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Luo TD, Sogbein OA, MacDonald BM, Masse JA, Willing RT, Lanting BA. Central cone design demonstrates greater micromotion compared to keel design in cementless tibial baseplates: A biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713877 DOI: 10.1002/ksa.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The purpose of this study was to compare micromotion of two new cementless tibial baseplates to a cementless design with well-published clinical success. METHODS Three cementless tibial baseplate designs (fixed-bearing [FB] with keel and cruciform pegs, rotating-platform with porous central cone and pegs, FB with cruciform keel and scalloped pegs) were evaluated on sawbone models. Loading was applied to the baseplate at a rate of 1 Hz for 10,000 cycles, which represents 6-8 weeks of stair descent. This time frame also represents the approximate time length for the induction of biologic fixation of cementless implants. Compressive and shear micromotion at the sawbone-implant interface were measured. RESULTS At the end of the loading protocol, the central cone rotating-platform design exhibited greater micromotion at the anterior (p < 0.001), posterior (p < 0.001) and medial locations (p = 0.049) compared to the other two implants. The central cone design also exhibited greater translational micromotion in the sagittal plane at the medial (p = 0.001) and lateral locations (p = 0.034) and in the coronal plane anteriorly (p = 0.007). CONCLUSION The cementless central cone rotating-platform baseplate demonstrated greater vertical and translational micromotion compared to the two FB baseplates with a keel underloading. This may indicate lower initial mechanical stability in implants without a keel, which possibly affects osseointegration. The implication of this is yet unknown and requires further long-term clinical follow-up to correlate these laboratory findings. LEVEL OF EVIDENCE V (biomechanical study).
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Affiliation(s)
- Tianya David Luo
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
- Orthopaedics Northeast, Fort Wayne, Indiana, USA
| | - Olawale A Sogbein
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brett M MacDonald
- Department of Mechanical & Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - Jarrett A Masse
- Department of Mechanical & Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - Ryan T Willing
- Department of Mechanical & Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - Brent A Lanting
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Frazer A, Lim JBT, Teeter MG, Howard J, Vasarhelyi EM, Lanting BA. Gap patterns and radiographic follow-up of newer-generation cementless total knee arthroplasty designs. Can J Surg 2024; 67:E85-E90. [PMID: 38453351 PMCID: PMC10927283 DOI: 10.1503/cjs.008223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Interest in cementless total knee arthroplasty (TKA) has increased with advancement of biomaterials and implant design and associated improved longevity. We sought to evaluate the gap patterns and radiolucent zones radiographically for 2 newer-generation cementless TKA designs. METHODS We retrospectively reviewed our single-institution database between January 2017 and December 2019. We identified patients with a porous keeled tibia base-plate with 4-bullet cruciform spikes and peri-apatite coated femoral component (study group 1) and patients who received a cementless porous coated femoral component and rotating platform tibia baseplate with 4 peripheral porous coated pegs around a central cone (study group 2). We identified gap patterns at 6 weeks and at 1 year or more postoperatively on radiographs, noting indications for reoperation. RESULTS We identified 228 patients in study group 1 and 41 patients in study group 2. At 1-year follow-up, we found evidence of resolved femoral gaps in 52 (72.2%) of 72 patients in study group 1 and 10 (58.8%) of 17 patients in study group 2 (p = 0.124). We identified 27 (84.3%) of 32 patients in study group 1 and 7 (70.0%) of 10 patients in study group 2 with resolved tibia gaps (p = 0.313). After 1 year, there were significantly more Zone 3a femoral zonal radiolucent gaps (p = 0.001) and Zone 8 tibia zonal radiolucent gaps (p = 0.002) in study group 2 than in study group 1. There were 4 reoperations for study group 1 and 0 reoperations for study group 2. CONCLUSION The modern cementless TKA systems have varied gap patterns in postoperative radiographs, which may be attributed to the implant design. Most radiolucent gaps resolve radiographically on follow-up.
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Affiliation(s)
- Abigail Frazer
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Jason B T Lim
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Matthew G Teeter
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - James Howard
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Edward M Vasarhelyi
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
| | - Brent A Lanting
- From the Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ont. (Frazer, Teeter, Howard, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore (Lim)
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Polizzotti G, Lamberti A, Mancino F, Baldini A. New Horizons of Cementless Total Knee Arthroplasty. J Clin Med 2023; 13:233. [PMID: 38202240 PMCID: PMC10780266 DOI: 10.3390/jcm13010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation. DISCUSSION Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young's modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability. CONCLUSIONS Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients.
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Affiliation(s)
- Giuseppe Polizzotti
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Sapienza University of Rome, 00185 Rome, Italy
| | | | - Fabio Mancino
- University College London Hospital, London NW1 2BU, UK
- The Princess Grace Hospital, London W1U 5NY, UK
| | - Andrea Baldini
- Istituto Fiorentino di Cura e Assistenza, 50139 Florence, Italy
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Baker JF, Nadar AC, Jouflas AC, Smith LS, Sachdeva S, Yakkanti MR, Malkani AL. Cementless metal-backed patellar components in primary total knee arthroplasty using an implant of modern design. Bone Joint J 2023; 105-B:1279-1285. [PMID: 38035601 DOI: 10.1302/0301-620x.105b12.bjj-2023-0670.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to evaluate the clinical results of a second-generation cementless, metal-backed patellar component of a modern design. Methods This was a retrospective review of 707 primary TKAs in 590 patients from a single institution, using a cementless, metal-backed patellar component with a mean follow-up of 6.9 years (2 to 12). A total of 409 TKAs were performed in 338 females and 298 TKAs in 252 males. The mean age of the patients was 63 years (34 to 87) and their mean BMI was 34.3 kg/m2 (18.8 to 64.5). The patients were chosen to undergo a cementless procedure based on age and preoperative radiological and intraoperative bone quality. Outcome was assessed using the Knee Society knee and function scores and range of motion (ROM), complications, and revisions. Results A total of 24 TKAs (3.4%) in 24 patients failed and required revision surgery, of which five were due to patellar complications (0.71%): one for aseptic patellar loosening (0.14%) and four for polyethylene dissociation (0.57%). A total of 19 revisions (2.7%) were undertaken in 19 patients for indications which did not relate to the patella: four for aseptic tibial loosening (0.57%), one for aseptic femoral loosening (0.14%), nine for periprosthetic infection (1.3%), one for popliteus impingement (0.14%), and four for instability (0.57%). Knee Society knee and function scores, and ROM, improved significantly when comparing pre- and postoperative values. Survival of the metal-backed patellar component for all-cause failure was 97.5% (95% confidence interval 94.9% to 100%) at 12 years. Conclusion The second-generation cementless TKA design of metal-backed patellar components showed a 97.5% survival at 12 years, with polyethylene dissociation from the metal-backing being the most common cause of patellar failure. In view of the increased use of TKA, especially in younger, more active, or obese patients, these findings are encouraging at mean follow-up of seven years.
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Affiliation(s)
- James F Baker
- UofL Health, ULP Orthopedics, Louisville, Kentucky, USA
| | - Arun C Nadar
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Alex C Jouflas
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Shikha Sachdeva
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Arthur L Malkani
- Adult Reconstruction Program, Dept. of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
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Hannon CP, Salih R, Barrack RL, Nunley RM. Cementless Versus Cemented Total Knee Arthroplasty: Concise Midterm Results of a Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:1430-1434. [PMID: 37347823 DOI: 10.2106/jbjs.23.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND We previously reported the 2-year results of a prospective randomized controlled trial of cementless versus cemented total knee arthroplasty (TKA) implants of the same design. The purpose of the present study was to provide concise results at intermediate-term follow-up. METHODS The original study included 141 TKAs (76 performed without cement and 65 performed with cement). Since then, 8 patients died and 4 withdrew. Of the remaining 129 patients, 127 (98%) were available for analysis. Survivorship analysis was performed; Oxford Knee, Knee Society, and Forgotten Joint Scores were calculated; and radiographs reviewed. Mean follow-up was 6 years. RESULTS The survivorship free of any revision was 100% in both groups. There were no differences between the groups in any patient-reported functional outcome measure (p = 0.2 to 0.5). However, a higher percentage of patients in the cementless TKA group were either extremely or very satisfied with their overall function (p = 0.01). Radiographically, there was no evidence of implant loosening in either group. CONCLUSIONS At 6 years, there were no differences between cementless and cemented TKA implants of the same design in terms of survivorship, clinical, or radiographic outcomes. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Helvie PF, Deckard ER, Meneghini RM. Cementless Total Knee Arthroplasty Over the Past Decade: Excellent Survivorship in Contemporary Designs. J Arthroplasty 2023; 38:S145-S150. [PMID: 36791890 DOI: 10.1016/j.arth.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Cementless fixation in total knee arthroplasty (TKA) is re-emerging due to improvements in biomaterials, surgical technique, and implant design. Albeit rare, failure of osseointegration typically occurs within the first 2 years, and limited data exist on survivorship of the modern cementless TKA designs. This study evaluated clinical survivorship of 2 contemporary cementless TKA designs at minimum 2-year follow-up. METHODS A total of 627 cementless TKAs were performed up to July 2022. Three hundred thirty-nine cases were eligible for 2-year follow-up. Indications centered around bone quality and involved predominantly younger patients. The 2 designs consisted of tibial components with a highly porous titanium ingrowth surface, a central keel, and peripheral cruciform pegs with a porous cobalt-chromium femur. Survivorship estimates were calculated using right-censored non-parametric Kaplan-Meier methodologies. A total of 226 TKAs obtained minimum 2-year follow-up with a mean of 3.6 years (range, 2 to 10). RESULTS The all-cause revision rate was 2.4% (8 of 339). The revision rate due to aseptic loosening was 0.6% (2 of 339) consisting of 2 femoral components. No tibial components were revised for aseptic loosening. Kaplan-Meier survivorship free from aseptic loosening was 99% (95% confidence interval 98 to 100) at a maximum of 10 years. CONCLUSION These results demonstrate encouraging survivorship of cementless fixation in primary TKA with use of contemporary ingrowth biomaterials and modern implant designs. This particular tibial implant design with a highly porous titanium fixation surface, central keel, and peripheral cruciform pegs demonstrated excellent clinical survivorship without failure which may portend superior fixation. LEVEL OF EVIDENCE IV-case series, no control group/historical control group.
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Affiliation(s)
- Peter F Helvie
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Gustke KA, Simon P, Meheux CJ. Metal-Backed Patella Implants in Knee Arthroplasty: Can the Past Predict the Future? J Arthroplasty 2023; 38:S131-S136. [PMID: 36791886 DOI: 10.1016/j.arth.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND There is a renewed interest in uncemented total knee arthroplasty to potentially provide longer durability, including the use of newer design metal-backed patellae (MBPs). The purpose of this study was to review survivorship with failure mode and time to failure of an earlier version MBP at up to 10-30 years of follow-up that may influence the desirability of using these components today. METHODS A retrospective review was performed of patients that had uncemented total knee arthroplasty with an uncemented MBP. All-cause revision rates were obtained from chart reviews and telephone discussions with patients and family members of deceased patients. Kaplan-Meier plots were used to determine the implant survivorship. Outcome scores were compared between revised and nonrevised patients. RESULTS The 97 knees that had an end point of an aseptic revision or last known contact with implant survivorship averaged 15 years (range, 0-32 years). There were 40 knees that underwent revision that included 37 patella component failures (38.1%). All patellar failures had polyethylene wear or fracture. None were revised due to loosening. Survivorship was 97.9% at 5 years, 88.7% at 10 years, and 53.0% at 20 years. Median time to failure was 11 years. CONCLUSION Loosening is not a failure mode with this MBP. There were 75% of the failures occurring after 10 years. Use of contemporary MBP with improved but still thin polyethylene warrants guarded optimism when used in younger patients where longer survivorship than with a cemented all-polyethylene patellar component is the goal.
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Affiliation(s)
- Kenneth A Gustke
- Florida Orthopaedic Institute, Tampa, Florida; Department of Orthopaedic Surgery, University of South Florida College of Medicine, Tampa, Florida
| | - Peter Simon
- Foundation for Orthopaedic Research & Education, Tampa, Florida; Department of Medical Engineering, University of South Florida, Tampa, Florida
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Schwabe MT, Hannon CP. The Evolution, Current Indications and Outcomes of Cementless Total Knee Arthroplasty. J Clin Med 2022; 11:jcm11226608. [PMID: 36431091 PMCID: PMC9693456 DOI: 10.3390/jcm11226608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Total knee arthroplasty (TKA) has been performed by orthopedic surgeons for decades, but the cementless TKA has only recently gained much interest in the world of arthroplasty. Initially, early designs had multiple complications, particularly with aseptic loosening due to osteolysis and micromotion. However, modifications have shown good outcomes and excellent survivorship. Over the last several decades, changes in implant designs as well as implant materials/coatings have helped with bone in growth and stability. Furthermore, surgeons have been performing TKA in younger and more obese patients as these populations have been increasing. Good results from the cementless TKA compared to cemented TKA may be a better option in these more challenging populations, as several studies have shown greater survivorship in patients that are younger and have a greater BMI. Additionally, a cementless TKA may be more cost effective, which remains a concern in today's healthcare environment. Overall, cemented and cementless TKA have great results in modern times and there is still a debate as to which implant is superior.
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