Total Knee Arthroplasty with an Uncemented Trabecular Metal Tibial Component

Niemeläinen, Mika; Skyttä, Eerik; Remes, Ville; Mäkelä, Keijo; Eskelinen, Antti

doi:10.1016/j.arth.2013.04.014

Cited by 40 publications

(36 citation statements)

References 23 publications

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“…Our findings that a highly porous metal tibial component provided durable fixation at midterm followup is in agreement with most of the available data on this implant design at short-and midterm followup. Niemelainen et al [13] reporting the registry-based data from Finland found that the uncemented trabecular metal tibial component was used in 1143 primary TKAs between 2003 and 2010 and had 7-year survivorship of 97% for all causes and 100% with aseptic loosening of the tibia as the endpoint. Neither patient age nor sex had an influence on durability of the trabecular metal tibia in that study from the Finnish Arthroplasty Registry.…”

Section: Discussionmentioning

confidence: 99%

“…There was no difference in the risk of knee stiffness, reoperation, or complications in that study. The report by Niemelainen et al of the Finnish Registry data with uncemented trabecular metal tibias does not include clinical followup data but does stratify the revision and reoperation data by patient age [13]. In that analysis, there was no difference in the reliability of the uncemented trabecular metal tibia at 1 year or 5 years based on patient age as stratified into three categories, namely age \ 55 years, age 55 to 65 years, and age [ 65 years with [ 97% survival free of reoperation in each group.…”

Section: Discussionmentioning

confidence: 99%

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The Mark Coventry Award

Pulido

Abdel

Lewallen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Although highly porous metals have demonstrated excellent bone ingrowth properties and so are an intriguing option for fixation in total knee arthroplasty (TKA), some surgeons are skeptical about the durability of uncemented tibial fixation and the potential for soft tissues to adhere to these porous metals and perhaps cause knee stiffness or pain. Questions/purposesThe purpose of this study was to compare, in the context of a randomized clinical trial, a highly porous metal tibia compared with a traditional modular cemented tibia in terms of survivorship, Knee Society scores, range of motion (ROM), and complications. MethodsFrom 2003 to 2006, 397 patients (age 67.8 ± 8.7 years; 54% female) were randomized to three groups: (1) traditional modular cemented tibia; (2) cemented highly porous metal tibia; and (3) uncemented highly porous metal tibia. The same posterior-stabilized femoral component and patella component were cemented in every case. Stratified randomization was done for surgeon, patient's age, sex, and body mass index. Survivorship at 5 years was compared between the groups, as were Knee Society scores, ROM, and complications. Radiographic assessment included alignment, radiolucency, and implant migration/loosening. Patients were followed until death, revision, or for a minimum of 2 years (mean, 5 years; range, 2-9 years). Four patients were lost to followup before 2 years. ResultsHighly porous metal tibias (both uncemented and cemented) were no different from traditional cemented modular tibial modular components in terms of survivorship at 5 years using a intention-to-treat analysis (96.8% [1]; 97.6% [2]; 96.7% [3]; p = 0.59). A per-protocol analysis revealed that no highly porous metal tibia was revised for aseptic loosening. Highly porous metal tibias performed comparably to traditional cemented modular tibias in terms of Knee Society scores, ROM, and the frequency of complications. ConclusionsAt 5 years this randomized clinical trial demonstrated that highly porous metal tibias provided comparably durable fixation and reliable pain relief and restoration of function when compared with a traditional cemented modular tibia in TKA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Mark Coventry Award

Pulido

Abdel

Lewallen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Numerous recent clinical studies have demonstrated good to excellent results with porous tantalum components in primary total knee replacement (Table 10.5 ) [ 55 -61 ]. In a recent study from the Finnish registry, Niemelanin et al reported the 7-year survivorship of 1143 TKRs using monoblock tantalum tibial components [ 59 ]. They noted 100 % survivorship with revision for aseptic loosening of the tibial component and 97 % with revision for any reason as the respective endpoints, thus demonstrating excellent outcome in a large population-based study.…”

Section: Knee Reconstructive Surgerymentioning

confidence: 97%

The Use of Porous Tantalum for Reconstructing Bone Loss in Orthopedic Surgery

Patil¹,

Goodman

2015

Springer Series in Biomaterials Science and Engineering

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Porous tantalum, a novel biomaterial, was approved for use in orthopedic surgery by the Food and Drug Administration (FDA) in 1997. Several preclinical and experimental studies have demonstrated excellent biocompatibility with physical, mechanical, and tissue ingrowth properties conducive for enhanced osseointegration and superior structural integrity. Porous tantalum has high volumetric porosity (75-80 %). The modulus of elasticity of tantalum (3 Gpa) compares favorably to cancellous bone (1.2 GPa) or subchondral bone (2 GPa). Porous tantalum also has a high coeffi cient of friction with a high resistance to compression (50-80 Mpa) and rotational deformity (40-60 Mpa). Tantalum has been used in a wide array of clinical applications in orthopedics including primary and revision joint replacement, tumor reconstructive surgery, spine fusion, management of osteonecrosis of the femoral head, and foot and ankle surgery. Recent studies have demonstrated excellent clinical and radiographic outcomes, even in the presence of extensive bone loss in hip and knee reconstructive surgeries. Its use in spine surgeries and osteonecrosis of the hip has been associated with mixed clinical results. Further clinical studies are necessary to establish its role and refi ne its indications in specifi c orthopedic applications and determine whether the theoretical advantages of porous tantalum can provide long-term biological fi xation and stability. This chapter presents a synopsis of the biomaterial properties and preclinical and clinical studies of porous tantalum in orthopedic surgery.

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“…The monoblock design consists of a porous tantalum ingrowth surface with an ultra-high molecular weight (UHMWPE) bearing surface compression molded into it and two hexagonal porous tantalum pegs for initial stability. This monoblock design was intended to prevent backside wear, which may reduce long-term UHMWPE particle burden [18, 19]. An alternate design, the porous tantalum modular component, consists of a titanium alloy modular tray with a porous tantalum layer that also includes two hexagonal pegs.…”

Section: Introductionmentioning

confidence: 99%

“…Several clinical studies and one registry study of the porous tantalum tibial tray have shown no cases of tibial loosening [18, 20–22]. In a recent study using the Finnish registry with seven year follow up there were no reported revisions due to aseptic loosening in 1143 patients with a monoblock porous tantalum tibial tray [18].…”

Section: Introductionmentioning

confidence: 99%

Is There A Difference in Bone Ingrowth in Modular Versus Monoblock Porous Tantalum Tibial Trays?

Hanzlik

Day

Rimnac

et al. 2015

The Journal of Arthroplasty

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Contemporary total knee designs incorporating highly porous metallic surfaces have demonstrated promising clinical outcomes. However, stiffness differences between modular and monoblock porous tantalum tibial trays may affect bone ingrowth. This study investigated effect of implant design, spatial location and clinical factors on bone ingrowth in retrieved porous tantalum tibial trays. Three modular and twenty-one monoblock tibial trays were evaluated for bone ingrowth. Nonparametric statistical tests were used to investigate differences in bone ingrowth measurements by implant design, spatial location on the tray, substrate depth and clinical factors. Modular trays (5.3±3.2%) exhibited higher bone ingrowth than monoblock trays (1.6±1.9%, p=0.032). Bone ingrowth in both designs was highest in the initial 500 μm from the surface. Implantation time was positively correlated with bone ingrowth for monoblock trays.

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Total Knee Arthroplasty with an Uncemented Trabecular Metal Tibial Component

Cited by 40 publications

References 23 publications

The Mark Coventry Award

The Mark Coventry Award

The Use of Porous Tantalum for Reconstructing Bone Loss in Orthopedic Surgery

Is There A Difference in Bone Ingrowth in Modular Versus Monoblock Porous Tantalum Tibial Trays?

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