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Postler A, Beyer F, Lützner C, Tille E, Lützner J. Similar outcome during short-term follow-up after coated and uncoated total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2018; 26:3459-3467. [PMID: 29616285 DOI: 10.1007/s00167-018-4928-0] [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: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Patients with known hypersensitivity to metals often require hypoallergenic TKA implants. Coating of a standard implant is a common solution, and although in vitro tests have demonstrated reduction of polyethylene wear for these coatings, it is still unknown whether these implants have any clinical benefit. This study was initiated to investigate metal ion concentrations, knee function and patient-reported outcome (PRO) after coated and uncoated TKA. METHODS One hundred and twenty-two (122) patients were randomized to receive a coated or a standard TKA and, after exclusions, 59 patients were included in each group. Knee function and PRO were assessed with validated scores up to 3 years after surgery. Metal ion concentrations in blood samples were determined for chromium, cobalt, molybdenum and nickel, preoperatively and 1 year after surgery. RESULTS Chromium concentrations in patient plasma increased from a median of 0.25 to 1.30 µg/l in the standard TKA group, and from 0.25 to 0.75 µg/l in the coated TKA group (p = 0.012). Thirteen patients (3 coated, 10 standard TKA) had chromium concentrations above 2 µg/l. The concentrations of cobalt, molybdenum and nickel did not change. Patient-reported outcome measures (PROM) demonstrated a substantial improvement after TKA, without any differences between the groups. CONCLUSION The increase in chromium concentration in the standard group needs further investigation. If surgeons use coated implants, they can be confident that these implants perform as well as standard implants. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Eric Tille
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Conlisk N, Howie CR, Pankaj P. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit. Knee 2017; 24:994-1005. [PMID: 28778499 DOI: 10.1016/j.knee.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/12/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. METHODS Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. RESULTS The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. CONCLUSION In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; School of Engineering, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Howie
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, UK
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Beyer F, Lützner C, Kirschner S, Lützner J. Midterm Results After Coated and Uncoated TKA: A Randomized Controlled Study. Orthopedics 2016; 39:S13-7. [PMID: 27219721 DOI: 10.3928/01477447-20160509-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 02/03/2023]
Abstract
Patients undergoing total knee arthroplasty (TKA) who have hypersensitivity to metals usually receive hypoallergenic TKA implants. Coating of a standard implant is a common solution. Although in vitro tests have demonstrated reduction in polyethylene wear for these coatings, it is unknown whether these costly implants have a clinical benefit for patients. One hundred twenty patients undergoing TKA were randomly assigned to receive a novel 7-layer-coating implant or a standard TKA implant. One revision occurred in the standard group, resulting in a calculated 5-year survival of 100% in the coated group and 98.1% in the standard group. The Oxford Knee Score improved substantially in both groups from a mean of 21.6 points preoperatively in the coated group and 21.9 points in the standard group to 39.2 points and 39.2 points, respectively. The current authors observed no adverse effects with the new coating during midterm follow-up. However, longer follow-up time is needed to evaluate possible advantages of this coating. [Orthopedics. 2016; 39(3):S13-S17.].
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Bergschmidt P, Bader R, Ganzer D, Hauzeur C, Lohmann CH, Krüger A, Rüther W, Tigani D, Rani N, Esteve JL, Prats FL, Zorzi C, Madonna V, Rigotti S, Benazzo F, Rossi SMP, Mittelmeier W. Prospective multi-centre study on a composite ceramic femoral component in total knee arthroplasty: Five-year clinical and radiological outcomes. Knee 2015; 22:186-91. [PMID: 25805085 DOI: 10.1016/j.knee.2015.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/02/2015] [Accepted: 02/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Enhanced wear resistance of ceramics in general and improved mechanical characteristics of composite ceramics in terms of strength and resistance meet the demands for application in TKA. The aim of this prospective international multi-centre study was to evaluate the 5-year clinical and radiological outcomes of an unconstrained TKA with a composite ceramic femoral component. METHODS A total of 107 patients (109 knees) underwent TKA with the MULTIGEN-PLUS Ceramic Knee at seven centres in three European countries. Clinical and radiological assessments were performed preoperatively and postoperatively at 3, 12, 24 and 60 months, using HSS, WOMAC, SF-36 and standardised radiographs. RESULTS Mean HSS and WOMAC increased significantly from 55.1±11.5 (21-83) and 48.1±16.6 (3-90) preoperatively to 85.6±9.6 (49-98) and 73.3±20.4 (17-100) at 60 months. Mean SF-36 showed significant improvements in patients' quality of life (49.1±17.6 (12-96) preoperatively versus 67.7±23.1 (12-100) at 60 months). Non-progressive radiolucent lines (<1 mm) were observed around the femoral component in four cases. Neither implant migration nor loosening were registered. Kaplan-Meier survivorship was 96.0% at 60 months (92.1-100%, CI 95%). CONCLUSIONS Five-year implant survival rate of the ceramic knee is comparable to other metallic and ceramic unconstrained TKA systems. Although the assessment of long-term implant survivorship is still pending, the ceramic implants represent a promising solution for patients with allergies against metallic components and furthermore for the general osteoarthritis population due to enhanced wear resistance.
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Affiliation(s)
- Philipp Bergschmidt
- Department of Orthopaedics, University Medicine Rostock, Doberaner Strasse 142, Rostock 18057, Germany.
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Strasse 142, Rostock 18057, Germany
| | - Dirk Ganzer
- Department of Orthopaedics, Klinikum Neubrandenburg, Klosterberg 1a, Altentreptow 17087, Germany
| | - Christian Hauzeur
- Department of Orthopaedics, Klinikum Neubrandenburg, Klosterberg 1a, Altentreptow 17087, Germany
| | - Christoph H Lohmann
- Department of Orthopaedics, University of Magdeburg, Leipziger Strasse 44, Magdeburg 39120, Germany
| | - Alexander Krüger
- Department of Orthopaedics, University of Magdeburg, Leipziger Strasse 44, Magdeburg 39120, Germany
| | - Wolfgang Rüther
- Department of Orthopaedics, University Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Domenico Tigani
- Istituti Ortopedici Rizzoli, 7 Divisione, Via Pupilli 1, Bologna 40136, Italy
| | - Nicola Rani
- Istituti Ortopedici Rizzoli, 7 Divisione, Via Pupilli 1, Bologna 40136, Italy
| | - José Luis Esteve
- Hospital General Universitario de Elche, Camino de la Azara 11, Elche, Alicante, Spain
| | - Fernando Lopez Prats
- Hospital General Universitario de Elche, Camino de la Azara 11, Elche, Alicante, Spain
| | - Claudio Zorzi
- Clinica Ortopedica e Traumatologica, Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, Negrar (VR) 37024, Italy
| | - Vincenzo Madonna
- Clinica Ortopedica e Traumatologica, Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, Negrar (VR) 37024, Italy
| | - Stefano Rigotti
- Clinica Ortopedica e Traumatologica, Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, Negrar (VR) 37024, Italy
| | - Francesco Benazzo
- Clinica Ortopedica e Traumatologica, Fondazione I.R.C.C.S. Policlinico San Matteo, Università di Pavia, V.le Golgi 19, Pavia 27100, Italy
| | - Stefano Marco Paolo Rossi
- Clinica Ortopedica e Traumatologica, Fondazione I.R.C.C.S. Policlinico San Matteo, Università di Pavia, V.le Golgi 19, Pavia 27100, Italy
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Strasse 142, Rostock 18057, Germany
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Ardestani MM, Moazen M, Maniei E, Jin Z. Posterior stabilized versus cruciate retaining total knee arthroplasty designs: conformity affects the performance reliability of the design over the patient population. Med Eng Phys 2015; 37:350-60. [PMID: 25703743 DOI: 10.1016/j.medengphy.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/05/2015] [Accepted: 01/15/2015] [Indexed: 02/01/2023]
Abstract
Commercially available fixed bearing knee prostheses are mainly divided into two groups: posterior stabilized (PS) versus cruciate retaining (CR). Despite the widespread comparative studies, the debate continues regarding the superiority of one type over the other. This study used a combined finite element (FE) simulation and principal component analysis (PCA) to evaluate "reliability" and "sensitivity" of two PS designs versus two CR designs over a patient population. Four fixed bearing implants were chosen: PFC (DePuy), PFC Sigma (DePuy), NexGen (Zimmer) and Genesis II (Smith & Nephew). Using PCA, a large probabilistic knee joint motion and loading database was generated based on the available experimental data from literature. The probabilistic knee joint data were applied to each implant in a FE simulation to calculate the potential envelopes of kinematics (i.e. anterior-posterior [AP] displacement and internal-external [IE] rotation) and contact mechanics. The performance envelopes were considered as an indicator of performance reliability. For each implant, PCA was used to highlight how much the implant performance was influenced by changes in each input parameter (sensitivity). Results showed that (1) conformity directly affected the reliability of the knee implant over a patient population such that lesser conformity designs (PS or CR), had higher kinematic variability and were more influenced by AP force and IE torque, (2) contact reliability did not differ noticeably among different designs and (3) CR or PS designs affected the relative rank of critical factors that influenced the reliability of each design. Such investigations enlighten the underlying biomechanics of various implant designs and can be utilized to estimate the potential performance of an implant design over a patient population.
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Affiliation(s)
- Marzieh M Ardestani
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.
| | - Mehran Moazen
- Medical and Biological Engineering, School of Engineering, University of Hull, Hull, UK
| | - Ehsan Maniei
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, UK
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