Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees

Rawlinson, Jeremy; Closkey, Robert F.; Davis, Nicole; Wright, Timothy M.; Windsor, Russell E.

doi:10.1007/s11999-008-0424-z

Cited by 31 publications

(29 citation statements)

References 19 publications

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“…We recommend the use of at least two screws for initial stability of the graft and to achieve compression at the graft host bone interface. Rawlinson et al ., in their cadaveric study, concluded that the use of stem extenders improves knee stability by reducing bone stresses and micromotion between the implant and the adjacent bone 16. We also recommend and prefer to use stem extenders in all our cases.…”

Section: Discussionmentioning

confidence: 76%

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

Kharbanda

Sharma

2014

IJOO

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Background:Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting) reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees.Materials and Methods:Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used.Results:Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years). We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in terms of pain, stiffness and physical function during activities of daily living.Conclusion:Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.

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Section: Discussionmentioning

confidence: 76%

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

Kharbanda

Sharma

2014

IJOO

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“…When tibia plateau has peripheral bone defects, various surgical options can be used for handling such defects in TKA including: prosthetic augments – using metal wedges, custom made prostheses, and spacer to fill the defect; autograft – correcting the defect through bone grafting with autogenous bone; allograft – using allograft reconstruction of the defect; and cement – filling the defect with bone cement or using bone cement reinforced with buttressing screws 1–6 …”

Section: Discussionmentioning

confidence: 99%

“…This bone deficiency may be reconstructed in various ways such as with bone graft, screws, and cement, bone bag technique or commercially available metal tibial tray augments 1–6 . Current surgical opinion holds that when tibial tray augments are used then stem augmentation of the tibial tray is also routinely required for construct stability 2,3,5,7–10 . However, there has been little in the way of published data to support this position and further this approach may not be routinely necessary for all tibial tray designs.…”

Section: Introductionmentioning

confidence: 99%

Stem Requirements of Tibial Augmentations in Total Knee Arthroplasty

Hashemi

Ziada

Adili

et al. 2012

Experimental Techniques

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Various tibial augmentations have been employed to overcome the problem associated with proximal tibial bony deficiencies mainly in revision total knee arthroplasty (TKA). It has generally been recommended that stem extensions should always be applied to the tibial tray in the event that block augments have been used to compensate for bone loss. The rationale for such routine use of stems has not been clearly established and further this adds to implant costs and may contribute to substantial bone loss if a future revision is required. We investigated the stability of three implant configurations (Deltafit Keel tibial tray only (no bone loss), tray with block augment (with bone loss), and tray with block and extended stem) utilizing both cadaveric human bone as well as commercially available composite tibias. The experimental results revealed that comparable stability can be achieved with the configuration of Deltafit Keel tibial tray and a block as compared to the case of Deltafit Keel tray only without bone loss. Addition of a stem provided moderate improvement of stability but with significant stress shielding. For the amount of bone loss evaluated in this study, a Deltafit Keel tibial tray with a block provided adequate stability and avoided obvious stress shielding.

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“…Bár a press fi t rögzí-tési módszer élettani el nyei ismeretesek, biomechanikai kísérletek alapján több tanulmány a cementezett rögzítés mellett foglal állást. Cementes rögzítés esetén terhelés hatására szignifi kánsan kisebb mikromozgások észlel-het k, mint press fi t rögzítés esetén 18,19,20,21 .…”

Section: A Protézis Rögzítése éS a Rögzítés Biomechanikájaunclassified

The Biomechanics of the Hinged Knee Prostheses

Bazsó¹,

Manó²

2011

Biomech Hung

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AbsztraktA térdízületi artrózis sebészi kezelésében alkalmazott térdízületiprotézis-beültetések száma világszerte növekv tendenciát mutat. Az 1990-es évekt l Magyarországon is egyre nagyobb számban végezzük a térdízületi ízfelszínek pótlását. Kezdetben inkább részleges pótlást végez-tünk, majd egyre inkább a teljes, ún. totál endoprotézis-beültetés került el térbe, napjainkban is ez az els dlegesen alkalmazott eljárás. A protézisek várható élettartama 15-20 év. Ahogy növek-szik az ilyen m tétek száma, az id el rehaladtával egyre több revízióra van szükség. A revíziós m tétek sebészileg mindig nehezebbek az els dleges m téteknél, eredményeikben pedig gyakran elmaradnak a primer m tétekét l, köszönhet en annak is, hogy a m tét során egyre több kompromisszumra kényszerül az operációt végz sebész. A revíziók nagy része során alkalmazott implantátumok mozgásszabadsága kisebb, mint a primer m tétek során alkalmazott modelleké, zsanéros jellegük -kényszerpályán történ mozgásuk -miatt. A legjobb eredmény akkor várható, ha a revízió során is lehet ség van non-constrained típus beültetésére. Legtöbbször hátsó stabilizálással ellátott, semiconstrained típusok kerülnek alkalmazásra, míg vannak esetek, amikor a biomechanikailag legkedvez tlenebb tulajdonságú constrained protézisek használata elkerülhe-tetlen. A szerz k áttekintik a revíziók során választható protézistípusokat, különös tekintettel a zsanéros protézisek m ködésére és biomechanikai tulajdonságaira. Kulcsszavak: térdprotézis-revízió, zsanéros protézis The Biomechanics of the Hinged Knee Prostheses AbstractThe number of knee arthroplasty surgery for the treatment of sever knee osteoarthritis is increasing worldwide. Since the 90's the same tendency can be seen in Hungary as well. In the beginning mostly unicondylar knee arthroplasty was performed, but nowadays total knee arthroplasty is more dominant. Even today the expectable lifetime of prostheses is around 15-20 years. Due to the fact that the number of these surgical procedures are rapidly growing, more and more revision surgery is required. These surgeries are always more complicated than the primary procedures, often giving moderate results and the surgeon frequently is forced to make more compromises. The mostly used revision implants have decreased range of motion due to their semiconstrained or constrained character. The best result can be expected if the revision is possible with a non-constrained type of implant. During most of these surgeries semiconstrained implants are used, but occasionally the use of constrained prostheses is necessary, which have the most disadvantageous characters. The authors review the types of prostheses used in revision surgeries, especially the functional and biomechanical characters of the constrained prostheses.

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Stemmed Implants Improve Stability in Augmented Constrained Condylar Knees

Cited by 31 publications

References 19 publications

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

Stem Requirements of Tibial Augmentations in Total Knee Arthroplasty

The Biomechanics of the Hinged Knee Prostheses

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