The effect of the preoperative bone quality on the fixation of the tibial component in total knee arthroplasty

Li, Ming G.; Nilsson, Kjell

doi:10.1054/arth.2000.6617

Cited by 76 publications

(57 citation statements)

References 33 publications

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“…The same effect occurred in valgus knees. Studies with controls [5,6,9,20] have found no evidence of BMD change either in the contralateral knee or spine after TKA. This implies a local effect attributable to the implant and changes in mechanical alignment as opposed to a global BMD change.…”

Section: Discussionmentioning

confidence: 99%

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

Munro

Pandit

Walker

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Little is known about tibial bone remodeling with TKA and its clinical relevance. We performed a randomized clinical trial to compare tibial bone density changes in cemented components with different bearing designs. Bone density changes were assessed using quantitative computed tomography (qCT)-assisted osteodensitometry. Twenty-eight rotating-platform and 26 fixed-platform cemented TKAs were included. The nonoperated contralateral side was used as a control. CT scans were performed postoperatively and 1 year and 2 years after the index operation. Cancellous bone density loss (up to 12.6% at 2 years) was observed in all proximal tibial regions in both cohorts. In contrast, we found lower cortical bone density loss (up to 3.6% at 2 years). We found no differences in bone loss between fixed-and rotating-platform implants. The decrease of cancellous bone density after TKA suggests stress transfer to the cortical bone.

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Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Munro

Pandit

Walker

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…To reach these goals, different types of tibial stems have been designed. In knees with cemented fixation, the bone cement can compensate for variations in-bone quality, and consequently, the subsidence of the tibial platform is homogenous [7]. In some studies, the most rigid implant fixation was achieved using four peripheral screws in cancellous bone.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical loosening of the tibial component is a frequent cause of failure of total knee arthroplasty (TKA) [7], and it is related to malalignment and unbalanced ligaments, with an unstable fixation or with bone quality decrease near the prosthesis. The mineral density of trabecular bone is directly associated with bone quality and its mechanical properties, and these are considered to be important predictors of TKA failure.…”

Section: Introductionmentioning

confidence: 99%

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Hernández-Vaquero

García-Sandoval

Fernández-Carreira

et al. 2006

International Orthopaedics (SICO

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We prospectively measured the changes in bone mineral density (BMD) in the proximal tibia of 20 total knee arthroplasties, ten with cruciform stems and ten with cylindrical stems. The measurements were made one, four and seven years after surgery. We observed a uniform density decrease in three regions of interest from one to seven years of follow-up. Cylindrical stems showed an asymmetrical density decrease between the three regions of interest, with no change in the central region, a slight decrease in the lateral region, and large decrease in the medial region. Multivariate analysis with general linear model showed the stem type factor as statistically significant for medial region of interest (p=0.006). The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component. Résumé Nous avons de façon prospective mesuré les modifications de la densité minérale osseuse (BMD) au niveau de la partie proximale du tibia chez 20 patients ayant bénéficié d'une prothèse totale du genou, 10 avec une quille cruciforme et 10 avec une quille cylindrique. Les mesures ont été réalisées de 1.4 à 7 ans après l'intervention chirurgicale. Nous avons observé une diminution uniforme de la densité minérale osseuse dans trois zones, durant cette période de 1 à 7 ans de suivi. La quille cylindrique montre que la densité minérale osseuse diminue de façon asymé-trique dans ces 3 régions sans modification au niveau de la région centrale, avec une légère diminution de la région externe (latérale) et une diminution plus importante de la région interne (médiale). Une analyse de régression multi variable montre que le type de quille est l'élément le plus significatif au niveau de la région interne (p=0.006). La quille cylindrique étant un facteur statistiquement significatif et entraînant des modifications hétérogènes de la BMD, sous le plateau tibial. Ces modifications peuvent être un risque potentiel de migration du composant tibial.

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“…The femurs with highest BMD lost most bone. Even Li and Nilsson 19 could relate postoperative change in BMD in the proximal tibia to the baseline level; most bone loss was seen in knees with high postoperative BMD. Variations in the definition of the ROI's, implant design, type of fixation, and choice of methodology may at least partly explain the discrepancy between the studies.…”

Section: Discussionmentioning

confidence: 96%

Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement

Saari

Uvehammer

Carlsson

et al. 2007

Journal Orthopaedic Research

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After total knee replacement (TKR) the bone mineral density (BMD) decreases in the proximal tibia. Our aim was to evaluate if changes in constraint of the cemented AMK TKR (DePuy, Johnson & Johnson, Leeds, UK) had any effect on postoperative bone remodeling in the proximal tibia. We used dual-energy X-ray absorptiometry in 43-53 knees to record changes in BMD in three regions of interest around the tibial component up to 5 years after operation with the AMK (DePuy) TKR. The knees had been randomly allocated to receive a flat or a concave tibial insert with retention of the posterior cruciate ligament when preoperative deformity was less severe, and either a concave or a posterior-stabilized (PS) insert with resection of the posterior cruciate ligament when deformity was more pronounced. All designs were associated with loss of BMD in the proximal tibia. The mean bone loss varied from 5 to 23% depending on the region of interest. There were no statistically significant differences between the groups, and the alteration of tibial insert constraint did not influence the bone remodeling. However, low precision values may have impaired the detection of differences. ß

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The effect of the preoperative bone quality on the fixation of the tibial component in total knee arthroplasty

Cited by 76 publications

References 33 publications

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

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

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement

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