Revision total knee arthroplasty: The influence of femoral stems in load sharing and stability

Completo, António; Simões, J. A.; Fonseca, Fernando

doi:10.1016/j.knee.2008.12.008

Cited by 51 publications

(50 citation statements)

References 29 publications

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“…Stiffness and strength served as preliminary measurements, which should be followed up with more detailed assessments using other techniques. 14,16,17 Specimen preparation Twenty medium, left, synthetic femurs were used (Model #3303; Sawbones, Vashon, WA, USA), having a midshaft outer diameter of 27 mm and inner canal diameter of 13 mm. The femurs were randomly assigned to four groups of five femurs each (Figure 1).…”

Section: Overall Testing Strategymentioning

confidence: 99%

“…5 A recent computational study assessed press-fit cementless versus cemented stems for revision TKR surgery regarding load sharing properties and suggested that press-fit stems are adequate if structural allografts for femur revision are employed. 16 Also, a recent experimental report showed that sliding stems can provide sufficient stability, while minimizing stress shielding since the compressive contact forces are still transferred to the distal femur. 17 It appears that the choice of which stem design or operating principle is optimal for revision TKR surgery is a matter of ongoing investigation in the literature.…”

Section: Introductionmentioning

confidence: 99%

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A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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Few biomechanical studies exist on femoral cementless press-fit stems for revision total knee replacement (TKR) surgeries. The aim of this study was to compare the mechanical quality of the femur–stem interface for a series of commercially available press-fit stems, because this interface may be a ‘weak link’ which could fail earlier than the femur–TKR bond itself. Also, the femur–stem interface may become particularly critical if distal femur bone degeneration, which may necessitate or follow revision TKR, ever weakens the femur–TKR bond itself. The authors implanted five synthetic femurs each with a Sigma Short Stem (SSS), Sigma Long Stem (SLS), Genesis II Short Stem (GSS), or Genesis II Long Stem (GLS). Axial stiffness, lateral stiffness, ‘offset load’ torsional stiffness, and ‘offset load’ torsional strength were measured with a mechanical testing system using displacement control. Axial (range = 1047–1461 N/mm, p = 0.106), lateral (range = 415–462 N/mm, p = 0.297), and torsional (range = 115–139 N/mm, p > 0.055) stiffnesses were not different between groups. The SSS had higher torsional strength (863 N) than the other stems (range = 167–197 N, p < 0.001). Torsional failure occurred by femoral ‘spin’ around the stem’s long axis. There was poor linear correlation between the femur–stem interface area versus axial stiffness (R = 0.38) and torsional stiffness (R = 0.38), and there was a moderate linear correlation versus torsional strength (R = 0.55). Yet, there was a high inverse linear correlation between interfacial surface area versus lateral stiffness (R = 0.79), although this did not result in a statistical difference between stem groups (p = 0.297). These press-fit stems provide equivalent stability, except that the SSS has greater torsional strength.

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Section: Overall Testing Strategymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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“…With the purpose to simulate this condition, a value of coefficient of friction equal to unity is considered for the cement -bone interface. This situation has been demonstrated to be appropriate for this type of studies as it can be found in the work by Completo, Fonseca, Simoes, Oliveira, et al (2008) and Completo et al (2009). In fact, this premise intends to simulate a mid/long-term clinical scenario based on the radiolucent lines, which are usually visible at the interface.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Castro

Completo

Simões

et al. 2014

Computer Methods in Biomechanics and Biomedical Engineering

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Isolated patellofemoral (PF) arthritis of the knee is a common cause of anterior knee pain and disability. Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with PF degeneration. Failure mechanisms of PFA include growing tibiofemoral arthritis and loosening of components. The implant loosening can be associated with bone resorption or fatigue-failure of bone by overload. This research work aims at determining the structural effects of the implantation of PF prosthesis Journey PFJ (Smith & Nephew, Inc., Memphis, TN, USA) on femoral cancellous bone. For this purpose, the finite element method is considered to perform computational simulations for different conditions, such as well-fixed and loosening scenarios. From the global results obtained, in the well-fixed scenario, a decrease in strain on cancellous bone was noticed, which can be related to bone resorption. In the loosening scenario, when the cement layer becomes inefficient, a significant increase in cancellous bone strain was observed, which can be associated with bone fatigue-failure.These strain changes suggest a weakness of the femur after PFA.

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“…(Figures 10, 11 and 12) Nowadays, several scientific articles, clinical trials including multicentric ones and treatment guideline protocols on knee revision surgery use the AORI classification for bone loss. [11][12][13][14][15] Classifications should have the following main objectives: to standardize the language and communication on similar clinical situations, to enable the development of conduct protocols and to allow the comparative analysis of clinical data. The reproducibility of the classifications used in scientific studies and in treatment guideline flowcharts is essential for these to be comparable, and to allow their adequate clinical application.…”

Section: Introductionmentioning

confidence: 99%

Correlação inter-observador da classificação de falhas ósseas em artroplastia de joelho

et al. 2011

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Objective: Considering the difficulty for classifying bone losses the present study was designed to analyze if the AORI classification based on pre-operative radiographies is consistent and reproducible between different orthopedic surgeons. Methods: Six orthopedists specialized in knee surgery were trained for the use of the classification based on radiographic evaluation. All the surgeons individually classified 26 pre operative knee radiographs. Results: There was a moderate (> 50%) matching of the classification in 24 of 26 cases in the femur and 22 of 26 in the tibia. A good matching (> 80%) was present in 12 of 26 cases in the femur and in 7 of 26 cases in the tibia. Conclusion: We observed that the AORI classification presented a moderate radiographic correlation between surgeons. Evidence of level III, Study of nonconsecutive patients; without consistently applied reference ''gold'' standard.

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Revision total knee arthroplasty: The influence of femoral stems in load sharing and stability

Cited by 51 publications

References 29 publications

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Correlação inter-observador da classificação de falhas ósseas em artroplastia de joelho

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