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Fontalis A, Kayani B, Asokan A, Haddad IC, Tahmassebi J, Konan S, Oussedik S, Haddad FS. Inflammatory Response in Robotic-Arm-Assisted Versus Conventional Jig-Based TKA and the Correlation with Early Functional Outcomes: Results of a Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:1905-1914. [PMID: 36074816 DOI: 10.2106/jbjs.22.00167] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the exact etiology of patient dissatisfaction in total knee arthroplasty (TKA) is unclear, the inflammatory response precipitated by surgery may be implicated. Robotic TKA has been shown to result in reduced bone and soft-tissue trauma. The objectives of this study were to compare the inflammatory response in conventional jig-based TKA versus robotic-arm-assisted TKA and to examine the relationship with early functional outcomes. METHODS This prospective randomized controlled trial included 15 patients with symptomatic knee osteoarthritis undergoing conventional TKA and 15 undergoing robotic-arm-assisted TKA. Blood samples were collected for up to 28 days postoperatively, and predefined markers of systemic inflammation were measured in serum. The local inflammatory response was assessed by analyzing samples from the intra-articular drain fluid at 6 and 24 hours. Relationships with early functional outcomes were evaluated using the Spearman rank correlation coefficient. RESULTS Patients in the robotic TKA group demonstrated lower levels of interleukin (IL)-6 in the drain fluid at 6 hours (798.54 pg/mL versus 5,699.2 pg/mL, p = 0.026) and 24 hours and IL-8 at 6 hours. Robotic TKA was associated with lower pain scores on postoperative days 1, 2, and 7. Patient-reported outcome measures were comparable between the 2 groups at 2 years. Significant correlations were observed between all serum markers except IL-1b and self-reported pain on postoperative day 7; between drain IL-8 levels and pain on postoperative days 1 (r = 0.458), 2, and 7; and between drain IL-6, IL-8, and tumor necrosis factor-alpha levels at 6 hours and knee flexion or extension. CONCLUSIONS Robotic-arm-assisted TKA was associated with a reduction in the early postoperative local inflammatory response. We also found a moderate relationship between the inflammatory responses and self-reported pain, knee flexion, and knee extension. Further validation of these findings on a larger scale and using longer-term outcomes will be key to developing the optimal TKA procedure. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom.,Division of Surgery and Interventional Science, University College, London, United Kingdom
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ajay Asokan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Isabella Catrina Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Sujith Konan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom.,Division of Surgery and Interventional Science, University College, London, United Kingdom
| | - Sam Oussedik
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom.,Division of Surgery and Interventional Science, University College, London, United Kingdom
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Lawrie CM, Bartosiak KA, Barrack TN, Nunley RM, Wright RW, Barrack RL. James A. Rand Young Investigator's Award: Questioning the "Nickel Free" Total Knee Arthroplasty. J Arthroplasty 2022; 37:S705-S709. [PMID: 35378232 DOI: 10.1016/j.arth.2022.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A study was performed to measure metal ions present in the knee joint after performing a total knee arthroplasty (TKA) with standard cobalt chromium (CoCr) components as well as with "nickel-free" oxidized zirconium femoral and titanium tibial (OxZr/Ti) components. METHODS Knee joint fluid was collected prior to arthrotomy, and on postoperative day one to determine the amount of metal debris generated when performing a TKA with standard instrumentation from consecutive cases with CoCr components (n = 24) and OxZr/Ti components (n = 16). RESULTS CoCr implant patients had statistically higher levels of nickel (Ni) (29.7%, P = .033), cobalt (Co), (1,100.7%, P < .0001) and chromium (Cr) (118.9%, P < .0001) postoperatively. The cutting blocks and sawblades do not contain Co, which therefore must have come from the components. The metal ions generated from the sawblades and cutting blocks, therefore, could be discerned from the OxZr/Ti whose components don't contain Co, Cr, or Ni. The OxZr patients had significantly higher Cr (9.5×, P < .001) and Ni (5.1×, P < .001) post-TKA vs pre-TKA; Co levels were not significantly different as expected with the absence of Co in the components (P = .60). The Ni levels generated in performing an Oxinium TKA was 3.3 times higher than when performing a CoCr TKA (1.37 vs. 41 ppb, P < .001). CONCLUSIONS The substantial degree of Ni generation resulting from performing a hypoallergenic "nickel-free" TKA calls into questions the rationale of utilizing more expensive lower Ni components on the basis of known or suspected Ni or Cr allergy.
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Affiliation(s)
- Charles M Lawrie
- Miami Orthopedics and Sports Medicine Institute, Baptist Health South Florida, Miami, Florida
| | - Kimberly A Bartosiak
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Toby N Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Oppel E, Kapp F, Böhm AS, Pohl R, Thomas P, Summer B. Contact sensitization to iron - a potentially underestimated metal allergen and elicitor of complications in patients with metal implants. Contact Dermatitis 2022; 86:531-538. [PMID: 35172024 DOI: 10.1111/cod.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about sensitization to iron (Fe) in private, working and medical settings, particulary implantology. OBJECTIVES To investigate sensitization to metals, particularly to Fe, both in pre-implant individuals with presumed metal allergy and in patients with suspected metal implant allergy. To further characterize Fe-sensitized individuals. METHODS Analysis of patch test reactions to an Fe (II)-sulfate-containing metal series in 183 consecutive patients (41 pre-implant, 142 metal implant-bearers). Test readings on D2, D3 and D6. Evaluation of questionnaire-aided history, of metal reactivity patterns, and demographics of Fe-reactors. RESULTS Metal reactivity in pre-implant/implant/total group was: to nickel 39%/30%/32%; to cobalt 17%/15%/15%; to chromium 7%/13%/11%. Co-sensitizations cobalt/nickel (19/58) and cobalt/chromium (11/21) were significant at P < .001; co-sensitizations Fe/Nickel (4/10) and chromium/knee arthroplasty (11/73) at P = .03. Ten of 183 (5.5%) reacted to Fe (2 of 41 pre-implant patients, 8 of 142 implant-bearers) with 10 only reacting on D6. Fe-reactivity was highest in complicated knee arthroplasty (7/73). Further peculiarities of Fe reactors included frequent isolated Fe reactivity (6/10), occupational metal exposure (7/10), previous (par)enteral Fe-substitution (6/10). CONCLUSIONS The 5.5% prevalence of Fe-reactions suggests a potentially underestimated role of this metal allergen in general and in implant-bearers. The latter also show a distinct metal sensitization pattern. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eva Oppel
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Florian Kapp
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Ann-Sophie Böhm
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Ralf Pohl
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Peter Thomas
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
| | - Burkhard Summer
- Clinic for Dermatology and Allergology, Ludwig-Maximilians-University Munich, Germany
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Tibial bone loss in revision TKA: Options for management without sleeves and cones -a schematic review. J Orthop 2021; 23:191-198. [PMID: 33551612 DOI: 10.1016/j.jor.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022] Open
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[Is the unlimited use of surgical instruments safe? : Discussion using the example of endoprosthetics]. DER ORTHOPADE 2020; 49:1049-1055. [PMID: 33112972 DOI: 10.1007/s00132-020-04022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As medical devices surgical instruments are important components when performing surgery. They can significantly influence the course and outcome of the surgery. Instruments are mechanically stressed in daily use and resterilized multiple times. The majority of manufacturer documentation for endoprostheses lacks specific information regarding tolerable instrument wear and the maximum number of applications for surgical instruments. So far, there are no mandatory algorithms for the necessity of checking and replacing surgical instruments. The risk of mechanical failure, surface damage and ultimately incidents is illustrated using endoprosthesis instruments as examples.
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Cementless TKA: Past, Present, and Future. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feczko PZ, Fokkenrood HJP, van Assen T, Deckers P, Emans PJ, Arts JJ. Accuracy of the Precision Saw versus the Sagittal Saw during total knee arthroplasty: A randomised clinical trial. Knee 2017; 24:1213-1220. [PMID: 28823809 DOI: 10.1016/j.knee.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/12/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to compare the accuracy of the oscillating tip saw system (Precision Saw=PS) with the more conventional fully oscillating blade system (Sagittal Saw=SS) during computer-assisted total knee arthroplasty (CAS-TKA). METHODS A prospective, randomised, controlled trial included 58 consecutive patients who underwent primary CAS-TKA and were randomly assigned in the PS group or the SS group to compare the accuracy of both blades. The primary outcome was the difference between the intended cutting planes and the actual cutting planes in degrees (°) in two planes of both the femur and the tibia. The secondary outcome was total surgery time. RESULTS Tibia: In the VV-plane no significant differences were registered for the mean absolute deviation (p=0.28). The PS was more accurate in the AP-plane (p=0.03). Femur: The PS showed significantly fewer mean absolute deviations in the VV-plane (p=0.03); however, the SS revealed better accuracy in the FE-plane (p=0.04). The difference in the surgery time between the groups was not statistically significant (p=0.45). Two outliers were measured using the SS, while seven outliers were detected using the PS. CONCLUSION The Precision Saw is not proven to be overall more accurate than the Sagittal Saw. Significantly better accuracy was shown with the PS in the two cutting planes, with the exception of one cutting plane that favoured the SS. Greater number of outliers were found using the PS. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Peter Z Feczko
- Dept. of Orthopedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | - Tijmen van Assen
- Dept. of Sports Medicine, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Patrick Deckers
- Dept. of Orthopedic Surgery, Zuyderland Hospital, Heerlen, The Netherlands.
| | - Pieter J Emans
- Dept. of Orthopedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jacobus J Arts
- Dept. of Orthopedic Surgery, CAPHRI Research School, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Hoffart HE, Dinges H, Kolbeck S, Ritschl P, Hommel H. Novel computer-assisted method for revision arthroplasty of the knee. World J Orthop 2015; 6:821-828. [PMID: 26601064 PMCID: PMC4644870 DOI: 10.5312/wjo.v6.i10.821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To introduce the navigation system of software and instruments designed specifically for revision total knee arthroplasty (TKA).
METHODS: We present an imageless navigation system for revision TKA, with optical point and tracker identification to assess kinematic and anatomical landmarks. The system automatically positions the cutting guides with a motorized cutting unit. The cutting unit is placed on the distal femur with a femoral clamp and acts as a rigid body and the base for all femoral cuts. The surgical technique for using the navigation system for revision TKA is based on the technique used in primary TKA. However, there are some important differences. The most notable are: (1) differences in estimation of the position of the primary implant relative to the bone and the mechanical axes; (2) the specific possibilities the revision navigation software offers in terms of optimal joint level positioning; and (3) the suggested “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are taken into account to find the optimal femoral component position. We assessed the surgical technique, and accompanying software procedural steps, of the system, identifying any advantages or disadvantages that they present.
RESULTS: The system aims to visualize critical steps of the procedure and is intended as a tool to support the surgeon in surgical decision-making. Combining a computer-assisted cutting device with navigation makes it possible to carry out precise cuts without pinning. Furthermore, the femoral clamp provides a stable fixation mechanism for the motorized cutting unit. A stable clamp is paramount in the presence of periarticular bony defects. The system allows the position of the primary implant relative to the bone and mechanical axes to be estimated, at which point any malalignments can be corrected. It also offers an optimal joint level position for implantation, and suggests a “best fit” position, in which the clock position, stem position and offset, femoral component size, and mediolateral position of the femoral component are considered. The surgeon can therefore make decisions intraoperatively to maximise alignment and, hence, outcomes. Based on the intraoperative findings of joint stability, the surgeon can modify the preoperative plan and switch from a constrained condylar system to a hinged version, or vice versa.
CONCLUSION: The system is flexible and easy to learn and allows improvements in workflow during TKA.
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Zietz C, Reinders J, Schwiesau J, Paulus A, Kretzer JP, Grupp T, Utzschneider S, Bader R. Experimental testing of total knee replacements with UHMW-PE inserts: impact of severe wear test conditions. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:134. [PMID: 25716024 DOI: 10.1007/s10856-015-5470-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
Aseptic implant loosening due to inflammatory reactions to wear debris is the main reason for the revision of total knee replacements (TKR). Hence, the decrease in polyethylene wear particle generation from the articulating surfaces is aimed at improving implant design and material. For preclinical testing of new TKR systems standardized wear tests are required. However, these wear tests do not reproduce the entire in vivo situation, since the pattern and amount of wear and subsequent implant failure are underestimated. Therefore, daily activity, kinematics, implant aging and position, third-body-wear and surface properties have to be considered to estimate the wear of implant components in vivo. Hence, severe test conditions are in demand for a better reproduction of the in vivo situation of TKR. In the present article an overview of different experimental wear test scenarios considering clinically relevant polyethylene wear situations using severe test conditions is presented.
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Affiliation(s)
- Carmen Zietz
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medicine Rostock, Doberaner Str. 142, 18057, Rostock, Germany,
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Third-body abrasive wear of tibial polyethylene inserts combined with metallic and ceramic femoral components in a knee simulator study. Int J Artif Organs 2013; 36:47-55. [PMID: 23335379 DOI: 10.5301/ijao.5000189] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2012] [Indexed: 11/20/2022]
Abstract
AIM Total knee arthroplasties have reached a high grade of quality and safety, but most often fail because of aseptic implant loosening caused by polyethylene wear debris. Wear is generated at the articulating surfaces, e.g. caused by third-body particles. The objective of this experimental study was to determine the wear of tibial polyethylene inserts combined with metallic and ceramic femoral components under third-body wear conditions initiated by bone cement particles.
METHODS AND MATERIALS Wear testing using a cemented unconstrained bicondylar knee endoprosthesis (Multigen Plus CR knee system) was performed in a knee wear simulator. Tibial polyethylene inserts were combined with the identical femoral component design, but made of two different materials (cobalt-chromium and ceramic). Bone cement debris including zirconium oxide particles was added every 500,000 cycles between the articulating surfaces. After 5 million load cycles, the amount of wear was determined gravimetrically and compared with results from standard wear test conditions. The surfaces of tibial inserts were also analyzed.
RESULTS The average gravimetrical wear of the tibial polyethylene inserts in combination with
cobalt-chromium and ceramic femoral components under third-body wear conditions amounted to 31.88 ± 4.53 mg and 13.06 ± 1.88 mg after 5 million cycles, respectively, and was higher than under standard wear test conditions in both cases.
CONCLUSIONS The wear simulator test demonstrates that wear of polyethylene inserts under third-body wear conditions, in combination with ceramic femoral components, was significantly lower than with metallic femoral components.
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Qiu YY, Yan CH, Chiu KY, Ng FY. Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong) 2012; 20:78-86. [PMID: 22535817 DOI: 10.1177/230949901202000116] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bone deficiency hinders implant alignment and stabilisation of the bone-implant interface in revision total knee arthroplasty (TKA). Treatments for bone defects include bone cement, bone cement with screw reinforcement, metal augments, impaction bone grafts, structural allografts, and tantalum, depending on the location and size of the defects. Small defects are usually treated with cement, cement plus screws, or impaction allograft bone. Large defects are repaired with structural allografts or metal augments. Recent developments involve the use of highly porous osteoconductive tantalum. We reviewed the pros and cons of each method for bone defect management in revision TKA.
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Affiliation(s)
- Yi Yan Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Qiu YY, Yan CH, Chiu KY, Ng FY. Review article: bone defect classifications in revision total knee arthroplasty. J Orthop Surg (Hong Kong) 2011; 19:238-43. [PMID: 21857054 DOI: 10.1177/230949901101900223] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are several classification systems for bone defects in revision total knee arthroplasty. Each has its own drawbacks, and none satisfies all the clinical demands. Therefore, a new classification system and treatment guideline based on a combination of criteria (location, side, containment, and severity of the bone defect) is necessary.
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Affiliation(s)
- Yi Yan Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Brown TD, Lundberg HJ, Pedersen DR, Callaghan JJ. 2009 Nicolas Andry Award: clinical biomechanics of third body acceleration of total hip wear. Clin Orthop Relat Res 2009; 467:1885-97. [PMID: 19399565 PMCID: PMC2690766 DOI: 10.1007/s11999-009-0854-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 04/08/2009] [Indexed: 01/31/2023]
Abstract
Aseptic loosening attributable to wear-related osteolysis historically has been the predominant cause of failure in THA. Advances in low-wear bearing couples show great promise to substantially reduce this long-standing problem. However, there always has been striking variability in wear rate in any given cohort of patients who are similarly implanted, with some individuals typically experiencing near order-of-magnitude elevations above group mean. Third-body wear is likely a major contributor to many of these most osteolysis-prone outliers. For the patients affected, third-body effects may obviate many of the gains otherwise achieved by contemporary bearing surface improvements. Toward heightening visibility in terms of consequences for patients, this review paper summarizes an interrelated series of investigations quantifying construct level manifestations of third-body wear. Long-term followup of a unique group of patients with elevated third-body challenge shows statistically significant and clinically important wear-rate increases. A series of finite element models, validated physically, shows the linkage of location of third-body damage with variability of volumetric wear-rate acceleration and shows the effects of various implant factors, surgeon factors, and patient factors in the presence of third-body challenge. Finally, a mechanism for third-body debris access to wear-critical locations on the bearing surface is identified analytically and corroborated in laboratory experiments and implant retrievals.
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Affiliation(s)
- Thomas D Brown
- Department of Orthopaedics and Rehabilitation, Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn Building, Iowa City, IA 52242, USA.
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De Baets T, Waelput W, Bellemans J. Analysis of third body particles generated during total knee arthroplasty: is metal debris an issue? Knee 2008; 15:95-7. [PMID: 18255297 DOI: 10.1016/j.knee.2008.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/24/2007] [Accepted: 01/07/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE There is a concern amongst knee surgeons that during total knee arthroplasty (TKA) certain particles could be generated which might become left inside the knee, and which could become a possible cause of third body wear. Especially during the sawing process, when an oscillating saw is used through slots in a cutting block, there is a potential cause for metal debris generation. So far however, no data exist to substantiate and quantify the amount of metal debris left in situ after TKA, and it was the purpose of this study to evaluate this. METHODS In seven consecutive patients undergoing primary cemented TKA, we measured the amount of debris that was present at the end of the operation immediately before closure. The debris was retrieved using pulsed irrigation with 1 l of normal saline, which was then collected and centrifuged. Obtained pellets were subsequently washed and chemically treated to quantify the different components present in the debris. RESULTS Overall an average amount of 134.9 mg (range 73.6-198.0 mg) debris was retrieved. The debris contained on average 75.8 mg of bone particles (range 41.2-109.3 mg), 57.2 mg (range 31.2-83.9 mg) of cement particles, and 1.96 mg (range 0-7.2 mg) of metal particles. On average the total amount of debris consisted for 56.5% of bony fragments, 42% cement fragments and 1.5% metal particles. CONCLUSION Even despite precise surgical technique including pressurized irrigation, a significant amount of debris is still present after TKA. The debris consists predominantly of bone and cement particles. The presence of metal debris is limited, and contributes only 1.5% to the total amount.
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Affiliation(s)
- T De Baets
- Department of Orthopaedic Surgery, University Hospital Pellenberg, Katholieke Universiteit Leuven, Weligerveld 1, 3012 Pellenberg, Belgium
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