Aseptic Loosening at the Tibia in Total Knee Arthroplasty: A Function of Cement Mantle Quality?

Hampton, Chadwick B.; Berliner, Zachary P.; Nguyen, Joseph; Mendez, Logan; Smith, Sinéad M.; Joseph, Amethia; Padgett, Douglas E.; Rodríguez, José A.

doi:10.1016/j.arth.2020.02.028

Cited by 48 publications

(32 citation statements)

References 41 publications

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“…For TBR at 2 years after surgery, no correlations were found with the alignment of components at 1 week after surgery in our research (Table S2). Some studies have assessed the correlation between the alignment of components and tibial component loosening or migration [29,[39][40][41]. Our result was similar with that in a previous study, in which Abdel et al [41] discovered that the incidence of tibial loosening did not significantly differ according to coronal alignment.…”

Section: Discussionsupporting

confidence: 90%

“…Some studies have focused on aseptic loosening or TBR in patients undergoing TKA [14,16,29]. Regarding the relationship between the tibial component size and TBR, to date, only one study has reported TBR at 2 years following TKA due to under-hang of the tibial component [14].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that the malalignment of components can cause poor PROMS [22][23][24][25], while some have shown that it does not cause poor PROMS [7,26,27]. Regarding aseptic loosening, many studies have shown that the malalignment of components can result in aseptic loosening in the long-term follow-up, but only a few studies have reported the relationship between the alignment of components and TBR in the short-term follow-up [14,28,29].…”

Section: Introductionmentioning

confidence: 99%

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Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

et al. 2021

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Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

et al. 2021

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“…The diagnosis of implant failure or aseptic loosening was made clinically and radiologically. The Modern Knee Society Radiographic Evaluation System (MKSRES) was used to diagnose loosening around the tibial and femoral components [ 14 ]. A standing scanogram for deformity assessment and a computed tomography (CT) scan to address bone loss were performed in patients who had a primary complex knee deformity as well as during revision surgery.…”

Section: Methodsmentioning

confidence: 99%

“…At each follow-up visit, the patients were asked about possible complications and were evaluated clinically as well as radiologically. Patients’ radiographs were compared with the earliest radiograph performed post-operatively to look for signs of loosening [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Mid-term results and survival rates following a single-design rotating hinge knee arthroplasty in non-tumor conditions in a Pakistani population

Memon

Iqbal²,

Noor

et al. 2021

Knee Surg & Relat Res

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Background Information regarding the use of hinged implants in non-oncological conditions is limited in our region due to a lack of adequate data collection and follow-up. The purpose of this study is to evaluate mid-term results and risk factors affecting the survivorship of third-generation rotating hinge knee (RHK) patients in non-oncological conditions. Methods We retrospectively reviewed 41 single, third-generation, rotating hinge prostheses in three complex primary knee procedures and 38 revision knee surgeries in between 2007 to 2014. Implant survival was assessed using the Kaplan-Meier method. Factors influencing implant survival were identified using the log-rank test. During the study period, clinical results along with complications were assessed. Clinical outcomes were assessed by using the Knee Society Score (KSS). Results RHK arthroplasty was used in 41 patients. Out of 41 patients, a RHK was used in three patients with a complex primary deformed knee whereas in 38 patients, a RHK was used in revision arthroplasty surgery. The cumulative implant survival rate with re-revision due to any cause was found to be 87.8% (95% CI 69.2–90.1) at 5–7 years. Prosthetic joint infection, peri-prosthetic fracture and extensor mechanism complications were the commonest mode of failure. The P value was found to be significant when comparing KSS pre-operatively and post-operatively. Conclusion The cumulative implant survival rate was found to be 87.8%. Prosthetic joint infection was the commonest mode of failure in patients who underwent third-generation RHK surgery for variable indications. Being a patient with a high Charlson comorbidity index is the main risk factor associated with failure of the rotating hinge implant.

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Pulsed lavage is associated with better quality of bone–cement–implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review

Di Maria,

Das,

Abermann

et al. 2024

J. exp. orthop.

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PurposeThe purpose of this systematic review is to analyse the available literature to ascertain the optimal method of bone preparation to improve the quality of bone–cement–implant interface with either pulsed lavage or syringe lavage in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).MethodsA comprehensive search was conducted across MEDLINE, Scopus and Embase databases until July 2023. Both inclusion and exclusion criteria were clearly stated and used to identify all the published studies. Subsequent screening throughout the title, abstract and full text was made, followed by complete critical appraisal and data extraction. This sequential process was performed by two reviewers independently and summarised following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines). A quality assessment of the systematic review was performed according to the Quality Appraisal for Cadaveric Studies scale (QUACS), reaching a quality level ranging from 69% to 85%.ResultsA total of 10 articles, out of 47, nine biomechanical cadaveric studies and one human clinical study were analysed. A total of 196 UKA tibial components, 74 patellar components, 36 TKA tibial components and 24 UKA femoral components were retrieved, and a high level of heterogeneity resulted overall. The pulsed lavage group showed better cement penetration and higher pull‐out force than the syringe lavage group; a higher interface temperature was also found in the pulsed lavage group. No differences were found regarding tension ligament forces between the groups.ConclusionOur systematic review suggests that pulsed lavage is superior to syringe lavage in terms of the quality of bone–cement–implant interface in knee arthroplasties (TKA/UKA). However, translation of these results from cadaveric studies to individual clinical settings may be hazardous; therefore, clinical in vivo prospective studies are highly needed.PROSPERO CRDPROSPERO CRD number CRD42023432399Level of EvidenceLevel III.

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Aseptic Loosening at the Tibia in Total Knee Arthroplasty: A Function of Cement Mantle Quality?

Cited by 48 publications

References 41 publications

Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

Mid-term results and survival rates following a single-design rotating hinge knee arthroplasty in non-tumor conditions in a Pakistani population

Pulsed lavage is associated with better quality of bone–cement–implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review

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