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Zhao E, Zhu X, Tang H, Luo Z, Zeng W, Zhou Z. Randomized Controlled Trial of a Novel Cementless vs. Cemented Total Knee Arthroplasty: Early Clinical and Radiographic Outcomes. Orthop Surg 2024. [PMID: 39171362 DOI: 10.1111/os.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE Previous cementless total knee arthroplasty (TKA) designs faced challenges with insufficient initial fixation on tibial side, resulting in inferior functional outcomes and survival rates. The Zoned Trabecular Bone Cementless Knee is a novel implant designed for cementless TKA which aims to achieve excellent initial fixation, promoting effective osseointegration. The aim of this research was to compare the early clinical and radiographic results of this cementless TKA with cemented TKA. METHODS Between September 2021 and April 2022, 64 patients (64 knees) were recruited in this prospective randomized controlled trial to receive either cementless 3D-printed trabecular metal TKA or a cemented posterior stabilized TKA. Preoperative and postoperative clinical evaluations, including the range of motion (ROM), Knee Society Score (KSS), and the Reduced Western Ontario and MacMaster Universities Score (WOMAC), were conducted and analyzed for comparison. Radiographs and computed tomography scans were utilized to assess the initial fixation. The complications between the two groups were also recorded and compared. Continuous data were analyzed for significance using independent-samples t-test or the Mann-Whitney U test and categorical data were analyzed using chi-squared or Fisher's exact test. RESULTS Both groups demonstrated significant enhancement at 12 months follow-up in the ROM compared with baseline (ROM: 94.7 ± 23.4 vs. 113.1 ± 12.3 in cementless group and 96.5 ± 14.7 vs. 111.0 ± 12.8 in cemented group, p < 0.05). However, no statistical differences were observed between the two groups in postoperative ROM, KSS, or WOMAC score. The radiographs and computed tomography scans showed similar results, including radiolucent lines and osteolysis in either femoral or tibial. Additionally, there was no statistical difference in the overall complication rate between the two groups. Notably, one patient in the cementless TKA group required revision for periprosthetic infection as the end point. CONCLUSIONS This novel 3D-printed trabecular metal cementless TKA achieved comparable clinical outcomes and initial fixation to cemented TKA in early stage. Longer-term examination is necessary to validate these results.
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Affiliation(s)
- Enze Zhao
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China
| | - Xiaoyan Zhu
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Haiwei Tang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China
| | - Zhenyu Luo
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China
| | - Weinan Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, People's Republic of China
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Chahidi E, Martinov S, Simion F, Mercier C, Sabot L, Kyriakydis T, Callewier A, Hernigou J. Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis. SICOT J 2024; 10:22. [PMID: 38819292 PMCID: PMC11141522 DOI: 10.1051/sicotj/2024017] [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: 03/06/2024] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. METHODS Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. RESULTS When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. CONCLUSION We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period.
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Affiliation(s)
- Esfandiar Chahidi
- Université Libre de Bruxelles Av. Franklin Roosevelt 50 1050 Brussels Belgium
| | - Sagi Martinov
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals Rue Louis Caty 136 7331 Saint-Ghislain Hainaut Belgium
| | - Filip Simion
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals Rue Louis Caty 136 7331 Saint-Ghislain Hainaut Belgium
| | - Camille Mercier
- Université Libre de Bruxelles Av. Franklin Roosevelt 50 1050 Brussels Belgium
| | - Liam Sabot
- Université Libre de Bruxelles Av. Franklin Roosevelt 50 1050 Brussels Belgium
| | - Theofylaktos Kyriakydis
- 2nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, “G. Gennimatas” General Hospital Thessaloniki Hellas Greece
| | - Antoine Callewier
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals Rue Louis Caty 136 7331 Saint-Ghislain Hainaut Belgium
| | - Jacques Hernigou
- Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals Rue Louis Caty 136 7331 Saint-Ghislain Hainaut Belgium
- Laboratoire de Biochimie Osseuse et Métabolique ULB, Bone and Metabolic Biochemistry Research Laboratory, Université Libre de Bruxelles Lenniksebaan 808 1070 Brussels Belgium
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Khetan V, Baxter I, Hampton M, Spencer A, Anderson A. Cementless total knee arthroplasty in young patients using tantalum trabecular implants results in significantly lower rates of aseptic loosening. Bone Jt Open 2024; 5:277-285. [PMID: 38583872 PMCID: PMC10999277 DOI: 10.1302/2633-1462.54.bjo-2023-0132.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Aims The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery. Methods A total of 454 consecutive patients who underwent cementless TKA between August 2004 and December 2021 were reviewed. The mean follow-up was ten years. Plain radiographs were analyzed for radiolucent lines. Patients who underwent revision TKA were recorded, and the cause for revision was determined. Data from the National Joint Registry for England, Wales, Northern Island, the Isle of Man and the States of Guernsey (NJR) were compared with our series. Results No patients in our series had evidence of radiolucent lines on their latest radiological assessment. Only eight patients out of 454 required revision arthroplasty, and none of these revisions were indicated for aseptic loosening of the tibial baseplate. When compared to data from the NJR annual report, Kaplan-Meier estimates from our series (2.94 (95% confidence interval (CI) 1.24 to 5.87)) show a significant reduction in cumulative estimates of revision compared to all cemented (4.82 (95% CI 4.69 to 4.96)) or cementless TKA (5.65 (95% CI 5.23 to 6.10)). Our data (2.94 (95% CI 1.24 to 5.87)) also show lower cumulative revision rates compared to the most popular implant (PFC Sigma Cemented Knee implant fixation, 4.03 (95% CI 3.75 to 4.33)). The prosthesis time revision rate (PTIR) estimates for our series (2.07 (95% CI 0.95 to 3.83)) were lower than those of cemented cases (4.53 (95% CI 4.49 to 4.57)) from NJR. Conclusion The NexGen trabecular (tantalum) cementless implant has lower revision rates in our series compared to all cemented implants and other types of cementless implants, and its use in younger patients should be encouraged.
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Affiliation(s)
- Vatsal Khetan
- Netaji Subhash Chandra Bose District Hospital, Gorakhpur, Uttar Pradesh, India
- Trauma and Orthopaedics, The Rotherham NHS Foundation Trust Hospital, Rotherham, UK
| | - Ian Baxter
- Trauma and Orthopaedics, Alder Hey Children’s Hospital, Liverpool, UK
| | - Matthew Hampton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Amy Spencer
- Statistical Services Unit, University of Sheffield, Sheffield, UK
- Exploristics, Belfast, UK
| | - Alexander Anderson
- Trauma and Orthopaedics, The Rotherham NHS Foundation Trust Hospital, Rotherham, UK
- University of Sheffield, Sheffield, UK
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Wojtowicz R, Otten V, Henricson A, Crnalic S, Nilsson KG. Uncemented trabecular metal high-flex posterior-stabilized monoblock total knee arthroplasty in patients aged 60 years or younger. Knee 2024; 46:99-107. [PMID: 38070382 DOI: 10.1016/j.knee.2023.11.006] [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: 07/20/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Uncemented trabecular metal (TM) monoblock tibial components in total knee arthroplasty (TKA) have shown excellent clinical results for up to 10 years. However, these studies were performed in highly specialized units, with few surgeons and often excluding knees with secondary osteoarthritis (OA), severe malalignments and previous surgery. The purpose of this study was to investigate implant survivorship and clinical and radiological outcome of the uncemented TM high-flex posterior stabilized (PS) monoblock tibial component in routine clinical practice. METHODS A retrospective study of 339 knees (282 patients) operated with the implant in routine clinical practice at two hospitals on patients aged 60 years or younger between 2007 and 2015. The operations were performed by 12 surgeons and there were no specific contraindications for use of the implant. Follow up ended in 2020. The status of the implant of deceased patients at death and those not attending follow up was checked with the Swedish Knee Arthroplasty Register. Clinical follow up consisted of clinical investigation, PROMs, and knee X-ray. RESULTS Follow up was mean (range) 8.5 (5-13.8) years, and the 8-year survival rate was 0.98 (standard error 0.007). Five patients five knees) were deceased, five knees were revised (none due to aseptic loosening), and 16 patients did not attend the clinical follow up. Forty-four percent of the knees had secondary OA and 45% had had previous operations. 93% were satisfied or very satisfied with the operation and forgotten joint score (FJS) was median (interquartile range) 81 (44-94). Radiographic analysis revealed bone in close contact with the tibial tray and pegs in most cases, and in only 2% of the knees were potential radiolucent lines found. CONCLUSION The results indicate that this uncemented implant performs excellently in routine clinical practice and also in younger patients with secondary OA or previous knee operations.
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Affiliation(s)
- Radoslaw Wojtowicz
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden.
| | - Volker Otten
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
| | - Anders Henricson
- Department of Orthopedics, Falun General Hospital, Falun, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
| | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences - Orthopedics, Umeå University, Umeå, Sweden
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5
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Puijk R, Sierevelt IN, Pijls BGCW, Spekenbrink-Spooren A, Nolte PA. Increased risk of aseptic loosening for posterior stabilized compared with posterior cruciate-retaining uncemented total knee replacements: a cohort study of 13,667 knees from the Dutch Arthroplasty Registry. Acta Orthop 2023; 94:600-606. [PMID: 38093649 PMCID: PMC10719730 DOI: 10.2340/17453674.2023.33283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND PURPOSE While registry studies have suggested a higher risk of revision for posterior-stabilized (PS) compared with posterior cruciate-retaining (CR) total knee replacements (TKR) using cement, it is unknown whether this is also the case for uncemented TKR. We aimed to compare the revision rates of PS and CR designs in patients receiving primary uncemented TKR. PATIENTS AND METHODS Data from the Dutch arthroplasty register (LROI) was analyzed, comprising 12,226 uncemented primary CR TKRs and 750 uncemented PS TKRs registered between 2007 and 2022. Competing risk and multivariable Cox regression analyses were used to compare revision rates, risks of revision, and reasons for revision between groups. Sensitivity analyses were performed to analyze the risk, concerning the 5 most commonly used implants and performing hospitals for each group. RESULTS Uncemented PS TKRs had higher 10-year revision rates for any reason and aseptic loosening (6.5%, 95% confidence interval [CI] 4.6-9.2 and 3.9%, CI 2.6-6.7) compared with uncemented CR TKRs (4.2%, CI 3.8-4.7 and 1.4%, CI 1.2-1.7). PS TKRs were 1.4 and 2.5 times more likely to be revised for any reason and aseptic loosening, respectively. These results remained consistent after adjustment for age, sex, BMI, previous surgeries, bearing mobility, and surface modification, with sensitivity analyses. CONCLUSION We found that uncemented PS implants have a higher rate of revision than uncemented CR implants, mainly due to a higher risk of aseptic loosening.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp.
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp; Department of Orthopaedic Surgery, Xpert Clinics Orthopedic Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam
| | - Bart G C W Pijls
- Landelijke Registratie Orthopedische Interventies (LROI; Dutch Arthroplasty Register), Bruistensingel 230, 5232 AD, 's Hertogenbosch; Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Anneke Spekenbrink-Spooren
- Landelijke Registratie Orthopedische Interventies (LROI; Dutch Arthroplasty Register), Bruistensingel 230, 5232 AD, 's Hertogenbosch
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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6
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Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [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: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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Puijk R, Puijk RH, Laende EK, Dunbar MJ, Plevier JWM, Nolte PA, Pijls BGCW. 6-month migration sufficient for evaluation of total knee replacements: a systematic review and meta-analysis. Acta Orthop 2023; 94:577-587. [PMID: 38038237 PMCID: PMC10690979 DOI: 10.2340/17453674.2023.24579] [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] [Received: 04/22/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND PURPOSE This updated meta-analysis evaluates the migration pattern of the tibial component of primary total knee replacements measured with radiostereometric analysis (RSA). We aimed to evaluate whether 6-month maximum total point motion (MTPM) values could be used instead of 1-year MTPM for RSA threshold testing and to present the pooled migration patterns for different implant designs that can be used as a benchmark. PATIENTS AND METHODS The search included all published RSA studies on migration patterns of tibial components until 2023. Study groups were classified according to their prosthesis brand, fixation, and insert (PFI). Sub-analyses were performed to compare the mean tibial component migration patterns of different implant variables, stratified according to fixation. RESULTS 96 studies (43 new studies), including 197 study groups and 4,706 knees, were included. Most migration occurred within the first 6 postoperative months (126 study groups: mean 0.58 mm, 95% confidence interval [CI] 0.50-0.65), followed by minimal migration between 6 and 12 months (197 study groups: mean 0.04 mm, CI 0.03-0.06), irrespective of the fixation method used. Distinct migration patterns were observed among the different fixation methods. No differences were found in migration patterns among cemented components in any of the sub-group analyses conducted. For uncemented implants, trabecular metal surfaced components seemed to migrate less than porous-coated or uncoated components Conclusion: Based on the small difference between MTPM values at 6 months and 1 year, MTPM at 6 months could be used instead of MTPM at 1 year for RSA threshold testing. The pooled migration patterns can be used as benchmark for evaluation of new implants by defining fixation-specific RSA thresholds when combined with implant survival.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - Rowan H Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Elise K Laende
- Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - José W M Plevier
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bart G C W Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Andersen MR, Winther N, Lind T, Schrøder H, Flivik G, Petersen MM. Tibial Component Undersizing Is Related to High Degrees of Implant Migration Following Cementless Total Knee Arthroplasty: A Study of Radiostereometric Analysis Data for 111 Patients with 2-Year Follow-up. JB JS Open Access 2023; 8:e23.00032. [PMID: 37575962 PMCID: PMC10412432 DOI: 10.2106/jbjs.oa.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Radiostereometric analysis (RSA) studies have shown that the continuous migration of tibial components is predictive of aseptic loosening following total knee arthroplasty (TKA). In the present study, we investigated whether accurate sizing and placement of tibial components are related to the degree of implant migration as measured with use of RSA. Methods A total of 111 patients who underwent TKA surgery with a cementless tibial component were followed for a period of 2 years postoperatively, during which implant migration was assessed with use of RSA. RSA was performed within 7 days postoperatively and after 3, 6, 12, and 24 months. Postoperative radiographs were evaluated for component size and placement in the tibia. The evaluations were performed by experienced knee surgeons who were blinded to the migration data and clinical outcomes. A multivariable linear regression analysis was conducted. Results Continuous implant migration (i.e., migration occurring between 12 and 24 months postoperatively) had a negative association with tibial component size (coefficient [B], -0.2; 95% confidence interval [CI], -0.33 to -0.08). Subsidence was associated with the absence of posterior cortical bone support (B, -0.7; 95% CI, -1.09 to -0.28), the absence of lateral cortical bone support (B, 0.8; 95% CI, 0.29 to 1.37), frontal-plane varus malalignment (B, 0.6; 95% CI, 0.12 to 1.16), and component undersizing (B, -0.4; 95% CI, -0.06 to -0.68). Posterior tilt was associated only with undersizing (B, 0.6; 95% CI, 0.27 to 1.11). Conclusions Undersized cementless tibial components are at a higher risk for poor fixation with continuous migration following TKA. Therefore, a higher risk of aseptic loosening should be expected. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mikkel Rathsach Andersen
- Department of Orthopedics, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Winther
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Lind
- Department of Orthopedics, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Schrøder
- Department of Orthopedics, Næstved Sygehus, Syddansk Universitet, Odense, Denmark
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Michael Mørk Petersen
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Kievit AJ, Buijs GS, Dobbe JGG, Ter Wee A, Kerkhoffs GMMJ, Streekstra GJ, Schafroth MU, Blankevoort L. Promising results of an non-invasive measurement of knee implant loosening using a loading device, CT-scans and 3D image analysis. Clin Biomech (Bristol, Avon) 2023; 104:105930. [PMID: 36906985 DOI: 10.1016/j.clinbiomech.2023.105930] [Citation(s) in RCA: 1] [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: 11/25/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND After total knee arthroplasty up to 13% requires revision surgery to address loosening. No current diagnostic modalities have a sensitivity or specificity higher than 70-80% to detect loosening, leading to 20-30% of patients undergoing unnecessary, risky and expensive revision surgery. A reliable imaging modality is required to diagnose loosening. This study presents a new and non-invasive method and evaluates its reproducibility and reliability in a cadaveric study. METHODS Ten cadaveric specimens were implanted with a loosely fitted tibial components and CT scanned under load towards valgus and varus using a loading device. Advanced three-dimensional imaging software was used to quantify displacement. Subsequently, the implants were fixed to the bone and scanned to determine the differences between the fixed and the loose state. Reproducibility errors were quantified using a frozen specimen in which displacement was absent. FINDINGS Reproducibility errors, expressed as mean target registration error, screw-axis rotation and maximum total point motion were 0.073 mm (SD 0.033), 0.129 degrees (SD 0.039) and 0.116 mm (SD 0.031), respectively. In the loose condition, all displacements and rotation changes were larger than the reported reproducibility errors. Comparing the mean target registration error, screw axis rotation and maximum total point motion in the loose condition to the fixed condition resulted in mean differences of 0.463 mm (SD 0.279; p = 0.001), 1.769 degrees (SD 0.868; p < 0.001) and 1.339 mm (SD 0.712; p < 0.001), respectively. INTERPRETATION The results of this cadaveric study show that this non-invasive method is reproducible and reliable for detection of displacement differences between fixed and loose tibial components.
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Affiliation(s)
- Arthur J Kievit
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - George S Buijs
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Johannes G G Dobbe
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Annemiek Ter Wee
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Geert J Streekstra
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Matthias U Schafroth
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Leendert Blankevoort
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
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Quevedo González FJ, Sculco PK, Kahlenberg CA, Mayman DJ, Lipman JD, Wright TM, Vigdorchik JM. Undersizing the Tibial Baseplate in Cementless Total Knee Arthroplasty has Only a Small Impact on Bone-Implant Interaction: A Finite Element Biomechanical Study. J Arthroplasty 2023; 38:757-762. [PMID: 36280162 DOI: 10.1016/j.arth.2022.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The tibial component in total knee arthroplasty (TKA) is often chosen to maximize coverage of the tibial cut, which can result in excessive internal rotation of the component. Optimal rotational alignment may require a smaller baseplate with suboptimal coverage that could threaten fixation. We asked: "does undersizing the tibial component of a cementless TKA to gain external rotation increase the risk of bone failure?" METHODS We developed computational finite element (FE) analysis models from the computed tomography (CT) scans of 12 patients scheduled for primary TKA. The models were implanted with a cementless tibial baseplate that maximized coverage and one or two sizes smaller and externally rotated by 5°. We calculated the risk of bone collapse under loads representative of stair ascent. RESULTS Undersizing the implant increased the area at risk of collapse for eight patients. However, the area at risk of collapse for the undersized implant (range, 5.2%-16.4%) was no different (P = .24) to the optimally sized implant (range, 4.5%-17.9%). The bone at risk of collapse was concentrated along the posterior edge of the implant. The area at risk of collapse was not proportional to implant size, and for four subjects undersizing the implant actually decreased the area at risk of collapse. CONCLUSION While implants should maximize coverage of the tibial cut and seek support on dense bone, undersizing the tibial component to gain external rotation had minimal impact on the load transfer to the underlying bone. This FE analysis model of a cementless tibial baseplate may require further validation and additional studies to investigate the long-term biomechanical effects of undersizing the tibial baseplate. In conclusion, while surgeons should strive to use the appropriate tibial baseplate for each patient, our model identified only minor biomechanical consequences of undersizing the implant for the immediate postoperative bone-implant interaction and implant subsidence.
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Affiliation(s)
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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11
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HENRICSON A, UNDÉN A, CARLSSON Å, JEHPSSON L, ROSENGREN B. Outcomes of trabecular metal total ankle replacement: a longitudinal observational cohort study of 239 consecutive cases from the Swedish Ankle Registry. Acta Orthop 2022; 93:689-695. [PMID: 35919022 PMCID: PMC9348131 DOI: 10.2340/17453674.2022.4387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Information on outcomes after some modern total ankle replacement (TAR) designs is scarce. We therefore examined outcomes after trabecular metal (TM) TAR in Sweden by use of data from the national registry. PATIENTS AND METHODS On December 31, 2020, 239 primary TM TARs had been reported to the Swedish Ankle Registry. We analyzed prosthesis survival probability, using exchange or permanent extraction of components as endpoint for 239 protheses with mean follow-up of 2.2 years (0.1-6.6), risk of revision, as well as patient-reported outcome measures (SEFAS/EQ-5D/EQ-VAS) and satisfaction with surgery. RESULTS 7/239 prostheses (3%) had been revised by December 31, 2020. We found an overall prosthesis survival probability of 95% (95% CI 89-98) after 3 years. 2 years after surgery 81% of the answering patients were satisfied or very satisfied with surgery and patients reported median SEFAS 36 (max 48), EQ-5D 0.90 (max 1), and EQ-VAS 80 (max 100). INTERPRETATION We found short- to mid-term outcomes after TM TAR to be at least as good as after other TAR designs regarding prosthesis survival and patient-reported satisfaction.
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Affiliation(s)
- Anders HENRICSON
- Department of Orthopedics, Falu Central Hospital and Center of Clinical Research Dalecarlia, Falun
| | - Alexandra UNDÉN
- Department of Radiology, Skåne University Hospital, Malmö,Department of Clinical Sciences Malmö (IKVM), Lund University
| | - Åke CARLSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Lars JEHPSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Björn ROSENGREN
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
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Lin H, Xu A, Wu H, Xu H, Lu Y, Yang H. Effect of Proprioception and Balance Training Combined with Continuous Nursing on BBS Score and HSS Score of Patients Undergoing Total Knee Arthroplasty. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7074525. [PMID: 35813432 PMCID: PMC9270129 DOI: 10.1155/2022/7074525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Background Total knee arthroplasty is one of the most effective methods for the treatment of end-stage knee osteoarthritis, but 10% of patients still show insufficient function, strength, and mobility. Continuous nursing service plays an important role in the rehabilitation of patients undergoing total knee arthroplasty. For discharged and convalescent patients, the traditional follow-up model cannot solve the nursing problems of discharged patients. How to meet the health needs of discharged patients under the limited nursing resources has become an existing problem. Objective To explore the effect of proprioception and balance training combined with continuous nursing on Berg balance scale (BBS) score and Hospital for Special Surgery (HSS) score of patients undergoing total knee arthroplasty (TKA) is the objective of this study. Methods Sixty patients undergoing TKA in our hospital from December 2019 to April 2021 were enrolled. The patients were randomly assigned into the control group and the study group. The control group received continuous nursing, and the study group received proprioception and balance training combined with continuous nursing. Results The nursing satisfaction of the study group was higher than that of the control group (P < 0.05). The HSS scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were higher than those in the control group (P < 0.05). It was higher in the study group than in the control group at 1 month, 3 months, and 6 months after discharge (P < 0.05). The pain catastrophizing score of the study group at discharge was lower than that of the control group at 1 month, 3 months, and 6 months after discharge (P < 0.05). The BBS scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were higher than those in the control group (P < 0.05). The Lindmark balance scores at discharge, 1 month, 3 months, and 6 months after discharge in the study group were lower than those in the control group (P < 0.05). Conclusion Proprioception and balance training combined with continuous nursing can effectively promote the recovery of knee joint function of patients after TKA, enhance patients' pain catastrophizing grade, enhance patients' quality of life, effectively promote patients' knee joint function and BBS score, and promote the improvement of disease.
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Affiliation(s)
- Hong Lin
- Department of Orthopedics, Hangzhou First People's Hospital, China
| | - Aihua Xu
- Department of Orthopedics, Hangzhou First People's Hospital, China
| | - Heping Wu
- Department of Orthopedics, Hangzhou First People's Hospital, China
| | - Hanchun Xu
- Department of Orthopedics, Hangzhou First People's Hospital, China
| | - Yifang Lu
- Department of Orthopedics, Hangzhou First People's Hospital, China
| | - Hongping Yang
- Department of Orthopedics, Hangzhou First People's Hospital, China
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13
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Øhrn FD, Lian ØB, Tsukanaka M, Röhrl SM. Early migration of a medially stabilized total knee arthroplasty : a radiostereometric analysis study up to two years. Bone Jt Open 2021; 2:737-744. [PMID: 34493056 PMCID: PMC8479839 DOI: 10.1302/2633-1462.29.bjo-2021-0115.r1] [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] [Indexed: 11/25/2022] Open
Abstract
Aims Medial pivot (MP) total knee arthroplasties (TKAs) were designed to mimic native knee kinematics with their deep medial congruent fitting of the tibia to the femur almost like a ball-on-socket, and a flat lateral part. GMK Sphere is a novel MP implant. Our primary aim was to study the migration pattern of the tibial tray of this TKA. Methods A total of 31 patients were recruited to this single-group radiostereometric analysis (RSA) study and received a medial pivot GMK Sphere TKA. The distributions of male patients versus female patients and right versus left knees were 21:10 and 17:14, respectively. Mean BMI was 29 kg/m2 (95% confidence interval (CI) 27 to 30) and mean age at surgery was 63 years (95% CI 61 to 66). Maximum total point motions (MTPMs), medial, proximal, and anterior translations and transversal, internal, and varus rotations were calculated at three, 12, and 24 months. Patient-reported outcome measure data were also retrieved. Results MTPMs at three, 12, and 24 months were 1.0 mm (95% CI 0.8 to 1.2), 1.3 mm (95% CI 0.9 to 1.7), and 1.4 mm (0.8 to 2.0), respectively. The Forgotten Joint Score was 79 (95% CI 39 to 95) and Knee Injury and Osteoarthritis Outcome Score obtained at two years was 94 (95% CI 81 to 100), 86 (95% CI 75 to 93), 94 (95% CI 88 to 100), 69 (95% CI 48 to 88), and 81 (95% CI59 to 100) for Pain, Symptoms, Activities of Daily Living, Sport & Recreation, and Quality of Life, respectively. Conclusion In conclusion, we found that the mean increase in MTPM was lower than 0.2 mm between 12 and 24 months and thus apparently stable. Yet the GMK Sphere had higher migration at one and two years than anticipated. Based on current RSA data, we therefore cannot conclude on the long-term performance of the implant, pending further assessment. Cite this article: Bone Jt Open 2021;2(9):737–744.
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Affiliation(s)
- Frank-David Øhrn
- Kristiansund Hospital, Møre and Romsdal Health Trust, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Bjerkestrand Lian
- Kristiansund Hospital, Møre and Romsdal Health Trust, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan Maximillian Röhrl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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