Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty

Cerquiglini, Arianna; Henckel, Johann; Hothi, Harry; Dall’Ava, Lorenzo; Shearing, Paul R.; Hirschmann, Michael T.; Hart, Alister

doi:10.1016/j.arth.2018.04.010

Cited by 8 publications

(10 citation statements)

References 38 publications

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“…Differences in thickness between medial and lateral compartments were investigated using a peer reviewed method, based on micro-Computed Tomography (micro-CT) [17].…”

Section: Linear Deformation In Polyethylene Tibial Inserts (Micro-ct)mentioning

confidence: 99%

Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance

Cerquiglini

Henckel

Hothi

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Background With the introduction of the Attune Knee System (DePuy) in March 2013 a new polyethylene formulation incorporating anti-oxidants was used. Although several in vitro studies have demonstrated the positive effects of antioxidants on UHMWPE, no retrieval study has looked at polyethylene damage of this system yet. It was the aim of this study to investigate the in vivo performance of this new design, by comparing it with its predecessors in retrieval analysis. Methods Twenty-four PFC (18 fixed bearing and 6 rotating platform designs) and 17 Attune (8 fixed bearing and 9 rotating platform designs) implants were retrieved. For retrieval analysis a macroscopic analysis of polyethylene components, using a peer-reviewed damage grading method was used. Medio-lateral polyethylene thickness difference was measured with a peerreviewed micro-CT based method. The roughness of metal components was measured. All findings were compared between the two designs. Results Attune tibial inserts with fixed bearings showed significantly higher hood scores on the backside surface when compared with their PFC counterparts (p=0.0150), no other significant differences were found in the polyethylene damage of all the other surfaces analysed, in the surface roughness of metal components and in medio-lateral linear deformations. Conclusion A significant difference between PFC and Attune fixed bearing designs were found in terms of backside surface damage: multiple changes in material and design features could lead to a potential decrease of implant performance. Our results may help to understand how the new Attune Knee System performs in vivo.

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“…Differences in thickness between medial and lateral compartments were investigated using a peer reviewed method, based on micro-Computed Tomography (micro-CT) [17].…”

Section: Linear Deformation In Polyethylene Tibial Inserts (Micro-ct)mentioning

confidence: 99%

Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance

Cerquiglini

Henckel

Hothi

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…The debate around which coronal alignment is best after TKA is not yet resolved. Initially, there was a consensus on the need to restore the neutral femorotibial axis [7], to balance the stresses on both tibiofemoral compartments [2] and to decrease wear of the polyethylene insert, considered to be the weak point of arthroplasty system [3]. This resulted in increasingly sophisticated surgical techniques being used to improve the reproducibility of TKA implantation [1, 11, 13].…”

Section: Discussionmentioning

confidence: 99%

The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty

Jenny

Baldairon

2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to analyze and quantify the changes in native coronal alignment of a population of TKA patients according to diferent alignment goals. Methods Five hundred and twenty TKAs were analyzed. The following angles were measured using an image-free navigation system prior to prosthetic implantation: medial femorotibial mechanical angle without stress and with maximum manual stress to reduce the deformity, medial distal femoral mechanical angle, medial proximal tibial mechanical angle. The native angles were derived from the osteoarthritic knee angles using a validated correction technique, and the overall, femoral and tibial coronal phenotypes were deined. Five diferent coronal alignment techniques were simulated: mechanical (MA), restricted mechanical (RMA), anatomical (AA), kinematic (KA) and restricted kinematic (RKA). The overall, femoral and tibial coronal phenotypes were compared before and after TKA. The primary endpoint was the binary criterion of whether or not TKA restored the natural overall phenotype. Secondary endpoints were the binary criteria of whether or not the natural femoral and tibial phenotypes were restored by TKA. The rates of restored and non restored phenotypes were compared with a Chi-square test at a 0.05 level of signiicance, with post hoc tests between all pairs of techniques at a 0.01 level of signiicance. ResultsThe overall phenotype was restored signiicantly diferently by the ive alignment techniques: 15% for MA, 23% for RMA, 2% for AA, 100% for KA and 79% for RKA (p < 0.001). There was a signiicant diference between each of the technique pairs (p < 0.01 to p < 0.001), except for the mechanical alignment-restricted mechanical alignment pair. The femoral phenotype was restored signiicantly diferently by the ive alignment techniques: 37% for MA, 58% for RMA, 19% for AA, 100% for KA and 85% for RKA (p < 0.001). The tibial phenotype was restored signiicantly diferently by the ive alignment techniques: 36% for MA, 36% for RMA, 17% for AA, 100% for KA and 88% for RKA (p < 0.001). There was a signiicant diference between each pair of techniques for both femoral and tibial phenotypes (p < 0.01 to p < 0.001). Conclusion Except for the kinematic alignment technique, the various alignment techniques induce signiicant changes in the pre-arthritic anatomy of the TKA patient. The surgeon must be aware of these modiications. The clinical relevance of this alteration still needs to be deined. Level of evidence III.

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“…In parallel, several retrieval studies have demonstrated the correlation between implant position and deformation of the polyethylene tibial component [ 14 , 17 , 18 , 19 ]: varus alignments were associated with more deformed medial compartments, whereas valgus alignments were associated with more deformed lateral compartments. Our present study helps to join up these previous clinical and retrieval studies by demonstrating that the compartment with the more extended SPECT/CT signal showed the comparatively thinnest PE thickness.…”

Section: Discussionmentioning

confidence: 99%

“…Retrieval analysis can help us further understand in-vivo implant performance and the influence of position and load distribution [ 14 ]. The association between increased bone tracer uptake in SPECT/CT, representing increased loading of the joint, and findings from retrieval studies have not, however, previously been investigated.…”

Section: Introductionmentioning

confidence: 99%

SPECT/CT Assessment of In-Vivo Loading of the Knee Correlates with Polyethylene Deformation in Retrieved Total Knee Arthroplasty

et al. 2022

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Background: SPECT/CT distribution patterns in patients with total knee replacements have previously been correlated with factors such as time of implantation, implant type and alignment. It is unknown, however, if an increased and more extended bone tracer uptake (BTU) in SPECT/CT, representing loading of the joint, correlates with findings from retrieval studies. The aim of this study was to further understand this subject. Materials and Methods: 62 retrieved TKA were included. SPECT/CT was performed prior to revision. Quantitative and qualitative medio-lateral comparisons of BTU intensity and distribution in the tibia were performed. Retrieval analysis was performed with a micro-CT method to assess the thickness differences between medial and lateral sides of polyethylene inserts with symmetrical designs. Results: In the subgroup of TKA with asymmetrical SPECT/CT distribution, there was a significant correlation between retrieval and medical imaging data (p = 0.0355): patients showing a more extended BTU in the medial compartment also had a significantly thinner insert in the medial compartment, and vice versa in the lateral side. Conclusion: This is the first study comparing BTU distribution patterns and retrieval findings. Our results support the hypothesis that SPECT/CT is able to identify bone activity due to implant position and loading.

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Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty

Abstract: III.

Cited by 8 publications

References 38 publications

Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance

Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance

The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty

SPECT/CT Assessment of In-Vivo Loading of the Knee Correlates with Polyethylene Deformation in Retrieved Total Knee Arthroplasty

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