Modes of Failure of Total Knee Arthroplasty: Registries and Realities

Siqueira, Marcelo; Klika, Alison K.; Barsoum, Wael K.

doi:10.1055/s-0034-1396014

Cited by 36 publications

(41 citation statements)

References 77 publications

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“…Revision surgery after TKA has long been used as the main outcome endpoint by joint registries worldwide [1,10,15,23]. However, such registries lack clinical and radiologic data, making accurate analysis of revision indications difficult.…”

Section: Discussionmentioning

confidence: 99%

“…National joint registries from Australia, United Kingdom, Sweden, and New Zealand all show aseptic loosening to be the most-common failure mechanism after primary TKA but capture of revision surgery resulting from infection often is poor [10,15,23,28]. Lindgren et al [12] reported a capture rate of 67% by the Swedish Hip Arthroplasty Register for reoperation resulting from PJI after THA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Koh

Zeng

Ravi

et al. 2017

Clinical Orthopaedics &Amp; Related Research

254

118

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Koh

Zeng

Ravi

et al. 2017

Clinical Orthopaedics &Amp; Related Research

254

118

View full text Add to dashboard Cite

show abstract

“…The aims of this therapy include the reduction of pain, regaining functionality as well as mobility and a faster integration into the patient’s daily life. However, implant failure can occur [1–3], thus requiring a revision surgery in which the whole implant or single parts must be replaced. Regarding knee joints, long-term outcome of revision implants (e.g.…”

Section: Introductionmentioning

confidence: 99%

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

et al. 2017

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IntroductionRevision total knee arthoplasty often requires modular implants to treat bone defects of varying severity. In some cases, it may not be clear which module size and implant combination (e.g. sleeve and stem) should be chosen for a specific defect. When balancing implant stability and osseointegration against stress-shielding, it is important to choose an appropriate implant combination in order to match the given level of bone loss. Therefore, the necessity of stems in less extensive tibial defects and the advantage of different stems (lengths and stiffnesses) in combination with large metaphyseal sleeves on implant fixation and bone flexibility using a modular tibial revision knee system, were analyzed.Materials and methodsFour different stem combinations for a tibial revision implant (Sigma TC3, DePuy) were compared to an intact bone. Standardized implantation with n = 4 synthetic tibial bones was performed after generating an Anderson Orthopaedic Research Institute (AORI) Type T1 bone defect. Axial torques around the longitudinal stem axis and varus-valgus torques were separately applied to the implant. Micromotions of bone and implant were tracked using a digital image correlation system to calculate relative micromotions at the implant-bone-interface and bone deformation.ResultsOverall, using stems reduced the proximal micromotions of tray and sleeve compared to no stem, while reducing bone deformation proximally at the same time, indicating some potential for proximal stress-shielding compared to no stem. The potential for increased proximal stress-shield due to reduced proximal deformation appeared to be greater when using the longer stems. The location of lowest relative micromotions was also more distal when using long stems as opposed to short stems. A short stem (especially a smaller diameter short stem which still achieves diaphyseal fixation) displayed less potential for stress-shielding, but greater bone deformation distal to the tip of the stem than in the natural model.DiscussionIn the case of tibial revision implants with metaphyseal sleeves in a simple fully contained Type I defect, the absence of a stem provides for more natural bone deformation. However, adding a stem reduces overall relative micromotions, while introducing some risk of proximal stress-shielding due to increased diaphyseal fixation. Increasing stem length intensifies this effect. Short stems offered a balance between reduced micromotions and more proximal bone deformation that reduced the potential for stress-shielding when compared to long stems. A short stem with slightly smaller diameter (simulating a less stiff stem which still has diaphyseal fixation) increased the proximal bone deformation, but also tended to increase the bone deformation even further at the distal stem’s tip.ConclusionIn conclusion, further investigation should be conducted on fully contained Type I defects and the addition of a stem to offer better initial stability, taking into account stem length (i.e. shorter or more flexible stems) to su...

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“…In the adult population, constrained implants have low failure rates in the setting of primary TKA, with approximately 3.5% failure with a mean follow-up of 5.3 years. 13 Although no comparison is available in the pediatric population, tumor literature has described the use of stemmed and cemented components that cross open physes. [1][2][3][4][5]11,12,14 Some studies have reported significant growth differences in the proximal tibia and distal femur between patients with and without stemmed and cemented reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Total Knee Arthroplasty in a 15 Year Old With Skeletal Dysplasia and Open Physes

Ho¹,

Siqueira²,

Jacob³

et al. 2016

Orthopedics

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There are limited reports of total knee arthroplasty (TKA) in the pediatric population. The use of constrained, stemmed components is particularly unusual in the setting of open physes due to concerns with growth arrest and implant survivorship. The current authors describe a 15-year-old boy with open growth plates and an epiphyseal dysplasia-like condition affecting the knees bilaterally. He had no other significant medical or orthopedic conditions and his genetic workup was negative. He had severe knee pain and a bilateral 40° valgus with severe lateral compartment arthritis. Conservative treatment provided no symptom relief, and the patient had been wheelchair bound for 18 months prior to presentation. Treatment with simultaneous bilateral TKA using cemented, stemmed, and constrained components was undertaken. There were no intraoperative complications, and his final follow-up was at 5.6 years postoperatively. Radiographic evaluation at follow-up showed that components were well placed with no loosening. The patient had pain-free motion and a perfect Knee injury and Osteoarthritis Outcome Score. Based on the review of the literature and the outcomes of this case, the authors believe simultaneous bilateral TKA using cemented, stemmed, and constrained components is a reasonable option for joint reconstruction in the pediatric patient with open physes who also has significant arthritis and deformity not of oncologic origin. [Orthopedics. 2016; 39(3):e549-e552.].

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Modes of Failure of Total Knee Arthroplasty: Registries and Realities

Cited by 36 publications

References 77 publications

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

Tibial revision knee arthroplasty with metaphyseal sleeves: The effect of stems on implant fixation and bone flexibility

Bilateral Total Knee Arthroplasty in a 15 Year Old With Skeletal Dysplasia and Open Physes

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