Abstract:Background. The screw and cement technique is a convenient method used to rebuild medial tibial plateau defects in primary total knee arthroplasty (TKA). The objective of this study was to perform a finite element assessment to determine the effect of different numbers of screws on the stability of TKA and to determine whether differences exist between two different insertion angles. Method. Six tibial finite element models with defects filled with screws and cement and one model with defects filled only with … Show more
“…В исследовании C. Zheng с соавторами при помощи программного обеспечения Mimics и компьютерной томографии коленного сустава была построена геометрическая модель коленного сустава. Авторы пришли к выводу, что техника использования винтов и цемента превосходит технику использования только одного цемента даже при дефектах не глубже 5 мм, а также, что вертикальное введение винтов обеспечивает лучшую устойчивость по сравнению с горизонтальным [39].…”
Background. The problem of management of bone tissue defects remains one of the tasks that a surgeon faces during primary total knee arthroplasty (TKA). Since the number of TKA is increasing every year, modern scientific research aimed at solving the problem of bone defect replacement remains important. The aim of the study was to evaluate the effectiveness of various methods of bone defects management in primary TKA based on the analysis of literature. Materials and Methods. We conducted a search of articles in PubMed, eLIBRARY, Scopus from 2005 to 2020. Results. On the whole our search led to 1217 papers. Finally 19 articles that met inclusion criteria were included in this review. Each of the methods of bone defect replacement has its advantages and disadvantages. The results of the studies show that the he defect size is not a key factor for choosing the method, since with relatively identical defect parameters, different plastic options were used with a satisfactory clinical outcome. The endoprosthesis component should be fixed in at least two zones in every chosen method. In young patients with good bone quality preference in chosen methods should be given to bone grafts, which allow to preserve the bone stock. Based on the papers analysis, we have proposed the algorithm for method choosing for each clinical case. Conclusion. Each surgeon chooses a method for replacing bone defects based on their own preferences and such criteria as the equipment of the operating room, the surgical team experience, the quality of the patients bone and the defect size.
“…В исследовании C. Zheng с соавторами при помощи программного обеспечения Mimics и компьютерной томографии коленного сустава была построена геометрическая модель коленного сустава. Авторы пришли к выводу, что техника использования винтов и цемента превосходит технику использования только одного цемента даже при дефектах не глубже 5 мм, а также, что вертикальное введение винтов обеспечивает лучшую устойчивость по сравнению с горизонтальным [39].…”
Background. The problem of management of bone tissue defects remains one of the tasks that a surgeon faces during primary total knee arthroplasty (TKA). Since the number of TKA is increasing every year, modern scientific research aimed at solving the problem of bone defect replacement remains important. The aim of the study was to evaluate the effectiveness of various methods of bone defects management in primary TKA based on the analysis of literature. Materials and Methods. We conducted a search of articles in PubMed, eLIBRARY, Scopus from 2005 to 2020. Results. On the whole our search led to 1217 papers. Finally 19 articles that met inclusion criteria were included in this review. Each of the methods of bone defect replacement has its advantages and disadvantages. The results of the studies show that the he defect size is not a key factor for choosing the method, since with relatively identical defect parameters, different plastic options were used with a satisfactory clinical outcome. The endoprosthesis component should be fixed in at least two zones in every chosen method. In young patients with good bone quality preference in chosen methods should be given to bone grafts, which allow to preserve the bone stock. Based on the papers analysis, we have proposed the algorithm for method choosing for each clinical case. Conclusion. Each surgeon chooses a method for replacing bone defects based on their own preferences and such criteria as the equipment of the operating room, the surgical team experience, the quality of the patients bone and the defect size.
“…Bone is also considered to be homogeneous, isotropic, and linearly elastic [ 28 ]. In the screw–bone cement–bone model, friction contact exists between the screw, bone cement, and bone block [ 18 , 29 ]. The maximum shear force test was used to evaluate the stress distribution at the screw fracture, and the maximum axial pullout test was used to evaluate the stress distribution at the screw–cement–bone interface.…”
Background
Biomechanical and finite element analyses were performed to investigate the efficacy of second-generation bone cement-injectable cannulated pedicle screws (CICPS) in osteoporosis.
Methods
This study used the biomechanical test module of polyurethane to simulate osteoporotic cancellous bone. Polymethylmethacrylate (PMMA) bone cement was used to anchor the pedicle screws in the module. The specimens were divided into two groups for the mechanical tests: the experimental group (second-generation CICPS) and control group (first-generation CICPS). Safety was evaluated using maximum shear force, static bending, and dynamic bending tests. Biomechanical stability evaluations included the maximum axial pullout force and rotary torque tests. X-ray imaging and computed tomography were used to evaluate the distribution of bone cement 24 h after PMMA injection, and stress distribution at the screw fracture and screw–cement–bone interface was assessed using finite element analysis.
Results
Mechanical testing revealed that the experimental group (349.8 ± 28.6 N) had a higher maximum axial pullout force than the control group (277.3 ± 8.6 N; P < 0.05). The bending moments of the experimental group (128.5 ± 9.08 N) were comparable to those of the control group (113.4 ± 20.9 N; P > 0.05). The screw-in and spin-out torques of the experimental group were higher than those of the control group (spin-in, 0.793 ± 0.015 vs. 0.577 ± 0.062 N, P < 0.01; spin-out, 0.764 ± 0.027 vs. 0.612 ± 0.049 N, P < 0.01). Bone cement was mainly distributed at the front three-fifths of the screw in both groups, but the distribution was more uniform in the experimental group than in the control group. After pullout, the bone cement was closely connected to the screw, without loosening or fragmentation. In the finite element analysis, stress on the second-generation CICPS was concentrated at the proximal screw outlet, whereas stress on the first-generation CICPS was concentrated at the screw neck, and the screw–bone cement–bone interface stress of the experimental group was smaller than that of the control group.
Conclusion
These findings suggest that second-generation CICPS have higher safety and stability than first-generation CICPS and may be a superior choice for the treatment of osteoporosis.
“…1 ). The combination of cement with the addition of screws has multiple advantages including enhanced strength of fixation when compared with cement alone, lower cost compared with other options, and simplification and shortening of operative times when compared with bone grafting and metal augmentation [ 29 ]. Fig.…”
Background
Although several techniques and implants have been developed to address bone loss in revision total knee arthroplasty (rTKA), management of these defects remains challenging. This review article discusses the indications and management options of bone loss following total knee arthroplasty based on preoperative workup and intraoperative findings.
Main text
Various imaging modalities are available that can be augmented with intraoperative examination to provide a clear classification of a bony defect. For this reason, the Anderson Orthopaedic Research Institute (AORI) classification is frequently used to guide treatment. The AORI provides a reliable system by which surgeons can classify lesions based on their size and involvement of surrounding structures. AORI type I defects are managed with cement with or without screws as well as impaction bone grafting. For AORI type IIA lesions, wedge or block augmentation is available. For large defects encompassing AORI type IIB and type III defects, bulk allografts, cones, sleeves, and megaprostheses can be used in conjunction with intramedullary stems.
Conclusions
Treatment of bone loss in rTKA continues to evolve as different techniques and approaches have been validated through short- and mid-term follow-up. Extensive preoperative planning with imaging, accurate intraoperative evaluation of the bone loss, and comprehensive understanding of all the implant options available for the bone loss are paramount to success.
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