Influence of pre-operative bone mineral content of the proximal tibia on revision rate after uncemented knee arthroplasty

Abstract

Between 1986 and 1991, 106 patients (127 knees) underwent uncemented knee arthroplasty for osteoarthritis. There were 106 total knee arthroplasties and 21 medial unicompartmental knee arthroplasties. The arthroplasties were evaluated for aseptic loosening during the year 2000. For total arthroplasty we used 77 porous-coated anatomic prostheses and 29 press-fit condylar prostheses. The mean bone mineral content of the proximal tibia, measured the day before surgery using dual-photon absorptiometry was 5.48 g/cm for the porous-coated anatomic prostheses which were revised for aseptic loosening (n = 9). This was significantly higher (p = 0.02) than the mean of 4.33 g/cm for those which were not revised. Values for the two revised press-fit condylar knees (4.78 and 4.93 g/cm) were above the mean value (4.23 g/cm) for those which were not revised. We found no statistically significant (p = 0.38) difference between the bone mineral content of the 12 revised and nine unrevised unicompartmental arthroplasties. Low trabecular bone quality, measured as the pre-operative bone mineral content of the proximal tibia, was not a predictor for later revision surgery following uncemented total knee or unicompartmental knee arthroplasty.

Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty

“…This has been suggested as a factor contributing to implant migration and loosening in TKA [18,31] and UKA [14,29,30]. Although studies have reported BMD loss ranging from 5% to as much as 36.4% none has been able to correlate this to failure of the implants.…”

“…Although these studies with limited numbers did not correlate BMD loss with clinical failure, some authors believe diminished BMD is a factor in implant migration and loosening [18,31]. The same failure mechanism has been proposed for UKA [14,29,30].…”

Loss of Tibial Bone Density in Patients with Rotating- or Fixed-platform TKA

“…Quality of proximal tibial bone mineral density (BMD) is a factor that may determine migration of implants after TKA [6,8,13,25]. Dual-energy xray absorptiometry (DEXA) studies suggest proximal tibial BMD declines after TKA [1,5,9,12,17,[19][20][21].…”

Intermittent Parathyroid Hormone Enhances Cancellous Osseointegration of a Novel Murine Tibial Implant

“…The quantity and quality of cancellous bone vary widely among individuals. Many patients are not considered candidates for cementless total knee arthroplasty because of concerns about insufficient cancellous bone in the proximal part of the tibia [13][14][15][16] . Biological enhancement of cancellous bone quantity and osseointegration would provide one mechanism to improve the outcomes of cementless total knee arthroplasty.…”