Femoral component migration in total knee arthroplasty: Randomized study comparing cemented and uncemented fixation of the Miller‐Galante I design

Abstract

The Miller-Galante I knee replacement was inserted in 25 women and three men (33 knees) with osteoarthrosis. All patients received a TiAlV femoral component with a commercially pure titanium fiber-mesh undersurface. Cemented or cementless fixation was used based on a randomization protocol. Micromotions of the femoral components were recorded with roentgen stereophotogrammetric analysis during the first 2 postoperative years. The magnitude of migration did not differ between cemented and uncemented fixation. The number of nonmigrating prostheses decreased from 21 (12 cemented and nine uncemented) at 3 months to six (three cemented and three uncemented) at 24 months. In both groups, the magnitude of prosthetic tilting about the longitudinal axis (internal-external rotation) was as large as that about the transverse axis (flexion-extension). Rotation into extension was as common as rotation into flexion. The largest translations were recorded at either of the posterior condyles. In 10 uncemented components, radiolucent lines were seen at the distal interface postoperatively. Proximal migration of the femoral component was recorded in these knees, and the width of the lines decreased or the lines disappeared totally at 24 months. After 2 years, lines were noted around four cemented and four uncemented replacements, mainly anteriorly or distally. All of these prostheses migrated. One prosthesis, revised because of malalignment, displayed pronounced migration after an initial period of stability. Bone ingrowth was observed anteriorly and anterodistally despite the presence of motions of 1 mm or more.

Effect of submicron polyethylene particles on an osseointegrated implant

“…However, these implants were not osseointegrated, which allowed the HDPE particles access to the interface, and in some animals, the implants were also exposed to motion-leading to more interface exposure. Several authors have shown that some implants never reach a stable situation and more frequently become loose than initially stable implants (Ryd and Linder 1989, Ryd 1992, Snorrason et al 1993, Kärrholm et al 1994, Nilsson et al 1995. A stable implant probably has a sealed interface, like the osseointegrated implants in the present study.…”

A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

“…A later study showed no difference in migration of the femoral component after two years. 29 Albrektsson et al 30 showed…”

RSA in the assessment of aseptic loosening

“…Most of these have shown varying amounts of migration before revision became necessary, and fibrous tissue, fibrocartilage and small areas of bony ingrowth have been found at the interface (Ryd and Linder 1989;Kärrholm, Carlsson and Snorrason 1995;Nilsson, Kärrholm and Linder 1995;Ryd et al 1995b). The migration of hydroxyapatite-coated tibial components has been associated with delamination of the coating (Nilsson et al 1994), while stable implants displayed small areas of direct bonding to bone (Nilsson, unpublished data).…”