More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up

Hoppe, Sven; Mainzer, Jens; Frauchiger, Lars; Ballmer, PE; Hess, R; Zumstein, Matthias A.

doi:10.3109/17453674.2012.747923

Cited by 20 publications

(21 citation statements)

References 26 publications

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“…Ristiniemi used hybrid ring fixators in different types of intra-articular fracture, with or without osteoinduction [60]. In the group without osteoinduction, the healing period was 21 weeks, which compares favorably with the 15 weeks for similar fractures in our study.…”

Section: Discussionmentioning

confidence: 49%

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Ramos

Karlsson

Eriksson

et al. 2013

BMC Musculoskelet Disord

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BackgroundThe management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement.MethodsThirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS.ResultsNo patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11–30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients.ConclusionsThe Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome.

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Section: Discussionmentioning

confidence: 49%

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Ramos

Karlsson

Eriksson

et al. 2013

BMC Musculoskelet Disord

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“…Assuming these tools are reliable and cost-effective, their wide usage could decrease the revision burden in the future. Studies demonstrating more reproducible implantation of TKA components in patients that were operated using navigation are currently available [144]. However, long-term data showing better clinical survival of navigated surgery over non-navigated are not available [145].…”

Section: Clinical Impact Of Research On Periprosthetic Osteolysismentioning

confidence: 99%

Osteolysis around total knee arthroplasty: A review of pathogenetic mechanisms

et al. 2013

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Aseptic loosening and other wear-related complications are one of the most frequent late reasons for revision of total knee arthroplasty (TKA). Periprosthetic osteolysis (PPOL) predates aseptic loosening in many cases indicating the clinical significance of this pathogenic mechanism. A variety of implant-, surgery-, and host-related factors have been delineated to explain the development of PPOL. These factors influence the development of PPOL due to changes in mechanical stresses within the vicinity of the prosthetic device, excessive wear of the polyethylene liner, and joint fluid pressure and flow acting on the peri-implant bone. The process of aseptic loosening is initially governed by factors such as implant/limb alignment, device fixation quality, and muscle coordination/strength. Later large numbers of wear particles detached from TKAs trigger and perpetuate particle disease, as highlighted by progressive growth of inflammatory/granulomatous tissue around the joint cavity. An increased accumulation of osteoclasts at the bone-implant interface, an impairment of osteoblast function, mechanical stresses, and an increased production of joint fluid contribute to bone resorption and subsequent loosening of the implant. In addition, hypersensitivity and adverse reactions to metal debris may contribute to aseptic TKA failure but should be determined more precisely. Patient activity level appears to be the most important factor when the long-term development of PPOL is considered. Surgical technique, implant design, and material factors are the most important preventative factors because they influence both the generation of wear debris and excessive mechanical stresses. New generations of bearing surfaces and designs for TKA should carefully address these important issues in extensive preclinical studies. Currently, there is little evidence that PPOL can be prevented with pharmacological interventions.

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“…15 New technology such as navigation has been shown to improve component positioning and alignment but has not been shown to reduce radiographic wear rates at intermediate follow-up in TKA patients. 20 Cementation techniques in TKA are also variable and may affect the rate of component wear and osteolysis. Full cementation can result in improved distal fixation but also results in greater stress shielding under the tibial baseplate and may predispose a patient to increased osteolysis when compared with surface cementing techniques.…”

Section: Wear Rates and Osteolysismentioning

confidence: 99%

Wear and Loosening in Total Knee Arthroplasty: A Quick Review

2014

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Wear and osteolysis are common problems that often require revision surgery following total knee arthroplasty (TKA). Wear rates can be reduced through proper implant positioning and the use of modern, highly cross-linked polyethylene liners. More research is needed to identify medications that could prevent or treat the bone loss associated with osteolysis. Bone defects resulting from osteolysis can be managed with a variety of bone-preserving strategies and often require the use of structural augmentation, either in the form of bulk allografts or metal augments. Recently, porous metal augments such as tantalum cones have gained popularity among surgeons performing revision TKA for osteolytic bone defects with promising early clinical results. A megaprosthesis with a rotating hinge device may be used in salvage cases for severe bone deficiencies.

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More accurate component alignment in navigated total knee arthroplasty has no clinical benefit at 5-year follow-up

Cited by 20 publications

References 26 publications

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Osteolysis around total knee arthroplasty: A review of pathogenetic mechanisms

Wear and Loosening in Total Knee Arthroplasty: A Quick Review

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