Implant Interface Debonding After Total Knee Arthroplasty: A New Cause for Concern?

Abstract

Background Aseptic loosening has long been an associated etiology for revision total knee arthroplasty (TKA). Methods This case series investigates commonalities between 9 patients who underwent revision TKA and were found to have complete debonding at the cement-implant interface of a femoral and/or tibial component within the past 2 years. Results Only 3 preoperative radiographs were indicative of aseptic loosening, and all patients had an infectious etiology ruled out. Conclusions This case series and other similar reports suggest that there may be a growing concern for debonding as a modern form of aseptic loosening. Further research through American Joint Replacement Registry and other national databases will need to be conducted to better understand if this is truly a new cause for concern after TKA and how it may be best prevented.

Tibial tray debonding from the cement mantle is associated with deformation of the backside of polyethylene tibial inserts

“…A tray having excessive micromotion may not be obvious on preoperative radiographs, nor immediately apparent at revision surgery. 14 Perhaps because of this, "loosening" was given as the reason for revision in only six of the TKAs in this series. An unstable component will shed greater volumes of particulate debris than a stable one.…”

“…There is concern about the debonding of tibial trays from the cement mantle in contemporary TKAs. 14 Attention has largely focused on the morphology of trays, 15 leading one manufacturer to introduce changes in design in an attempt to deal with this issue.…”

Comparative retrieval analysis of a novel anatomic tibial tray backside: alterations in tibial component design and surface coating can increase cement adhesions and surface roughness

“…According to communication with a representative, 81% of NexGen® tibial trays have a PMMA pre-coat with the remaining 19% NexGen® and all Persona® tibial trays not having a pre-coat [ 36 ]. With regard to Persona® implants, the literature on debonding and loosening testing is very scarce [ 39 ]. A case series reported intraoperative findings of nine patients, amongst them three Persona® implants, who underwent revision TKA due to several reasons [ 39 ].…”

“…With regard to Persona® implants, the literature on debonding and loosening testing is very scarce [ 39 ]. A case series reported intraoperative findings of nine patients, amongst them three Persona® implants, who underwent revision TKA due to several reasons [ 39 ]. It is striking that the majority of the implants investigated showed femoral and tibial intraoperative debonding and two of the three Persona® implants showed only tibial debonding.…”

“…In the course of time, other parameters have also been identified that modify the effect of pre-coating on the strength of the implant–bone interface, such as cement-related factors (cement type and mixing time) as well as surface roughness [ 18 , 29 , 40 , 41 ]. These reports have been helpful in identifying specific component design features that may be more prone to debonding, but there is not enough evidence or numbers to prove a certain type of implant has a higher incidence of debonding than any others [ 39 ]. In regards to surface roughness, the present study highlights significant differences in backside surface and stem roughness between the different tibial tray designs investigated.…”