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Breuer R, Fiala R, Hartenbach F, Pollok F, Huber T, Strasser-Kirchweger B, Rath B, Trieb K. Long term follow-up of a completely metal free total knee endoprosthesis in comparison to an identical metal counterpart. Sci Rep 2024; 14:20958. [PMID: 39251687 PMCID: PMC11384776 DOI: 10.1038/s41598-024-71256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/26/2024] [Indexed: 09/11/2024] Open
Abstract
Aseptic loosening is a feared and not yet fully-understood complication of total knee arthroplasty (TKA). Hypersensitivity reactions may be the underlying cause within some susceptible patients. Metal-free implants have been developed as a possible solution. The aim of this prospective, observational long-term study was the assessment of a completely metal-free ceramic knee replacement system compared to its identical metal counterpart 8 years after implantation, conducted as a follow-up of a previous report. A total of 88 patients (mean age 69 years) were enrolled in this prospective, observational long-term 8-year follow-up study. The "ceramic group" with a completely metal-free total knee replacement system was compared to the "conventional group" with an identical metal TKA system at the final follow-up. Clinical assessment included Knee Society Score (KSS), Oxford Knee Score (OKS), European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-L), European Quality of Life 5 Dimension Visual Analogue Scale (EQ-VAS) and High Activity Arthroplasty Score (HAAS) as well as perioperative or postoperative complications and need for revision. The tibial/femoral positioning, signs of periprosthetic fissures/fractures or radiolucent lines were documented radiographically. All postoperative clinical scores in the ceramic group primarily improved from baseline to 4-year follow-up, but then decreased at the final 8-year follow-up. At the final follow-up, statistically non-significant differences were found in comparison of both groups for the KSS (ceramic: 166 ± 31, conventional: 162 ± 29; p > 0.05), OKS (ceramic: 37, conventional: 39; p > 0.05), EQ-VAS (ceramic: 77 ± 17, conventional: 72 ± 18; p > 0.05), and HAAS (ceramic: 8.29 ± 3.32, conventional: 9.28 ± 4.44; p > 0.05). A significant difference was found for EQ-5D-L (ceramic: 0.819 ± 0.284, conventional: 0.932 ± 0.126; p ≤ 0.05). Progressive radiolucent lines have been found around the uncemented tibial stem (0.8 mm at initial diagnosis (mean 19 months); 1.3 mm at 4-year follow-up; 1.6 mm at 8-year follow-up) without any clinical signs of loosening. One revision surgery was performed after a traumatic polyethylene inlay-breakage. No allergic reactions could be detected. The used ceramic TKA system meets the functional performance standards of an established identical metal TKA system after an 8-year follow-up period, offering a safe option for patients with prior hypersensitivity reactions to metallic materials. Full cementation of ceramic components is recommended.
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Affiliation(s)
- Robert Breuer
- Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, 1220, Vienna, Austria
| | - Rainer Fiala
- Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, 1220, Vienna, Austria
| | - Florian Hartenbach
- Department of Orthopedics, Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Florian Pollok
- Department of Orthopedics, Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Thorsten Huber
- Department of Orthopedics, Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | | | - Bjoern Rath
- Department of Orthopedics, Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Klemens Trieb
- Department of Orthopedics, Paracelsus Medical University, 5020, Salzburg, Austria.
- Division for Orthopaedics and Traumatology, Center for Clinical Medicine, Danube Private University, 3500, Krems, Austria.
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Tidd JL, Gudapati LS, Simmons HL, Klika AK, Pasqualini I, Piuzzi NS. Do Patients With Hypoallergenic Total Knee Arthroplasty Implants for Metal Allergy Do Worse? An Analysis of Health Care Utilizations and Patient-Reported Outcome Measures. J Arthroplasty 2024; 39:103-110. [PMID: 37454947 DOI: 10.1016/j.arth.2023.07.005] [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: 02/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Metal allergy is a rare and controversial cause of implant failure and poor outcomes following total knee arthroplasty (TKA). Few studies have investigated clinical and patient-reported outcome measures (PROMs) in patients treated with hypoallergenic implants. This investigation aimed to compare: (1) health care utilizations (eg, hospital length of stay, 90-day readmission rate, and incidence of nonhome discharge) and (2) 1-year PROMs between patients who received hypoallergenic and standard TKA implants. METHODS This was a retrospective review of prospectively collected data from patients who underwent primary TKA between 2018 and 2019. Propensity score matching (3:1) was used to compare standard TKA patients with those who received hypoallergenic TKA implants, respectively. Knee injury and Osteoarthritis Outcome Score (KOOS) pain, KOOS Physical function Shortform (PS), and Veterans RAND 12-Item Health Survey Mental Component Score were collected preoperatively and at 1-year. After matching, 190 hypoallergenic and 570 standard TKAs were analyzed. RESULTS No differences were observed in length of stay (P = .98), 90-day readmission (P = .89), and nonhome discharge (P = .82). Additionally, there was no significant difference in change from preoperative to 1-year PROMs (KOOS pain, P = .97; KOOS PS, P = .88; Veterans RAND 12-Item Health Survey Mental Component Score, P = .28). Patient-reported satisfaction was similar at 1-year (P = .23). Patients achieved similar rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for KOOS pain (PASS, P = .77; MCID, P = .33) and KOOS PS (PASS, P = .44; MCID, P = .65). CONCLUSION Patients treated with hypoallergenic TKA implants for suspected metal allergy had similar outcomes compared to patients who had standard implants and no metal allergy.
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Affiliation(s)
- Joshua L Tidd
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | | | - Hannah L Simmons
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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Mödinger Y, Anttila ED, Baker GM, Gross DC, Porporati AA. Magnetic Resonance Safety Evaluation of a Novel Alumina Matrix Composite Ceramic Knee and Image Artifact Comparison to a Metal Knee Implant of Analogous Design. Arthroplast Today 2023; 22:101170. [PMID: 37521740 PMCID: PMC10374871 DOI: 10.1016/j.artd.2023.101170] [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: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
Background Image artifacts caused by metal knee implants in 1.5T and 3T magnetic resonance imaging (MRI) systems complicate imaging-based diagnosis of the peri-implant region after total knee arthroplasty. Alternatively, metal-free knee prostheses could effectively minimize MRI safety hazards and offer the potential for higher quality diagnostic images. Methods A novel knee arthroplasty device composed of BIOLOX delta, an alumina matrix composite (AMC) ceramic, was tested in a magnetic resonance (MR) environment. American Society for Testing and Materials test methods were used for evaluating magnetically induced displacement force, magnetically induced torque, radiofrequency-induced heating, and MR image artifact. Results Magnetically induced displacement force and magnetically induced torque results of the AMC ceramic knee indicated that these effects do not pose a known risk in a clinical MR environment, as assessed in a 3T magnetic field. Moreover, minimal radiofrequency-induced heating of the device was observed. In addition, the AMC ceramic knee demonstrated minimal MR image artifacts (7 mm) in comparison to a cobalt-chromium knee (88 mm). The extremely low magnetic susceptibility of AMC (2 ppm) underlines that it is a nonmetallic and nonmagnetic material well suited for the manufacturing of MR Safe orthopaedic implants. Conclusions The AMC ceramic knee is a novel metal-free total knee arthroplasty device that can be regarded as MR Safe, as suggested by the absence of hazards from the exposure of this implant to a MR environment. The AMC ceramic knee presents the advantage of being scanned with superior imaging results in 3T MRI systems compared to alternative metal implants on the market.
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Affiliation(s)
- Yvonne Mödinger
- Medical Products Division, CeramTec GmbH, Plochingen, Germany
| | | | | | | | - Alessandro A. Porporati
- Medical Products Division, CeramTec GmbH, Plochingen, Germany
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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Podzimek S, Himmlova L, Janatova T, Bjørklund G, Vrbova R, Janovska M, Peana M, Chasapis CT, Vinsu A, Prochazkova J, Duskova J. Metal hypersensitivity and pro-inflammatory cytokine production in patients with failed orthopedic implants: A case-control study. Clin Immunol 2022; 245:109152. [DOI: 10.1016/j.clim.2022.109152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
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Trieb K, Artmann A, Krupa M, Senck S, Landauer F. Evaluation of temperature of a full ceramic total knee arthroplasty during MRI examinations. Medicine (Baltimore) 2022; 101:e30685. [PMID: 36181043 PMCID: PMC9524968 DOI: 10.1097/md.0000000000030685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A diagnosis by magnetic resonance imaging (MRI) is often necessary before surgery of degenerative spine diseases. This can lead to a possible conflict with an inserted implant of the hip or knee. Heat generation or movement could be caused by the magnetic field. The aim of this study is to investigate temperature development in vitro in a 1.5T MRI of a ceramic knee arthroplasty. METHODS A full ceramic, complete metal-free non-constrained primary total knee arthroplasty is investigated. Temperature change was measured between platinum resistors before and after each MRI sequence by change of resistance. The knee implant was placed in a plastic container after the sensors were attached. Then the container was completely filled with ultrasound gel. To document any possible movement of the implant, a grid was placed under the container to document the position of the implant before and after the scans. RESULTS A total of four standard knee sequences were performed. The temperature at sites 1 to 5 per implant was always documented in the as-is state before MRI and then after each sequence. A total of 5 temperature measurement points were taken per implant. It was found that there were extremely small temperature variations. These were always in the range of less than 1°C. There was no case of movement of the implant triggered by the MRI scan. CONCLUSIONS The experimental investigations carried out here showed homogeneous results with this experimental setup. It is concluded that, at least in vitro, that this ceramic knee implant can be used in MRI examinations without heating or movement.
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Affiliation(s)
- Klemens Trieb
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
- Division for Orthopaedics and Traumatology, Center for Clinical Medicine, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
- *Correspondence: Klemens Trieb, Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllnerhauptstraße 48, 5020 Salzburg, Austria (e-mail: )
| | - Andreas Artmann
- Institute for Radiology, Competence Center Health, St. Stephan Wels, Austria
| | - Michael Krupa
- Institute for Radiology, Competence Center Health, St. Stephan Wels, Austria
| | - Sasch Senck
- Computed Tomography Research Group, University of Applied Sciences, Upper Austria, Wels, Austria
| | - Franz Landauer
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
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