How to Treat A Tibial Post Fracture in Total Knee Arthroplasty?

Lachiewicz, Paul F.

doi:10.1007/s11999-010-1609-9

Cited by 39 publications

(33 citation statements)

References 32 publications

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“…Tibial post damage in TKA remains an important issue [26] with the incidence of failure resulting from post fractures estimated at approximately 1% [17] but recorded as high as 12% in one implant series [2]. One recent study of three contemporary inserts established that tibial post damage was primarily determined by the insert design and to a lesser extent the duration of implantation and revision diagnosis [6].…”

Section: Discussionmentioning

confidence: 99%

“…It is well documented that the cam-post is not an innocuous articulation [14,26]. Tibial post wear is a major factor in the production of osteolytic polyethylene particles and can ultimately lead to catastrophic failure including post fractures [1,2,4,10,[17][18][19]26]. The creation of a high flexion tibial insert design was introduced with the intent of allowing deeper flexion, particularly in patients with high preoperative flexion.…”

Section: Introductionmentioning

confidence: 99%

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The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

Paterson

Teeter

MacDonald

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear. Questions/purposes We therefore examined whether the design changes between HF and posterior-stabilized (PS) tibial inserts would affect overall damage or damage on their articular surface, backside, and tibial post and whether flexion angle achieved related to damage. Methods We matched 20 retrieved HF inserts to 20 retrieved PS inserts from the same implant system on the basis of duration of implantation, body mass index, and age. Inserts were divided into 16 zones and a microscopic analysis of surface damage was carried out. Five inserts were scanned using micro-CT to further quantify instances of severe post notching. We determined overall damage with a scoring system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

Paterson

Teeter

MacDonald

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Articular surface post width, thickness, and shape were similar between designs. To simulate observed clinical results, no accelerated aging was performed: it has been shown that many post fractures occur soon after surgery, prior to significant oxidation.…”

Section: Methodsmentioning

confidence: 99%

“…Fracture of the articular surface tibial post is rare but a potential complication of posterior‐stabilized (PS) and constrained condylar knee (CCK) total knee replacements (TKR). PS post fractures in most systems present at a rate between 0.05% and 1%, often between 2 months to 3 years after implantation but have been reported to occur at a rate of up to 12.4% (in a specific design) . The cause of articular surface tibial post fracture appears to be due to two distinct loading conditions.…”

Section: Introductionmentioning

confidence: 99%

“…PS post fractures in most systems present at a rate between 0.05% and 1%, often between 2 months to 3 years after implantation but have been reported to occur at a rate of up to 12.4% (in a specific design). 1 The cause of articular surface tibial post fracture appears to be due to two distinct loading conditions. The first loading condition is an impingement between the intercondylar (IC) notch of the femoral component and post of the articular surface.…”

Section: Introductionmentioning

confidence: 99%

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Grafted Vitamin-E UHMWPE may increase the durability of posterior stabilized and constrained condylar total knee replacements

Wernle

Mimnaugh

Rufner

et al. 2016

J. Biomed. Mater. Res.

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The suitability of grafted vitamin-E highly crosslinked polyethylene (VE-HXPE) for use in posterior stabilized (PS) and constrained condylar knee (CCK) applications has not been explored. We hypothesized that VE-HXPE performs better than conventional and crosslinked polyethylene under clinically relevant conditions. PS tibial post fracture resistance under adverse shear loading conditions, CCK tibial post resistance to torsional fatigue, delamination resistance under high stress, and wear resistance were evaluated. Grafted VE-HXPE exhibits (1) 10% and 57% improved PS post fatigue strength compared to conventional PE (CPE) and remelted HXPE; (2) 45% improved CCK post fatigue strength compared to CPE; (3) Greater than 36× the delamination resistance of CPE; and (4) 96% and 73% wear reduction compared to CPE and HXPE. VE-HXPE performed well under clinically relevant in vitro conditions. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1789-1798, 2017.

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Third‐generation posterior‐stabilised cemented system for total knee arthroplasty: Survivorship and outcomes after 20‐year follow‐up

Patiño Contreras,

Sebastián Pérez,

Antonio

et al. 2024

J. exp. orthop.

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PurposeTotal knee arthroplasty is a common procedure due to increased life expectancy and ageing populations, necessitating implants with long‐term efficacy. After some initial designs, the third‐generation modular posterior‐stabilised NexGen® prosthesis aimed to enhance kinematics and reduce complications. This study evaluates the long‐term outcomes, survivorship, revision rates and complications of this implant. With promising results observed up to 15 years in previous studies, this investigation aims to assess the implant's performance over extended follow‐up periods, aiding in optimal implant selection for improved patient outcomes.MethodsWe carried out a retrospective study on 263 total knee arthroplasties performed in our centre between 1998 and 2002. Statistical analysis of complications was performed and study of survival using the Kaplan–Meier method and competing risk analysis were calculated. Description of reinterventions and complications were also included.ResultsResults show a 20‐year prosthesis survival rate of 90.8% for revision due to any reason, with an estimated survival of 92.3% considering competitive events. Estimated survivorship at 20 years is 98% for aseptic loosening as the end point, and an estimation of 98.80% considering competitive events. Twenty revisions were performed, with 10 cases due to infection and 10 for noninfectious reasons and three of them due to aseptic loosening. Radiographic analysis revealed radiolucent lines, but no clinical evidence of loosening was observed in these cases.ConclusionThis study offers survivorship data from longer follow‐up periods, what is difficult to find in the reported literature and showed excellent results of this implant in terms of survivorship and low rates of revision in our cohort.Level of EvidenceLevel IV.

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How to Treat A Tibial Post Fracture in Total Knee Arthroplasty?

Cited by 39 publications

References 32 publications

The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

Grafted Vitamin-E UHMWPE may increase the durability of posterior stabilized and constrained condylar total knee replacements

Third‐generation posterior‐stabilised cemented system for total knee arthroplasty: Survivorship and outcomes after 20‐year follow‐up

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