Fixation of High-Flexion Total Knee Prostheses: Five-Year Follow-up Results of a Four-Arm Randomized Controlled Clinical and Roentgen Stereophotogrammetric Analysis Study

Nieuwenhuijse, Marc J; Voort, Paul van der; Kaptein, Bart L; Zwaag, Henrica M. J. van der Linden–van der; Valstar, Edward R.; Nelissen, Rob G H H

doi:10.2106/jbjs.l.01523

Cited by 33 publications

(42 citation statements)

References 23 publications

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“…Among them, Li et al [14] included the largest of the 18 randomized controlled trials on the subject. Although they found no significant differences between high-flexion and standard TKA designs in terms of range of motion, knee scores, patient's satisfaction, and complications, the types of high-flexion and standard implants used in the randomized controlled trial were limited to NexGen knee system (Zimmer, Warsaw, IN) (LPS-flex [4,6,11,[23][24][25][26][27][28][29][30] or CR-flex [3,7]) or P.F.C. Sigma knee system (RP-F [1,2,31,32] or CR 150 [33]).…”

Section: Discussionmentioning

confidence: 99%

Is High-Flexion Total Knee Arthroplasty a Valid Concept? Bilateral Comparison With Standard Total Knee Arthroplasty

Kim

Koh

et al. 2016

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Is High-Flexion Total Knee Arthroplasty a Valid Concept? Bilateral Comparison With Standard Total Knee Arthroplasty

Kim

Koh

et al. 2016

The Journal of Arthroplasty

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“…While traditional TKAs rarely exhibit femoral component loosening, some groups have raised concerns about loosening with younger, more active patients undergoing this procedure [3,4,7], as well as with high-flexion knees [8–11]. The disparate findings of the high-flexion knee studies suggest that component design, initial fixation at the time of surgery, and loss of fixation with in vivo service are the likely contributors to the range of loosening rates reported clinically.…”

Section: Discussionmentioning

confidence: 99%

“…Without bony fixation, the implant can become unstable and migrate. In general, the tibial component loosens 2–3 times more frequently than the femoral component, but femoral component loosening is still a clinical concern, especially in younger populations [7] and with some high-flexion knees [8–11]. …”

Section: Introductionmentioning

confidence: 99%

The Distribution of Implant Fixation for Femoral Components of TKA: A Postmortem Retrieval Study

Howard

Miller

Damron

et al. 2014

The Journal of Arthroplasty

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Aseptic loosening of Total Knee Arthroplasty (TKA) components is the foremost cause of implant failure in the long term. While tibial component loosening is of primary concern, femoral loosening may become a clinical problem due to younger, more active patients seeking TKA, and also high-flexion designs. In this study, we analyzed the fixation for 19 non-revised, postmortem retrieved, femoral components of TKA with time in service ranging from 1–22 years. We found that average total contact fraction for cemented components was 9.5% and had a power law response with years in service. The average initial interdigitation depth was 0.7mm, and the average current interdigitation depth was 0.13mm. Loss of interdigitation was 81%. Over all, minimal fixation seems necessary for long term success of TKA.

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“…As a result, in the current study we have included 114 patients with 137 knee prostheses. Within this cohort, patients received different designs of knee prostheses, including Nexgen (Zimmer, Inc.), Triathlon (Stryker, Inc.), Rocc (Biomet, Inc.), Interax, Interax ISA, Interax PS (Howmedica Osteonics Corp) . The study was approved by the Medical Ethical Committee of the Leiden University Medical Center (P09.228), and informed consent was obtained from all patients.…”

Section: Methodsmentioning

confidence: 99%

Innate immune response and implant loosening: Interferon gamma is inversely associated with early migration of total knee prostheses

Schoeman

Pijls

Oostlander

et al. 2015

Journal Orthopaedic Research

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To allow prediction of the risk of loosening prior to surgery, we investigated the relationship between innate immune cytokine response via TLR2 stimulation and early migration of six different knee prostheses using RSA (radiostereometry). This study included 114 patients of a prospective RSA-cohort who received a total knee arthroplasty. Whole blood cytokine responses were obtained by ex vivo stimulation with tripalmitoyl-S-glycerylcysteine (Pam3Cys-SK4) for assessment of the TLR2 immune response. Early migration was calculated using the maximum total point motion (MTPM) 1 year post surgery. Principal component analysis (PCA) was applied to the cytokine data to reduce the correlated data of individual cytokines and identified two components. Subsequently, linear mixed model analyses were applied with adjustments for gender, age, BMI, time-to-blood sampling, and prosthesis type. Component 1, consisting of IFNg, IL-12p40, IL-10, IL-1b, TNFa, and IL-6, showed a significant inverse association (b ¼ À0.128; p ¼ 0.041) with MTPM. Further analysis showed that IFNg (b ¼ À0.161, p ¼ 0.008) had the highest contribution to this association and is particularly found in patients receiving another prosthesis than Nexgen (b ¼ À0.239; p < 0.001). In conclusion, patients with high levels of IFNg upon stimulation of TLR2 are at lower risk of early migration of their knee prosthesis. ß

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Fixation of High-Flexion Total Knee Prostheses: Five-Year Follow-up Results of a Four-Arm Randomized Controlled Clinical and Roentgen Stereophotogrammetric Analysis Study

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 33 publications

References 23 publications

Is High-Flexion Total Knee Arthroplasty a Valid Concept? Bilateral Comparison With Standard Total Knee Arthroplasty

Is High-Flexion Total Knee Arthroplasty a Valid Concept? Bilateral Comparison With Standard Total Knee Arthroplasty

The Distribution of Implant Fixation for Femoral Components of TKA: A Postmortem Retrieval Study

Innate immune response and implant loosening: Interferon gamma is inversely associated with early migration of total knee prostheses

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