Clinical Results of Oxidized Zirconium Femoral Component in TKA. A Review of Long-Term Survival

Civinini, Roberto; Matassi, Fabrizio; Carulli, Christian; Sirleo, Luigi; Lepri, Andrea Cozzi; Innocenti, Massimo

doi:10.1007/s11420-016-9512-x

Cited by 12 publications

(4 citation statements)

References 17 publications

(16 reference statements)

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“…It is produced by heating a zirconium alloy in air (97.5% zirconium + 2.5% niobium), forming a hard 5-μm outer oxidized surface that is over twice the hardness of a cobalt-chromium alloy, giving it the strength of a metal while also avoiding the risk of brittle fracture that can occur with ceramic [ [5] , [6] , [7] ]. Oxidized zirconium implants were initially introduced as an alternative bearing surface to reduce polyethylene wear and aseptic loosening in TKA and have demonstrated improved survival rates [ 8 ]. Owing to its proposed benefits, oxidized zirconium has been used in patients with metal sensitivities [ 9 , 10 ] and in revision after metallosis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability

et al. 2020

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Oxidized zirconium was introduced as an alternative bearing surface to decrease polyethylene wear and reduce aseptic mechanical failure of hip and knee arthroplasties. Oxidized zirconium combines the strength of a metal with wear properties of ceramic, proposing increased survivorship of implant components, and possible decreased rate of revision. Despite a harder surface than cobalt-chromium, the substrate of zirconium is a softer metal. Although uncommon, prior reports have described accelerated wear and severe metallosis after femoral head dislocation in oxidized zirconium total hip arthroplasty; however, this has not been described in total knee arthroplasty. We report a case of an oxidized zirconium total knee arthroplasty failure in a patient with knee instability. This is the first report of catastrophic failure of an oxidized zirconium total knee arthroplasty implant.

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Section: Introductionmentioning

confidence: 99%

Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability

et al. 2020

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“…Only few experiences have been reported in the literature concerning materials with in vitro high-performing tribological properties compared to the standard ones [ 47 , 48 , 49 , 50 ]. Such series have mainly focused on the use of oxidized zirconium components for younger patients, as well as on metal hypersensitive subjects with survival rates ranging from 100–98.7% at 5–7 years to 97.8% at 10 years [ 51 , 52 ]. Oxidized zirconium is composed of Zr (97.5%) and niobium (2.5%).…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty in Haemophilia: Long-Term Results and Survival Rate of a Modern Knee Implant with an Oxidized Zirconium Femoral Component

Carulli

Innocenti

Tambasco

et al. 2023

JCM

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(1) Background: Total Knee Arthroplasty (TKA) in patient with haemophilia (PWH) has usually been performed with the use of cobalt-chrome femoral and titanium tibial components, coupled with standard polyethylene (PE) inserts. The aim of this retrospective study was to evaluate the long-term outcomes and survival rates of TKA in a series of consecutive PWH affected by severe knee arthropathy at a single institution. (2) Methods: We followed 65 patients undergoing 91 TKA, implanted using the same implant, characterized by an oxidized zirconium femoral component, coupled with a titanium tibial component, and a highly crosslinked PE. At 1, 6, and 12 months; then every year for 5 years; and finally, every other 3 years, all patients were scored for pain (VAS), function (HJHS; KSS), ROM, and radiographic changes. Kaplan–Meier survivorship curves were used to calculate the implant survival rates. (3) Results: The mean follow-up was 12.3 years (4.2–20.6). All clinical and functional scores improved significantly from preoperatively to the latest follow-up (VAS: from 6.9 to 1.3; HJHS: from 13.4 to 1.9; KSS: from 19.4 to 79; ROM: from 42.4° to 83.6°). The overall survivorship of the implants was 97.5% at the latest follow-up. (4) Conclusions: The present series showed a high survival rate of specific implants potentially linked to the choice of an oxidized zirconium coupled with a highly crosslinked PE. We promote the use of modern implants in these patients in order to ensure long-lasting positive outcomes.

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“…To this end, moderately cross-linked polyethylene tibial components and oxidised zirconium femoral components have demonstrated significant improvements. 27,28 Ceramic bearings also have excellent wear properties, are chemically inert and corrosion resistant. Midand long-term survival rates are comparable to commonly used alloy components; its brittleness and therefore potential for implant fractures limited its application previously but more recent generations have eliminated this.…”

Section: Alternative Materials For Tkamentioning

confidence: 99%

Metal hypersensitivity in total knee arthroplasty

King

Royeca

Cunningham

et al. 2020

Journal of Arthroscopy and Joint Surgery

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Metals used in total knee arthroplasty cause hypersensitivity reactions in some patients. These reactions are known to be immune-mediated and are more likely to affect individuals with pre-existing metal sensitivity, but their mechanism is not fully known. It is difficult to predict pre-operatively whether a patient will be affected and there is no reliable investigation to guide implant choice. There appears to be little value in screening all patients for metal sensitivity before implantation as various studies have shown no significant difference in outcomes or failure rates post TKA in patients with history of metal sensitivity. However, the existing assessment tools are not specific enough to identify subtle problems with potential metal sensitivity association.Symptoms of hypersensitivity reactions following total knee arthroplasty are often non-specific and difficult to differentiate from other acute presentations following total knee arthroplasty, for example infection. Metal hypersensitivity reactions are often a diagnosis of exclusion, and for this reason they are most likely under-diagnosed and under-reported. Management is controversial but periprosthetic hypersensitivity reactions will often ultimately require revision if no other cause is found. Metal debris are a concern in total hip arthroplasty and could represent another cause of metal-related pathology in total knee arthroplasty. Non-metallic materials are currently in development which may represent a preventative solution for metal hypersensitivity reactions in total knee arthroplasty, potentially also addressing additional concerns around the use of metallic implants such as the high density and thermal conductivity of the material in comparison with the replaced tissue.

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Clinical Results of Oxidized Zirconium Femoral Component in TKA. A Review of Long-Term Survival

Cited by 12 publications

References 17 publications

Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability

Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability

Total Knee Arthroplasty in Haemophilia: Long-Term Results and Survival Rate of a Modern Knee Implant with an Oxidized Zirconium Femoral Component

Metal hypersensitivity in total knee arthroplasty

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