28 knees, respectively. Type C was observed in 12 knees and type M in 10 knees. The type U resorption group had significantly more preoperative varus deformity (varus 12.9 vs. 10.9 degrees, p = 0.017). Medial tibial bone resorption after TKAs using a thick cobalt chromium baseplate is not uncommon and has various locations, types, and severities. The medial tibial bone resorption might be related to various causes, including stress shielding, thermal necrosis from cement in the bony hole, and bony devascularization. The type-U resorption has to be closely observed in patients with preoperative severe varus deformity. This is a Level IV study.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea (the Republic of)
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
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Lee QJ, Wong WYD, Yau YL, Chang WYE, Wong YC. Proximal tibial bone loss in the first 2 years after unicondylar knee arthroplasty: Anatomical pattern, predictors and clinical correlation. Knee 2021; 32:201-210. [PMID: 34509826 DOI: 10.1016/j.knee.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 08/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial stress fracture, anteromedial bone pain, and early subsidence could occur after unicondylar knee arthroplasty (UKA). The change in metaphyseal tibial bone density (MTBD) in the coronal and sagittal planes after UKA might be a contributing factor, but this has rarely been investigated. The aim of this study was to assess the regional and temporal change in MTBD in the coronal and sagittal planes in the first 2 years after UKA. METHODS Patients with fixed-bearing medial UKA were recruited. The change in MTBD in the first 24 months after UKA using digital radiological densitometry (DRD) was measured. Potential predictors and clinical correlations were analyzed. RESULTS Eighty-four cases (female 60%) were selected for review. The follow up time was 63 (±17) months. Anterior and medial regions had the largest proportion of cases with MTBD reduction (90-97%, P < 0.05). Reduction was largest at anterior and medial regions (21-29%, P < 0.05) and smallest at posterior and lateral regions (5-15%, P < 0.05). Maximal reduction occurred at 12 months for the medial region and 24 months for the anterior region. MTBDs of both regions were not significantly influenced by any confounding factors. Significant correlation was found between medial MTBD and Function Score at 6 months. CONCLUSIONS Bone loss in a zonal pattern occurs in the first 2 years after UKA with the largest loss in the anterior region below the tibial tray. It is not affected by body mass index, perioperative alignment, or angle of correction. This suggests a physiological response to trauma other than a mechanical response to the change in bone strain.
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Affiliation(s)
- Qunn Jid Lee
- Total Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
| | - Wai Yip Daniel Wong
- Total Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region
| | - Yee Ling Yau
- Total Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region
| | - Wai Yee Esther Chang
- Total Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region
| | - Yiu Chung Wong
- Total Joint Replacement Center, Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region
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13
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Liao B, Sun J, Xu C, Xia R, Li W, Lu D, Jin Z. A mechanical study of personalised Ti6Al4V tibial fracture fixation plates with grooved surface by finite element analysis. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bo Liao
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
| | - Jipeng Sun
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
| | - Cheng Xu
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
| | - Rufeng Xia
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
| | - Wei Li
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
| | - Dong Lu
- Chengdu Advanced Metal Materials Industry Technology Research Institute Chengdu China
| | - Zhongmin Jin
- Key Laboratory for Advanced Technology of Materials of Ministry of Education Tribology Research Institute Southwest Jiaotong University Chengdu China
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14
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Towards a Standard Approach to Assess Tibial Bone Loss Following Total Knee Arthroplasty. Clin Rev Bone Miner Metab 2021. [DOI: 10.1007/s12018-021-09276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractLong-term implant failure in the form of aseptic loosening and periprosthetic fracture is the most common cause of revision procedures in total knee arthroplasty (TKA). While early loosening can often be attributed to failure of primary fixation, late implant failure could be associated with loss of fixation secondary to bone resorption, as a result of stress shielding in the proximal tibia. This current review study was performed to identify the clinical effects of different implant-, patient-, and surgery-related biomechanical factors on TKA-related tibial bone loss in clinical reality. Implant-related factors considered were the fixation method, and the implant type, geometry, and stiffness. In terms of patient characteristics, the effects of age, sex, knee alignment, bone density, body weight, and activity level were analyzed. The clinical literature on these topics mostly concerned longitudinal radiographic studies investigating the effect of a single factor on changes in the proximal tibia over time using bone densitometry. Implant stiffness, implant geometry and knee alignment were the only factors consistently found to affect regional bone density changes over time. Each clinical study used its own specific study design, with different definitions used for the baseline density, time points of baseline and follow-up measurements, and regions of interest. Due to the differences in study design, direct comparison between the clinical impact of different biomechanical factors was not possible. Based on the findings over the densitometry studies, a standardized guideline was proposed to allow reliable comparison between consistently reported outcome of future radiographic TKA studies.
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15
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Lachiewicz PF, Steele JR, Wellman SS. Unexpected high rate of revision of a modern cemented fixed bearing modular posterior-stabilized knee arthroplasty. Bone Joint J 2021; 103-B:137-144. [PMID: 34053294 DOI: 10.1302/0301-620x.103b6.bjj-2020-1956.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. METHODS This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending. RESULTS In total, 19 (11.5%) ATTUNE study TKAs have been revised at a mean 30.3 months (SD 15), and loosening of the tibial component was seen in 17 of these (90%). Revision is pending in 12 (7%) knees. There was no difference between the 31 knees revised or with revision pending and the remaining 135 study knees in terms of patient characteristics, type of bone cement (p = 0.988), or individual surgeon (p = 0.550). In the reference cohort, there were significantly fewer knees revised (n = 13, 2.6%) and with revision pending (n = 8, 1.5%) (both p < 0.001), and only two had loosening of the tibial component as the reason for revision. CONCLUSION This new TKA design had an unexpectedly high early rate of revision compared with our reference cohort of TKAs. Debonding of the tibial component was the most common reason for failure. Additional longer-term follow-up studies of this specific component and techniques for implantation are warranted. The version of the ATTUNE tibial component implanted in this study has undergone modifications by the manufacturer. Cite this article: Bone Joint J 2021;103-B(6 Supple A):137-144.
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Affiliation(s)
- Paul F Lachiewicz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - John R Steele
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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16
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Cho BW, Kwon HM, Hong YJ, Park KK, Yang IH, Lee WS. Anatomical tibial component is related to more medial tibial stress shielding after total knee arthroplasty in Korean patients. Knee Surg Sports Traumatol Arthrosc 2021; 29:710-717. [PMID: 32088805 DOI: 10.1007/s00167-020-05869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to investigate stress shielding of anatomical tibial components (ATCs) in comparison to conventional symmetric tibial components (STCs) in Korean patients which may be related to medial tibial bone loss. METHOD 78 knees in 59 patients with ATCs (Persona™) and 74 knees in 58 patients with STCs (NexGen LPS-Flex™) were retrospectively reviewed. Radiographic parameters and clinical outcomes in both groups were compared. Logistic regression analysis was performed to identify risk factors for medial tibial bone loss. RESULTS Medial tibial bone loss was significantly greater in the ATC group (1.6 ± 1.3 mm) than in the STC group (0.4 ± 0.8 mm) (p < 0.001). The ATC group showed a shorter distance between the distal metal tip and anteromedial cortex and higher invading into the sclerotic bone lesion (ISBL) than the STC group (p = 0.034 and p = 0.044, respectively). Multiple logistic regression analysis suggested ATC, a shorter distance to the anteromedial cortex, and the presence of ISBL as risk factors for medial tibial bone loss. The odds ratios of medial tibial bone loss according to type of prosthesis, distance to anteromedial cortex, and presence of ISBL were 6.25 (range 2.86-13.63, p < 0.001), 0.69 (range 0.51-0.93, p = 0.015), and 3.79 (range 1.56-9.21, p = 0.003), respectively. Notwithstanding, there was no difference in clinical outcomes between the two groups. CONCLUSION In Korean patients, ATCs potentially causes greater medial tibial bone loss due to stress shielding than STCs. The design, however, does not yet appear to affect clinical outcomes at mid-term follow-up. LEVEL OF EVIDENCE Retrospective cohort study, level III.
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Affiliation(s)
- Byung Woo Cho
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Yong Jae Hong
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ick Hwan Yang
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea.
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17
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Liu C, Zhao G, Chen K, Lyu J, Chen J, Shi J, Huang G, Chen F, Wei Y, Wang S, Xia J. Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty. J Orthop Surg Res 2021; 16:134. [PMID: 33579313 PMCID: PMC7881541 DOI: 10.1186/s13018-021-02250-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/20/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02250-7.
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Affiliation(s)
- Changquan Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Guanglei Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Kangming Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jinyang Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jie Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jingsheng Shi
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Gangyong Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Feiyan Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Yibing Wei
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Siqun Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jun Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China.
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18
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Yang H, Bayoglu R, Clary CW, Rullkoetter PJ. Impact of surgical alignment, tray material, PCL condition, and patient anatomy on tibial strains after TKA. Med Eng Phys 2021; 88:69-77. [PMID: 33485516 DOI: 10.1016/j.medengphy.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
Bone remodeling after total knee arthroplasty is regulated by the changes in strain energy density (SED), however, the critical parameters influencing post-operative SED distributions are not fully understood. This study aimed to investigate the impact of surgical alignment, tray material properties, posterior cruciate ligament (PCL) balance, tray posterior slope, and patient anatomy on SED distributions in the proximal tibia. Finite element models of two tibiae (different anatomy) with configurations of two implant materials, two surgical alignments, two posterior slopes, and two PCL conditions were developed. The models were tested under the peak loading conditions during gait, deep knee bending, and stair descent. For each configuration, the contact forces and locations and soft-tissue loads of interest were taken into consideration. SED in the proximal tibia was predicted and the changes in strain distributions were compared for each of the factors studied. Tibial anatomy had the most impact on the proximal bone SED distributions, followed by PCL balancing, surgical alignment, and posterior slope. In addition, the thickness of the remaining cortical wall after implantation was also a significant consideration when evaluating tibial anatomy. The resulting SED changes for alignment, posterior slope, and PCL factors were mainly due to the differences in joint and soft-tissue loading conditions. A lower modulus tray material did result in changes in the post-operative strain state, however, these were almost negligible compared to that seen for the other factors.
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Affiliation(s)
- Huizhou Yang
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO 80208, USA
| | - Riza Bayoglu
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO 80208, USA
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO 80208, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO 80208, USA.
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19
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Hoskins W, Gorup P, Claireaux H, Stokes C, Bingham R. High incidence of radiolucent lines at the implant-cement interface of a new total knee replacement. ANZ J Surg 2020; 90:1299-1302. [PMID: 32536016 DOI: 10.1111/ans.16046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recently introduced total knee arthroplasty (TKA) implants have been linked with the early development of periprosthetic radiolucency (PPRL). The aim of this study was to carry out a retrospective clinical and radiographical analysis of a consecutive series of a new TKA, and to assess the incidence and distribution of PPRL. METHODS A retrospective review of all new TKA implants performed by a single surgeon at a single hospital between March 2013 and October 2017 was performed. The minimum follow-up period was 3 months, with ongoing patient review at 6, 12 and 36 months. Sequential post-operative radiographs were performed to determine the presence of PPRL. RESULTS A total of 122 TKAs were identified in 112 patients over the 4.5-year study period. The average follow-up time was 21 months (range 3-51 months). PPRL was noted in 29 TKAs (23.8%). When comparing the PPRL group to those without PPRL, there was a difference in body mass index, with body mass index associated with an increased likelihood of PPRL (P = 0.003). There was no difference in constraint of implant (P = 0.818), cement type (P = 0.340), patella resurfacing (P = 0.286), age (P = 0.984) gender (P = 0.376) or initial mechanical axis deviation (P = 0.054) between groups. PPRL were most commonly seen in tibial anterior-posterior (AP) zone 1 and zone 2 (96.6%), followed by femoral lateral zone 5 (58.6%), tibia lateral zone 1 (55.2%) and tibial lateral zone 2 (53.2%). No patients have required revision surgery. CONCLUSION A high incidence of early PPRL is seen in patients undergoing primary TKA using a new implant system, mainly involving the tibial component. Ongoing clinical and radiological assessment for patients seems warranted based on these findings.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Traumaplasty Melbourne, Melbourne, Victoria, Australia
| | - Peter Gorup
- Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Harry Claireaux
- Nuffield Department of Orthopaedics, The University of Oxford, Oxford, UK.,John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Chris Stokes
- Traumaplasty Melbourne, Melbourne, Victoria, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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20
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Wong DWY, Lee QJ, Lo CK, Wong YC, Law KWK, Li AHY. Tibial tray thickness does not significantly increase medial tibial bone resorption: Using tibial bone density as an objective measurement method. Knee 2020; 27:572-579. [PMID: 31954609 DOI: 10.1016/j.knee.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/08/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent studies have reported the occurrence of medial tibial bone resorption following total knee replacement. One study proposed that a thick tibial tray results in stress shielding and increases the risk of bone resorption, but its findings were based on subjective radiological assessment. This study aimed to verify this hypothesis and to objectively quantify medial tibial bone density by using serial measurements with digital radiological densitometry. METHODS This was a retrospective cohort study involving 140 patients (70 thick tray vs. 70 thin tray) with cobalt-chromium implants with at least 24 months of follow-up. Standard radiographs were reviewed to look for incidence of medial tibial bone loss. Serial measurement of medial tibial bone density was also performed using the method of digital radiological densitometry. RESULTS There was no significant difference in the incidence of medial tibial bone loss. Both groups showed a significant drop in medial tibial bone density after operation (P < 0.01). Medial tibial bone density of the thick-tray cohort was significantly higher than the thin-tray cohort at one year (93.3 vs. 83.1 Greyscale; P = 0.04), but not at two and three years. Clinical outcomes in terms of postoperative range of motion, Knee Society score and complication rates were similar. CONCLUSIONS Medial tibial bone resorption is a common phenomenon. Implants with thicker tibial trays suffer less than those with thinner trays at one year, but the difference is transient and does not affect clinical outcome.
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Affiliation(s)
- Daniel Wai-Yip Wong
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong.
| | - Qunn-Jid Lee
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong
| | - Chi-Kin Lo
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong
| | - Yiu-Chung Wong
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong
| | - Kenneth Wing-Kin Law
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong
| | - Alwin Hok-Yin Li
- Total Joint Replacement Centre, Yan Chai Hospital, Hospital Authority, Hong Kong
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21
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Cerquiglini A, Henckel J, Hothi H, Allen P, Lewis J, Eskelinen A, Skinner J, Hirschmann MT, Hart AJ. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019; 8:136-145. [PMID: 30997039 PMCID: PMC6446526 DOI: 10.1302/2046-3758.83.bjj-2018-0102.r2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic. Methods We examined 12 titanium (Ti) PFC Sigma implants, eight cobalt-chromium (CoCr) PFC Sigma implants, eight cobalt-chromium PFC Sigma rotating platform (RP) implants, and 11 Attune implants. We used a peer-reviewed digital imaging method to quantify the amount of cement attached to the backside of each tibial tray. We then measured: 1) the size of tibial tray thickness, tray projections, peripheral lips, and undercuts; and 2) surface roughness (Ra) on the backside and keel of the trays. Statistical analyses were performed to investigate differences between the two designs. Results There was no evidence of cement attachment on any of the 11 Attune trays examined. There were significant differences between Ti and CoCr PFC Sigma implants and Attune designs (p < 0.05); however, there was no significant difference between CoCr PFC Sigma RP and Attune designs (p > 0.05). There were significant differences in the design features between the investigated designs (p < 0.05). Conclusion The majority of the earliest PFC Sigma designs showed evidence of cement, while all of the retrieved Attune trays and the majority of the RP PFC trays in this study had no cement attached. This may be attributable to the design differences of these implants, in particular in relation to the cement pockets. Our results may help explain a controversial aspect related to cement attachment in a recently introduced TKA design.Cite this article: A. Cerquiglini, J. Henckel, H. Hothi, P. Allen, J. Lewis, A. Eskelinen, J. Skinner, M. T. Hirschmann, A. J. Hart. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019;8:136-145. DOI: 10.1302/2046-3758.83.BJJ-2018-0102.R2.
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Affiliation(s)
- A Cerquiglini
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - J Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - H Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - P Allen
- Princess Alexandra NHS Trust, Harlow, UK
| | - J Lewis
- BMI Goring Hall Hospital, Goring-by-Sea, West Sussex, UK
| | - A Eskelinen
- The Coxa Hospital for Joint Replacement, Tampere, Finland
| | - J Skinner
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - M T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - A J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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22
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Gu S, Kuriyama S, Nakamura S, Nishitani K, Ito H, Matsuda S. Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1270-1279. [PMID: 30470851 DOI: 10.1007/s00167-018-5309-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE One of the causes of aseptic loosening is marked tibial bone resorption (TR) at the tibial bone-component interface after total knee arthroplasty (TKA). It was hypothesized that insufficient coverage of the tibial component and improper cementing technique would cause increased TR after cemented TKA. METHODS One hundred thirty-four primary TKAs in 107 patients with varus osteoarthritis were included in this study. The relationships between the TRs at 2 years after TKA and the tibial component underhang (TUH), the thickness of the cement mantle around the keel, and clinical parameters were evaluated. RESULTS The widths of TRs on anteroposterior radiographs were significantly larger on the medial side than on the lateral side (p = 0.001), whereas the difference between the anterior and posterior sides on lateral radiographs was relatively small. Multiple regression analyses showed that medial TR was positively related to medial TUH (p = 0.006), and lateral TR was positively related to a thicker distal cement mantle (p = 0.027). On the lateral view, stepwise selection indicated that postoperative knee flexion angle was the most significant risk factor (p = 0.005) for anterior TR, and posterior TUH was the strongest predictor (p = 0.001) of posterior TR. CONCLUSIONS To avert postoperative progressive TR, surgeons should perfectly fit a suitably sized tibial component to the medial edge of the tibia. Also, care should be taken to avoid an excessive cement mantle at the distal portion of the keel during TKA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- ShiZhong Gu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Orthopaedic Surgery, Sports Medicine and Joint Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Yoon C, Chang MJ, Chang CB, Song MK, Shin JH, Kang SB. Medial Tibial Periprosthetic Bone Resorption and Its Effect on Clinical Outcomes After Total Knee Arthroplasty: Cobalt-Chromium vs Titanium Implants. J Arthroplasty 2018; 33:2835-2842. [PMID: 29773278 DOI: 10.1016/j.arth.2018.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, concerns arose over the medial tibial bone resorption of a novel cobalt-chromium implant. This study aimed at investigating the effects of tibial component material, design, and patient factors on periprosthetic bone resorption and at determining its association with clinical outcomes after total knee arthroplasty (TKA). METHODS A total of 462 primary TKAs using 5 types of implants were included. To evaluate tibial periprosthetic bone resorption, we assessed radiolucent lines and change in bone mineral density at the medial tibial condyle (BMDMT). Factors related to bone resorption were assessed using regression analysis. Clinical outcomes were also evaluated with respect to periprosthetic bone resorption. RESULTS Compared to titanium implants, cobalt-chromium implants showed a higher incidence of complete radiolucent lines (23.1% vs 7.9% at 2 years post-TKA) and a greater degree of BMDMT reduction. However, there was no significant difference between the implants made of the same material. Increased medial tibial bone resorption was associated with male sex, osteoporosis, larger preoperative varus deformity, longer follow-up period, and lower body mass index. The periprosthetic bone resorption was not associated with clinical outcomes including changes in range of motion and Western Ontario and McMaster Universities Osteoarthritis Index score. Furthermore, no cases warranted additional surgery. CONCLUSION Periprosthetic bone resorption was associated with implant material but not with implant design. Moreover, patient factors were related to the medial tibial bone resorption post-TKA. However, the periprosthetic bone resorption was not associated with short-term clinical outcomes. We contend that researchers should incorporate integrative considerations when developing and assessing novel implants.
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Affiliation(s)
- Chan Yoon
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hoon Shin
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Martin JR, Fehring KA, Watts CD, Springer BD, Fehring TK. Radiographic Findings in Patients With Catastrophic Varus Collapse After Total Knee Arthroplasty. J Arthroplasty 2018; 33:241-244. [PMID: 28899593 DOI: 10.1016/j.arth.2017.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Catastrophic varus collapse is an uncommon mechanism of failure in primary total knee arthroplasty (TKA). Varus collapse has been associated with obesity and smaller implant sizes. However, to our knowledge, preoperative radiographic characterization of this cohort has not been performed. Therefore, the following study evaluated preoperative alignment and how this correlates with the degree of eventual varus collapse identified in this patient population prior to revision. METHODS Utilizing our institutional database, 1106 revision TKAs were performed from 2004 to 2017. Of these, 35 patients were revised secondary to tibial varus collapse. Twenty-seven patients had their primary TKA performed at our institution. Coronal alignment of the knee was recorded from anteroposterior knee radiographs. Medial tibial bone loss was recorded at final follow-up. RESULTS The average body mass index was 38 kg/m2. Twenty-six of 27 patients had a preoperative varus deformity (4.2° varus) and all were corrected to a valgus coronal alignment immediately postoperatively (5.2° valgus, P = .0001). Twenty-four of 27 patients' coronal alignment after varus collapse was within 2° of their preoperative alignment (5.8° varus). Twenty-five of 27 patients had radiographic medial tibial bone loss prior to varus collapse. CONCLUSION Tibial varus collapse in an uncommon cause of failure after primary TKA. Preoperative varus deformity, postoperative medial tibial bone loss, and obesity were common findings in this series of patients. Therefore, increased tibial stem lengths should be considered in patients with a preoperative varus deformity, small tibial implant size, and a body mass index ≥35 kg/m2 undergoing primary TKA.
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Affiliation(s)
| | | | - Chad D Watts
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina
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Proximal tibial resorption in a modern total knee prosthesis. Arthroplast Today 2017; 4:244-248. [PMID: 29896562 PMCID: PMC5994597 DOI: 10.1016/j.artd.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background In an effort to minimize backside polyethylene wear and osteolysis associated with titanium tibial baseplates, many manufacturers have transitioned to cobalt chromium alloys. Recent literature has implicated thicker cobalt chromium designs as a potential source of increased stress shielding and resorption. We report the incidence of proximal tibial bone resorption in a large consecutive series of patients undergoing total knee arthroplasty, with a modern total knee design. Methods Four hundred thirty-two consecutive primary total knee arthroplasties, performed by 2 fellowship-trained arthroplasty surgeons were identified over a 24-month period. In addition to review of the medical records, analysis of preoperative and postoperative radiographs was performed. Utilizing a novel classification system, the severity of resorption was quantified and correlated with patient and implant characteristics. Results After exclusions, 339 knees were evaluated in 292 patients. Mean follow-up was 13.2 months (range 6-41). Resorption was present in 119 knees (35.1%). Average time to diagnosis of bone loss was 6.9 months (range 2-32) postoperatively. There was a statistically significant difference between resorption and nonresorption groups with regards to gender and preoperative alignment. Most cases were classified as Grade 1. During the study period, 2 patients required revision for aseptic tibial loosening. Conclusions Our findings suggest that proximal tibial resorption is common with this particular implant, particularly in men and patients with preoperative varus deformity. Although this typically occurs relatively early in postoperative period and in most cases appears to remodel and stabilize, its ultimate clinical significance and effect on implant survivorship remains unclear.
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A Numerical Investigation into the Effects of Overweight and Obesity on Total Knee Arthroplasty. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:1496379. [PMID: 29065570 PMCID: PMC5474252 DOI: 10.1155/2017/1496379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
Abstract
Overweight and obesity increase risks of knee osteoarthritis, which is a major cause of disability. Severe knee osteoarthritis can be treated by knee arthroplasty. Total knee arthroplasty has been used in overweight and obese patients; however, clinical reports showed that the outcome of this group of patients was not good as normal-weight patients. Two computer models were created in this paper to simulate the effect of excess loads on the distal femoral bone and contact pressures in total knee arthroplasty during a gait cycle. The numerical results showed increased stress in periprosthetic distal femoral bones and higher contact pressure on tibial polyethylene insert during the stance phase. Based on the computer simulation results and published research work, cementless total knee arthroplasty with thicker tibial polyethylene insert may be a better option for overweight patients.
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Al-Tamimi AA, Peach C, Fernandes PR, Cseke A, Bartolo PJ. Topology Optimization to Reduce the Stress Shielding Effect for Orthopedic Applications. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.procir.2017.04.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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