Effect of minimally-invasive implantation of unicompartmental knee arthroplasty on cement penetration and biomechanical stability. An experimental study in human tibiae

Scheele, Christian; Pietschmann, Matthias F.; Schröder, Christian; Grupp, Thomas M.; Holderied, M.; Jansson, Volkmar; Müller, Peter E.

doi:10.1016/j.clinbiomech.2017.11.006

Cited by 4 publications

(8 citation statements)

References 30 publications

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“…In this analysis, it was fundamental for the identification of the significantly increased average bone density in the anterior and posterior area. In combination with the poorer accessibility for jet lavage and the more difficult pressure application, it uncovers the posterior tibial area, analogous to the posterior femoral condyle, as a potential weak point of minimally invasive UKA implantation [11,15]. As regional HU measurements focused on trabecular areas, the less positive correlation between HU and cortical BMD seems plausible.…”

Section: Discussionmentioning

confidence: 99%

“…In view of excellent functional results, good long-term survivorship, and advantages in terms of cost efficiency, unicompartmental knee arthroplasty (UKA) can make a significant contribution to meet the rapidly growing demand for knee arthroplasty [1][2][3][4][5]. Since the aseptic loosening of the tibial component, misinterpretation of radiolucent lines and cementation errors remain major reasons for revision in UKA [6][7][8][9]; improvements of the interface between prosthesis, cement, and trabecular bone, as well as the optimization of minimally invasive surgical techniques, are of outstanding importance [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…While former studies focused on levers to improve cemented fixation that can be controlled by the surgeon, such as bone bed preparation, cementing technique, or surgical access [11][12][13][14][15][16][17], little is known about the impact of bone density, which can hardly be altered, on cemented tibial fixation in UKA.…”

Section: Introductionmentioning

confidence: 99%

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Influence of bone density on morphologic cement penetration in minimally invasive tibial unicompartmental knee arthroplasty: an in vitro cadaver study

et al. 2019

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Background: Unicompartmental knee arthroplasty is an established treatment option for anteromedial osteoarthritis. However, large registry studies report higher rates of aseptic loosening compared to total knee arthroplasty. The objective of this study was to assess the impact of bone density on morphological cement penetration. Moreover, an alternative regional bone density measuring technique was validated against the established bone mineral density assessment. Methods: Components were implanted on the medial side of 18 fresh-frozen cadaver knees using a minimally invasive approach. Bone density has been quantified prior to implantation using Hounsfield units and bone mineral density. Morphological cement penetration has been assessed in different areas and was correlated with local bone density. Findings: A highly significant correlation between Hounsfield units and trabecular bone mineral density was detected (r = 0.93; P < 0.0001), and local bone density was significantly increased in the anterior and posterior area (P = 0.0003). The mean cement penetration depth was 1.5 (SD 0.5 mm), and cement intrusion into trabecular bone was interrupted in 31.8% (SD 23.7%) of the bone-cement interface. Bone density was correlated significantly negative with penetration depth (r = − 0.31; P = 0.023) and positive with interruptions of horizontal interdigitating (r = + 0.33; P = 0.014). Cement penetration around the anchoring peg was not significantly correlated with bone density. Interpretation: Areas with high bone density were characterized by significantly lower penetration depths and significantly higher areas without cement penetration. Anchoring pegs facilitate cement intrusion mechanically. Regional quantification of bone density using Hounsfield units is a simple but valuable extension to the established determination of bone mineral density.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of bone density on morphologic cement penetration in minimally invasive tibial unicompartmental knee arthroplasty: an in vitro cadaver study

et al. 2019

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“…However, former studies using single-layer technique show only limited cement penetration in knee arthroplasty [9, 14, 17]. In particular, a solid fixation in the posterior aspect of the joint seems to be difficult to achieve via a minimally invasive medial approach [13].…”

Section: Discussionmentioning

confidence: 99%

“…Based on bone mineral density (BMD), two groups with comparable bone density were formed (Table 1). The Hounsfield units in the anterior, central and posterior regions of the medial tibial plateau were additionally determined for the local determination of bone density [13–15].…”

Section: Methodsmentioning

confidence: 99%

Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty

Scheele

Pietschmann

Schröder

et al. 2019

BMC Musculoskelet Disord

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BackgroundThe objective of this study was to evaluate the impact of a single- vs. double-layer cementing technique on morphological cementation and the generation of microscopic cement layers or loose cement fragments in unicompartmental knee arthroplasty (UKA).MethodsUKAs were implanted in 12 cadaver knees. The specimens were divided into two groups of comparable bone mineral density. Six UKAs were implanted using a single-layer cementing technique (group A) and six UKAs were implanted using a double-layer cementing technique (group B). Morphological cementation was assessed on nine cuts through the implant–cement–bone interface in the frontal plane. Loose bone cement fragments and the microscopically quality of layer formation were evaluated.ResultsContact between bone and prosthesis was observed in 45.4% of interfaces in group A and 27.8% in group B (p = 0.126). The significant increase of areas without visible cement interlocking in the anteroposterior direction in group A (p = 0.005) was not evident in group B (p = 0.262). Penetration around the peg tended to occur more frequently in group B (67.5% vs. 90.6% p = 0.091). Scanning electron microscopy identified no evidence of fissure formations within the bilaminar cement mantle. Free bone cement fragments were documented in 66.7% in both groups with no difference concerning mass (p = 1.0).ConclusionsThis in-vitro study showed a tendency towards a more homogenous cementation of tibial UKAs using a double-layer cementing technique, although most of the differences did not reach the level of significance. However, theoretical downsides of the double-layer cementing technique such as an increased formation of free bone fragments or a microscopically fissure formation within the cement layer could not be detected either.

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Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty

et al. 2020

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Effect of minimally-invasive implantation of unicompartmental knee arthroplasty on cement penetration and biomechanical stability. An experimental study in human tibiae

Cited by 4 publications

References 30 publications

Influence of bone density on morphologic cement penetration in minimally invasive tibial unicompartmental knee arthroplasty: an in vitro cadaver study

Influence of bone density on morphologic cement penetration in minimally invasive tibial unicompartmental knee arthroplasty: an in vitro cadaver study

Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty

Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty

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