Femoral fixation pattern in cemented Oxford unicompartmental knee arthroplasty — An experimental cadaver study

Clarius, Michael; Mohr, G.; Jaeger, Sebastian; Seeger, Jörn Bengt; Bitsch, Rudi G.

doi:10.1016/j.knee.2009.11.006

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…Regarding cement penetration, the spongeous bone structure resembled sclerotic bone areas. Following clinical application [29], twelve small holes (diameter 3 mm, depth 5 mm) were drilled into the proximal tibia plateau using a custom made template.…”

Section: Methodsmentioning

confidence: 99%

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

et al. 2017

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IntroductionRevision total knee arthoplasty often requires modular implants to treat bone defects of varying severity. In some cases, it may not be clear which module size and implant combination (e.g. sleeve and stem) should be chosen for a specific defect. When balancing implant stability and osseointegration against stress-shielding, it is important to choose an appropriate implant combination in order to match the given level of bone loss. Therefore, the necessity of stems in less extensive tibial defects and the advantage of different stems (lengths and stiffnesses) in combination with large metaphyseal sleeves on implant fixation and bone flexibility using a modular tibial revision knee system, were analyzed.Materials and methodsFour different stem combinations for a tibial revision implant (Sigma TC3, DePuy) were compared to an intact bone. Standardized implantation with n = 4 synthetic tibial bones was performed after generating an Anderson Orthopaedic Research Institute (AORI) Type T1 bone defect. Axial torques around the longitudinal stem axis and varus-valgus torques were separately applied to the implant. Micromotions of bone and implant were tracked using a digital image correlation system to calculate relative micromotions at the implant-bone-interface and bone deformation.ResultsOverall, using stems reduced the proximal micromotions of tray and sleeve compared to no stem, while reducing bone deformation proximally at the same time, indicating some potential for proximal stress-shielding compared to no stem. The potential for increased proximal stress-shield due to reduced proximal deformation appeared to be greater when using the longer stems. The location of lowest relative micromotions was also more distal when using long stems as opposed to short stems. A short stem (especially a smaller diameter short stem which still achieves diaphyseal fixation) displayed less potential for stress-shielding, but greater bone deformation distal to the tip of the stem than in the natural model.DiscussionIn the case of tibial revision implants with metaphyseal sleeves in a simple fully contained Type I defect, the absence of a stem provides for more natural bone deformation. However, adding a stem reduces overall relative micromotions, while introducing some risk of proximal stress-shielding due to increased diaphyseal fixation. Increasing stem length intensifies this effect. Short stems offered a balance between reduced micromotions and more proximal bone deformation that reduced the potential for stress-shielding when compared to long stems. A short stem with slightly smaller diameter (simulating a less stiff stem which still has diaphyseal fixation) increased the proximal bone deformation, but also tended to increase the bone deformation even further at the distal stem’s tip.ConclusionIn conclusion, further investigation should be conducted on fully contained Type I defects and the addition of a stem to offer better initial stability, taking into account stem length (i.e. shorter or more flexible stems) to su...

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Section: Methodsmentioning

confidence: 99%

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

et al. 2017

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“…15 Pulsatile lavage was performed with 500 ml of physiological saline solution using OptiLavage (Biomet Cement and Cementing Systems, Malmö, Sweden). High viscosity cement (Optipac, Refobacin plus Bone Cement, Biomet Cement and Cementing Systems, Malmö, Sweden) was used following the manufacturer's instructions.…”

Section: Methodsmentioning

confidence: 99%

“…The cement was introduced into the peg holes, and a layer was spread on the surface of the component, at 23°C, as this corresponds to the temperature expected during surgery. 15,16 The femoral component was then impacted with a light mallet to allow complete seating. During curing of the cement, a constant compression force of 180 N 16 was applied by a linear motor (ET100, Parker Hannifin GmbH & Co., KG Electromechanical Automation, Offenburg, Germany) with the knee at 45° of flexion.…”

Section: Methodsmentioning

confidence: 99%

The stability of the femoral component in the Oxford unicompartmental knee replacement

Reiner

Jaeger

Schwarze

et al. 2014

The Bone & Joint Journal

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Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component. Medial Oxford UKR was performed in 12 pairs of human cadaver knees. In each pair, one knee received the single peg and one received the twin peg design. Three dimensional micromotion and subsidence of the component in relation to the bone was measured under cyclical loading at flexion of 40° and 70° using an optical measuring system. Wilcoxon matched pairs signed-rank test was performed to detect differences between the two groups. There was no significant difference in the relative micromotion (p = 0.791 and 0.380, respectively) and subsidence (p = 0.301 and 0.176, respectively) of the component between the two groups at both angles of flexion. Both designs of component offered good strength of fixation in this cadaver study.

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“…Preparation of the bone and pulse lavage can further improve cement interdigitation and bone penetrance . Reaming or drilling to deeper bone can avoid sclerotic bone impairment and result in greater porosity, leading to higher torsional resistance . As a dryer bone surface will result in deeper cement preparation, the cleaning and drying of bone directly before cement application is recommended …”

Section: Properties Of Cementmentioning

confidence: 99%

Acrylic bone cement in total joint arthroplasty: A review

et al. 2016

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Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. ß

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Femoral fixation pattern in cemented Oxford unicompartmental knee arthroplasty — An experimental cadaver study

Cited by 21 publications

References 20 publications

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

The stability of the femoral component in the Oxford unicompartmental knee replacement

Acrylic bone cement in total joint arthroplasty: A review

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