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Andronic O, Yang YH, Pabbruwe M, Jones CW, Yates PJ. Early aseptic loosening and inferior patient-reported outcomes of a cementless tibial baseplate in a modern total knee arthroplasty design. Bone Joint J 2025; 107-B:440-448. [PMID: 40164184 DOI: 10.1302/0301-620x.107b4.bjj-2024-0704.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Aims This study reports the outcome of a modern total knee arthroplasty design using a cementless tibial baseplate compared to the full-cemented version. Methods Consecutive cohorts with 12-month follow-up were evaluated. Patients receiving a cementless tibial baseplate were compared to those who received a cemented tibial component. Endpoints included revision rates and reason for revision, patient-reported outcome measures (PROMs) using the Oxford Knee Score (OKS), and progressive radiolucency. Retrieval analysis was performed for the revised cases. Pearson correlation analysis and multiple regression analysis were used. Results A total of nine knees (7%) from the cementless cohort were revised, all due to aseptic loosened baseplate at a mean follow-up of 10.4 months (3 to 19), whereas the incidence of aseptic loosening of the cemented tibial baseplate was significantly lower at 0.5% (3/534; p < 0.001). The cemented cohort PROMs outperformed the cementless baseplate group at both 12 months' follow-up and the improvement from baseline (mean OKS 40.4 (SD 6.8) vs 38.5 (SD 8.1); p = 0.006; mean ΔOKS 18.8 (SD 9.0) vs 15.5 (SD 12.8); p < 0.001). There were no significant differences between the groups in the occurrence of new radiolucency at 12 months (p = 0.325). An elevated BMI was the only factor to correlate (r = -0.195) with worse values of ΔOKS (p = 0.048) in the cementless cohort. The multiple regression analysis determined that an increased BMI was the single independent predictor for aseptic loosening (p = 0.024) for the knees with a cementless tibial baseplate. Retrieval analysis suggested failed osseointegration. Conclusion In our cohort, there was a significantly higher incidence of aseptic loosening and worse PROMs at one year for the cementless tibial baseplate. An increased BMI may be an independent risk factor for aseptic loosening and inferior PROMs.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Orthopaedic Research Foundation Western Australia, Perth, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Perth, Australia
| | - Yue H Yang
- Orthopaedic Research Foundation Western Australia, Perth, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Perth, Australia
| | - Moreica Pabbruwe
- Bioengineering Division, Health Technology Management Unit, East Metropolitan Health Service, Perth, Australia
- Curtin University, Perth, Australia
| | - Chris W Jones
- Orthopaedic Research Foundation Western Australia, Perth, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Perth, Australia
- Bioengineering Division, Health Technology Management Unit, East Metropolitan Health Service, Perth, Australia
| | - Piers J Yates
- Orthopaedic Research Foundation Western Australia, Perth, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Perth, Australia
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Sorbi R, Walker T, Nees TA, Renkawitz T, Moradi B, Reiner T. The incidence of radiolucent lines in cemented attune total knee arthroplasty- a retrospective clinical and radiological study. Arch Orthop Trauma Surg 2025; 145:201. [PMID: 40111513 PMCID: PMC11926027 DOI: 10.1007/s00402-025-05824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/07/2025] [Indexed: 03/22/2025]
Abstract
INTRODUCTION The Attune total knee arthroplasty (TKA) system was introduced with the goal to improve clinical outcome, patient satisfaction and implant survival. The aim of the present study was to investigate the clinical and radiological outcome of the cemented Attune knee and to assess the rate of radiolucent lines (RLL) at a median follow-up of 4 years. MATERIALS AND METHODS In this single-center cohort study, we retrospectively evaluated the clinical and radiological results of 165 consecutive patients following cemented TKA with the original design of the Attune knee at a minimum follow-up of two years. Postoperative radiographs were assessed for RLL and clinical outcome was measured using patient reported outcome scores. RESULTS A total of 115 patients (127 knees) were available for assessment at a mean follow-up of 47.8 ± 12.9 months. The overall incidence of femoral and tibial RLL was 24% and 26%, respectively. Of the original cohort, two patients had to be revised during the course of the study, resulting in a survival rate of 98.9% at two years with the endpoint "revision for any reason". Clinical outcome scores improved significantly up to the latest follow-up. CONCLUSIONS The findings of this study demonstrated good clinical results with significant improvement in pain and knee function and acceptable revision rates at a median follow-up of 4 years. However, a high incidence of periprosthetic RLL was seen in this cohort. No implant showed signs of component loosening, but patients with RLL should be monitored closely and future studies with longer follow-up durations are necessary to investigate the influence of these radiolucencies on the long-term performance of this knee system.
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Affiliation(s)
- Reza Sorbi
- Department of Orthopaedics and Trauma Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Timo A Nees
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Babak Moradi
- Department of Orthopaedics and Trauma Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
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Rodriguez-Merchan EC, Ribbans WJ. Retrieval analysis in total knee arthroplasty. World J Orthop 2025; 16:102160. [PMID: 40124734 PMCID: PMC11924018 DOI: 10.5312/wjo.v16.i3.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 01/23/2025] [Accepted: 02/08/2025] [Indexed: 03/12/2025] Open
Abstract
Retrieval analysis in total knee arthroplasty (TKA) has been little studied in the literature. A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted. On August 27, 2024, a literature search was performed in PubMed using "TKA retrieval analysis" as keywords. A total of 160 articles were found, of which only 19 were analyzed because they were directly related to the subject of this article. Rotating-platform (mobile-bearing) TKA has no surface damage advantage over fixed-bearing TKA. TKAs with central locking mechanisms are more prone to debond from the cement mantle. No major wear of the polyethylene (PE) component in TKA using oxidized zirconium components occurs. Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components. The use of a polished tibial tray over an unpolished design is advised. At short-run assessment (15 months on average), antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage, density of crosslinking, or oxidation compared to standard remelted highly crosslinked PE components. A correlation between implant position and PE component surface damage has been reported. It shows the importance of optimizing component position to reduce PE component damage. Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge. Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform. Such information can help to improve future prosthetic designs to increase prosthetic survival.
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Affiliation(s)
| | - William J Ribbans
- Faculty of Health, Education and Society, University of Northampton, Northampton, United Kingdom and The County Clinic, Northampton NN1 5DB, United Kingdom
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Wilson JM, Mika AP, Gilbert WW, Mason JB, Polkowski GG, Martin JR. Double-Butter: A Cementation Technique That Significantly Reduces Lipid Contamination of the Tibial Baseplate in Total Knee Arthroplasty. Arthroplast Today 2024; 30:101574. [PMID: 39717839 PMCID: PMC11665463 DOI: 10.1016/j.artd.2024.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/27/2024] [Accepted: 10/08/2024] [Indexed: 12/25/2024] Open
Abstract
Background Aseptic loosening is the most common aseptic failure modality following total knee arthroplasty. Recent literature suggests that the implant-cement interface is the "weak-link" in fixation and lipid contamination may drive this debonding pattern. Therefore, the purpose of this study was to determine if the "double-butter" technique would significantly decrease lipid contamination of the tibial tray. Methods Transparent acrylic models of 7 different tibial baseplates were created to allow for direct visualization of fluid contamination of the implant-cement interface during experimental cementation. Three cementation techniques were then employed in triplicate for each implant: coating only the tibia ("single butter") and coating of the tibia and baseplate (with and without keel included; "double-butter"). A dye was added centrally to simulate lipid contamination. After each trial, the degree of implant-cement contamination was calculated. Standard statistical analyses were conducted. Results With the double-butter technique, there was a significant reduction in contamination for all studied implant designs (range: 0%-7%; P < .05) and contamination was eliminated when the entire implant was coated prior to implantation. The single-butter technique resulted in contamination of 16%-43% of the tibial undersurface. There were significant differences in percent contamination between component designs (P < .05). Conclusions Cementation technique and implant design each influenced baseplate lipid contamination. While significant differences were noted between keel geometries, we found that the double-butter technique effectively eliminated baseplate contamination, even in the most susceptible designs in this study. We therefore advocate for the incorporation of the double-butter technique to limit lipid contamination and potentially reduce aseptic tibial loosening.
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Affiliation(s)
- Jacob M. Wilson
- Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA
| | - Aleksander P. Mika
- Department of Orthopedic Surgery, Vanderbilt University, Nashville, TN, USA
| | - William W. Gilbert
- Department of Orthopedic Surgery, Vanderbilt University, Nashville, TN, USA
| | | | | | - J. Ryan Martin
- Department of Orthopedic Surgery, Vanderbilt University, Nashville, TN, USA
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Smolle MA, Keintzel M, Staats K, Böhler C, Windhager R, Koutp A, Leithner A, Donner S, Reiner T, Renkawitz T, Sava MP, Hirschmann MT, Sadoghi P. Radiolucent lines and revision risk in total knee arthroplasty using the conventional versus the Attune S+ tibial baseplate. Bone Joint J 2024; 106-B:1240-1248. [PMID: 39481434 DOI: 10.1302/0301-620x.106b11.bjj-2024-0084.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]
Abstract
Aims This multicentre retrospective observational study's aims were to investigate whether there are differences in the occurrence of radiolucent lines (RLLs) following total knee arthroplasty (TKA) between the conventional Attune baseplate and its successor, the novel Attune S+, independent from other potentially influencing factors; and whether tibial baseplate design and presence of RLLs are associated with differing risk of revision. Methods A total of 780 patients (39% male; median age 70.7 years (IQR 62.0 to 77.2)) underwent cemented TKA using the Attune Knee System) at five centres, and with the latest radiograph available for the evaluation of RLL at between six and 36 months from surgery. Univariate and multivariate logistic regression models were performed to assess associations between patient and implant-associated factors on the presence of tibial and femoral RLLs. Differences in revision risk depending on RLLs and tibial baseplate design were investigated with the log-rank test. Results The conventional and novel Attune baseplates were used in 349 (45%) and 431 (55%) patients, respectively. At a median follow-up of 14 months (IQR 11 to 25), RLLs were present in 29% (n = 228/777) and 15% (n = 116/776) of the tibial and femoral components, respectively, and were more common in the conventional compared to the novel baseplate. The novel baseplate was independently associated with a lower incidence of tibial and femoral RLLs (both regardless of age, sex, BMI, and time to radiograph). One- and three-year revision risk was 1% (95% CI 0.4% to 1.9%)and 6% (95% CI 2.6% to 13.2%), respectively. There was no difference between baseplate design and the presence of RLLs on the the risk of revision at short-term follow-up. Conclusion The overall incidence of RLLs, as well as the incidence of tibial and femoral RLLs, was lower with the novel compared to the conventional tibial Attune baseplate design, but higher than in the predecessor design and other commonly used TKA systems.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Maximilian Keintzel
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Böhler
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Amir Koutp
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefanie Donner
- Charite - Center for Musculosceletal Surgery, Berlin, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel-Paul Sava
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
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van Duren BH, France J, Berber R, Matar HE, James PJ, Bloch BV. Is there an increased revision rate due to early tibial component loosening with a modern total knee arthroplasty design? A retrospective analysis from a large volume arthroplasty centre. ARTHROPLASTY 2024; 6:46. [PMID: 39095924 PMCID: PMC11297728 DOI: 10.1186/s42836-024-00264-0] [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: 03/06/2024] [Accepted: 05/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The Attune TKR was introduced in 2011 as a successor to its predicate design The PFC Sigma. However, following reports of early failures, there are ongoing concerns related to increased loosening rates. Given the concerns, this study aimed to compare revision rates of the Attune implant to an established predicate, and other implant designs used in a high-volume arthroplasty center. METHODS We identified 10,202 patients who underwent primary cemented TKR at our institution with a minimum of 1 year follow-up, involving 2406 Attune TKR (557 S +), 4642 PFC TKR, 3154 other designs. Primary outcomes were revision for all-causes, aseptic loosening of any component, and aseptic tibial loosening. Kaplan-Meier survival and Cox regression models were used to compare groups. Matched cohorts were selected for radiographic analysis. RESULTS 308 knees were revised. The Attune cohort had the lowest risk of revision, with a rate of 2.98 per 1000 implant-years while the PFC and All Other Implant groups had a rate of 3.15 and 4.4 respectively. Aseptic loosing was the most common cause for revision, with 76% (65/88) involving the tibia. Survival analysis showed no significant differences between the Attune and other cohorts. Radiolucent lines were detected in 7.1% of the Attune S + group, 6.8% of the standard Attune group, and 6.3% of the PFC group, with no significant differences found between them. CONCLUSION This study represents the largest non-registry review of the Attune TKR in comparison to a predicate and other designs. There was no significant increased revision rate for all-cause revision or aseptic loosening, or peri-implant radiolucencies. It appears that increased loosening may not be as concerning as originally thought. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bernard H van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK.
| | - Jonathan France
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Peter J James
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
- University of Nottingham, School of Medicine, Nottingham, UK
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Hall TAG, Cegla F, van Arkel RJ. Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants. SENSORS (BASEL, SWITZERLAND) 2024; 24:1696. [PMID: 38475232 DOI: 10.3390/s24051696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Wautier D, Thienpont E. Tibial implant design in primary TKA: retrospective comparison of two designs for the occurrence of radiolucent lines and aseptic loosening. Arch Orthop Trauma Surg 2024; 144:323-332. [PMID: 37733127 DOI: 10.1007/s00402-023-05030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION The purpose of this retrospective study was to study the effect of tibial implant design on the occurrence of radiolucent lines (RLLs) and aseptic loosening (AL) by comparing two different total knee arthroplasty (TKA) designs. MATERIALS AND METHODS Two types of total knee arthroplasty, different for tibial shape, size and keel design were compared, 255 for the first and 774 for the second. The occurrence of RLLs and radiological signs of micro- and macro-mobility and aseptic loosening was analyzed. Demographic data were compared, as well as the type and rate of RLLs, occurrence of aseptic loosening and the presence of potential risk factors. RESULTS The first implant design is morphometric and has a squarer keel than the second implant TKA. The overall rate of RLLs was similar (21% vs 23%), despite of a significantly lower rates of radiological signs of macro-mobility of the tibial component with the first implant (2% vs 17%). Survivorship of both designs was overall comparable (99.6% vs 98.8 %) the first implant group had more potential risk factors for poor bone quality than the second group (p < 0.05). CONCLUSION A morphometric design is more anatomic and offers better bone coverage of the epiphyseal tibial surface. RLLs, as a sign of implant micro-mobility, were equally present in both designs. Radiological signs of macro-mobility at the metaphysis were less frequently observed in squared keel design. The morphometric implant did not show improved survivorship compared with a symmetric implant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- D Wautier
- Department of Orthopedic Surgery, CHU UCL Namur, Godinne, Avenue Docteur Gaston Therasse 1, 5530, Yvoir, Belgium.
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Holzer LA, Finsterwald MA, Sobhi S, Jones CW, Yates PJ. Application of bone cement directly to the implant in primary total knee arthroplasty. Short-term radiological and clinical follow-up of two different cementing techniques. Arch Orthop Trauma Surg 2024; 144:333-340. [PMID: 37736767 DOI: 10.1007/s00402-023-05057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aimed to optimize cement application techniques in fully cemented primary total knee arthroplasty (TKA) by comparing the effects of two different approaches: cement on bone surface (CoB) versus cement on bone surface and implant surface (CoBaI) on the short-term presence of radiolucent lines (RLL) as indicators of potential complications. METHODS In this monocentric study, a total of 379 fully cemented primary TKAs (318 patients) were included. The two study groups were differentiated by the technique of cement application: CoB group (cement applied only on bone surface) and CoBaI group (cement applied on both bone surface and implant surface). The presence of RLL or osteolysis was evaluated using the updated Knee Society Radiographic Evaluation System. RESULTS In the whole study population, RLL were present in 4.7% of cases, with a significantly higher incidence in the CoBaI group (10.5%) at the 4-week follow-up. At the 12-month follow-up, RLL were observed in 29.8% of TKAs in the CoBaI group, while the incidence was lower in the CoB group (24.0%) (not statistically significant). There were two revisions in each group, none of which were due to aseptic loosening. CONCLUSION The findings of this study suggest that the application of bone cement on bone surface only (CoB) may be more beneficial than applying it on both bone surface and implant surface (CoBaI) in terms of short-term presence of RLL in fully cemented primary TKA. Long-term results, especially with regard to aseptic loosening, will be of interest and may provide valuable guidance for future directions in bone cement applications in TKA.
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia.
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia.
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michael A Finsterwald
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
| | - Salar Sobhi
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
| | - Christopher W Jones
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- Curtin University, Bentley, WA, Australia
- University of Western Australia, Crawley, WA, Australia
| | - Piers J Yates
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- University of Western Australia, Crawley, WA, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Murdoch, WA, Australia
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Saini MK, Reddy CD, Reddy NR, Reddy PJ, Singh M, Bhati M. Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design. Arch Orthop Trauma Surg 2023; 143:7139-7146. [PMID: 37530846 DOI: 10.1007/s00402-023-05000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND New total knee prostheses are being designed to improve clinical outcome, survivorship and patient satisfaction following total knee arthroplasty (TKA). A new knee system was developed with improvements in patellofemoral joint, trochlear geometry, polyethylene formulation and tibial baseplate. Aim of this study was to compare the newer kinematic knee system with its existing predecessor knee system in terms of clinical outcome, revision rates, radiographic outcomes specifically medial tibial bone resorption. METHODS The prospective matched-pair study included 88 TKA surgeries using newer kinematic design knee prostheses, performed between January 2015 and December 2016, out of which 82 patients were available for final follow-up. The control cohort of 82 traditional TKA prosthesis was matched in terms of age, gender and body mass index. All surgeries were performed by the single surgeon using medial parapatellar arthrotomy and posterior stabilized implants were used. Clinical outcomes were assessed using knee society score, range of motion (ROM), anterior knee pain and crepitation. Radiological examinations included recording of radiolucent lines and medial tibial bone resorption. RESULTS At the 5-year follow-up, no significant differences were noted in terms of mean knee society score (93.3 ± 6.6 vs 94.2 ± 8.1), knee function score (88.5 ± 10.5 vs 89.1 ± 11.2) and ROM. The incidences of anterior knee pain and crepitation were lower in the newer group (8.5% vs 21.9% and 14.6% vs 32.9%, respectively) compared to the traditional prosthesis group. No cases of aseptic loosening were observed in either cohort. No significant difference was seen in terms of radiolucent lines (29.3% vs 26.8%) and medial tibial resorption (2.43% in each group) incidences. CONCLUSIONS At the 5 years follow-up no significant differences were noted between the two groups in terms of clinical and radiological outcomes, except the former proved to be better for anterior knee pain and crepitation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mukesh Kumar Saini
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India.
| | - Challa Dinesh Reddy
- Department of Orthopaedics, Star Hospitals, B Block, Banjara Hills, Hyderabad, India
| | - Neelam Ramana Reddy
- Department of Orthopaedics, Star Hospitals, B Block, Banjara Hills, Hyderabad, India
| | | | - Mahendra Singh
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India
| | - Mahesh Bhati
- Department of Orthopaedics, Dr SN Medical College Jodhpur, Jodhpur, India
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Keiller T, Saari T, Sharegi B, Kärrholm J. No difference in clinical outcome but in RSA in total knee arthroplasty with the ATTUNE vs. the PFC Sigma: a randomized trial with 2-year follow-up. Acta Orthop 2023; 94:560-569. [PMID: 38032279 PMCID: PMC10688434 DOI: 10.2340/17453674.2023.24577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Despite usage of the ATTUNE total knee arthroplasty (TKA) for about 10 years, few randomized trials exist. We evaluated whether the ATTUNE CR design showed improved clinical results compared with the PFC Sigma CR after 2 years and if there was a difference in tibial component migration. PATIENTS AND METHODS 96 patients with knee osteoarthritis were randomly treated with cemented ATTUNE or PFC Sigma TKA. 42 patients with the ATTUNE and 48 with the PFC Sigma attended the 2-year follow-up. Patient-reported outcome measurements (PROMs), migration measured with RSA, implant position, and the development of radiolucent zones were studied. Non-parametric tests and repeated measures analysis were used at the statistical evaluation. RESULTS The Oxford Knee Score (OKS) at 2 years (primary outcome) and neither of the secondary PROM outcomes differed between the groups (mean difference OKS ATTUNE - PFC: -0.08, 95% confidence interval [CI] -2.9 to 2.7). RSA showed posterior tilt of the tibial component in the ATTUNE group with proximal lift-off anteriorly and subsidence of the tibial tray posteriorly. In contrast, the PFC Sigma tibial component tilted forward (mean difference ATTUNE - PFC: -0.7°, CI -1.1° to -0.4°) with maximum subsidence in the front and maximum lift-off of the posterior edge. The postoperative implant positions and the extension of radiolucent lines around the tibial component at 2 years did not differ. CONCLUSION We found no significant differences in clinical outcome between the 2 groups but minor differences in migration pattern of the tibial component. The clinical long-term significance of this finding if any is not known.
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Affiliation(s)
- Thom Keiller
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg.
| | - Tuuli Saari
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg
| | - Bita Sharegi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg; Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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12
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Yüksel Y, Koster LA, Kaptein BL, Nelissen RGHH, den Hollander P. No difference in component migration at five years between the cemented cruciate-retaining ATTUNE and PFC-Sigma knee prosthesis: an update of a randomized clinical radiostereometry trial. Bone Joint J 2023; 105-B:1168-1176. [PMID: 37907075 DOI: 10.1302/0301-620x.105b11.bjj-2022-0839.r4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes. Methods A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months' follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively. Results At five-year follow-up, RSA data from 61 patients were available and the mean maximum total point motion (MTPM) of the femoral components were: ATTUNE: 0.96 mm (95% confidence interval (CI) 0.79 to 1.14) and PFC-Sigma 1.37 mm (95% CI 1.18 to 1.59) (p < 0.001). The PFC-Sigma femoral component migrated more in the first postoperative year, but stabilized thereafter. MPTM of the tibial components were comparable at five-year follow-up: ATTUNE 1.12 mm (95% CI 0.95 to 1.31) and PFC-Sigma 1.25 mm (95% CI 1.07 to 1.44) (p = 0.438). RLL at the medial tibial implant-cement interface remained more prevalent for the ATTUNE at five-year follow-up compared to the PFC-Sigma (20% vs 3%). RLL did not progress over time, and varied between patients at different timepoints for both TKA systems. Clinical outcomes and PROMs improved compared with preoperative scores, and were not different between groups. Conclusion MTPM migration at five-year follow-up of the femoral and tibial component of the ATTUNE were similar and as low as that of the PFC-Sigma. MTPM migration of both knee implants did not significantly change from one year post-surgery, indicating stable fixation. Long-term ATTUNE performance may be expected to be comparable to the clinically well-performing PFC-Sigma. We have not found evidence of increased tibial component migration as measured by RSA to support concerns about cement debonding and a higher risk of aseptic loosening with the ATTUNE TKA.
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Affiliation(s)
- Yasin Yüksel
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
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13
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O'Donovan P, McAleese T, Harty J. Does lucency equate to revision? A five-year retrospective review of Attune and Triathlon total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:4773-4781. [PMID: 37516985 PMCID: PMC10598109 DOI: 10.1007/s00167-023-07509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The Attune® total knee arthroplasty system was introduced in 2013 to address lingering issues of patient dissatisfaction. However, recent literature reports concerns of early tibial tray debonding. The aim of this study was to compare the incidence of radiolucent lines, survivorship and patient reported outcome-measures between the Attune® system and the well-established Triathlon® system. METHODS This retrospective database review was conducted at a single institution in Cork, Ireland. All primary Attune® (N = 445) and Triathlon® (N = 285) systems implanted between 2015 and 2016 were reviewed. Radiolucent lines were assessed for those with a minimum two-year radiological follow-up (Attune® = 338; Triathlon® = 231). X-rays were taken post op, at 6 months, 2 years and 5 years. Radiolucent lines were documented using the Modern Knee Society Radiographic System. Five-year survival was assessed using Kaplan-Meier analysis with the Log Rank method to determine statistical significance. The Oxford Knee Score and EQ-5D-5L, were collected pre-op, at 6 months, 2 years and 5 years post-operatively and compared using the Kruskal-Wallis Test. RESULTS The Attune® had a higher proportion of radiolucent lines at the tibial tray [87.1% (54/62) vs 61.4% (27/44); p = 0.001] and at the implant-cement interface [62.9% (39/62) vs 43.2% (19/44); p = 0.02]. Conversely, the Triathlon® had a higher proportion AT the femur [38.6% (17/44) vs 12.9% (8/62); p = 0.001] and at the cement-bone interface [56.8% (25/44) vs 37.1% (23/62); p = 0.02]. The overall frequency of radiolucent lines was similar in both the Attune® and Triathlon® groups [17.8%, (60/338) vs 17.7%, (41/231); p = 0.49]. There was no difference in revision-free survival analysis at 5 years (Attune® 97.8% vs Triathlon® 95.8%; p = 0.129). The Attune® performed better at 5 years in the Oxford Knee Score [Attune® = 42.6 (SD 5.2) vs Triathlon® = 41 (SD 6.4); p = 0.001] and in the EQ-5D [Attune® = 0.773 (SD 0.187) vs Triathlon® = 0.729 (SD 0.218); p = 0.013]. There was no difference at 5 years in the EQ-VAS [Attune® = 80.4 (SD 13.7) vs Triathlon® = 78.5 (SD 15.3); p = 0.25]. CONCLUSION The Attune® system exhibited a higher incidence of radiolucent lines at the tibial tray. However, this did not lead to decreased survivorship at medium term follow-up compared to the Triathlon®. Furthermore, improvements in patient reported outcomes modestly favoured the Attune® system. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Paul O'Donovan
- School of Medicine, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland.
| | - Timothy McAleese
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
| | - James Harty
- Department of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland
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14
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Reinbacher P, Schittek GA, Draschl A, Hecker A, Leithner A, Klim SM, Brunnader K, Koutp A, Hauer G, Sadoghi P. Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years. J Clin Med 2023; 12:5088. [PMID: 37568489 PMCID: PMC10420252 DOI: 10.3390/jcm12155088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). METHODS Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. RESULTS Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. CONCLUSION Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Gregor A. Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Sebastian Martin Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Amir Koutp
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Georg Hauer
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Patrick Sadoghi
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
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15
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Prodromidis AD, Chloros GD, Thivaios GC, Sutton PM, Pandit H, Giannoudis PV, Charalambous CP. High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty. Bone Joint J 2023; 105-B:610-621. [PMID: 37259548 DOI: 10.1302/0301-620x.105b6.bjj-2022-0675.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening. Methods A systematic search was undertaken using the Cochrane methodology in three online databases: MEDLINE, Embase, and CINAHL. Studies were screened against predetermined criteria, and data were extracted. Available National Joint Registries in the Network of Orthopaedic Registries of Europe were also screened. A random effects model meta-analysis was undertaken. Results Of 263 studies, 12 were included with a total of 3,861 TKAs. Meta-analysis of ten studies showed high rates of overall tibial or femoral RLLs for the cemented original design of the ATTUNE TKA. The overall rate was 21.4% (95% confidence interval (CI) 12.7% to 33.7%) for all types of design but was higher for certain subgroups: 27.4% (95% CI 13.4% to 47.9%) for the cruciate-retaining type, and 29.9% (95% CI 15.6% to 49.6%) for the fixed-bearing type. Meta-analysis of five studies comparing the ATTUNE TKA with other implants showed a significantly higher risk of overall tibial or femoral RLLs (odds ratio (OR) 2.841 (95% CI 1.219 to 6.623); p = 0.016) for the ATTUNE. The rates of loosening or revision for loosening were lower, at 1.2% and 0.9% respectively, but the rates varied from 0% to 16.3%. The registry data did not report specifically on the original ATTUNE TKA or on revision due to loosening, but 'all-cause' five-year revision rates for the cemented ATTUNE varied from 2.6% to 5.9%. Conclusion The original cemented ATTUNE TKA has high rates of RLLs, but their clinical significance is uncertain given the overall low associated rates of loosening and revision. However, in view of the high rates of RLLs and the variation in the rates of loosening and revision between studies and registries, close surveillance of patients who have undergone TKA with the original ATTUNE system is recommended.
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Affiliation(s)
- Apostolos D Prodromidis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - George D Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | | | - Paul M Sutton
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hemant Pandit
- Department of Orthopaedics, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
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16
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Cox ZC, Engstrom SM, Shinar AA, Polkowski GG, Mason JB, Martin JR. Is cement mantle thickness a primary cause of aseptic tibial loosening following primary total knee arthroplasty? Knee 2023; 40:305-312. [PMID: 36592499 DOI: 10.1016/j.knee.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aseptic tibial loosening following primary total knee replacement is one of the leading causes of long-term failure. Cement mantle thickness has been implicated as a source of aseptic tibial loosening. Therefore, the following study was designed to determine (1) what is the cement mantle thickness in patients that develop aseptic tibial loosening, and (2) is there a difference in cement mantle thickness based on the interface of failure? METHOD This retrospective cohort included 216 patients revised for aseptic tibial loosening. Patient demographics, operative data, and clinical outcomes were recorded. A preoperative radiographic assessment was performed to determine the interface of failure and the thickness of the cement mantle using the Knee Society Radiographic Evaluation System zones. RESULTS The average patient age was 65 years and body mass index was 33.7 kg/m2. 203 patients demonstrated radiographic failure at the implant-cement interface and 13 patients demonstrated failure at the cement-bone interface. The average cement mantle thickness of each radiographic zone for the entire cohort on the AP and lateral views was 4.4 and 4.5 mm, respectively. The average cement mantle thickness of patients that developed failure at the implant-cement interface was significantly greater than patients that failed at the cement-bone interface in each radiographic zone (p < 0.001). CONCLUSIONS Patients that develop implant loosening at the cement-bone interface were noted to have a significantly decreased cement mantle compared to patients that failed at the implant-cement interface. Methods for decreasing tibial implant loosening should likely focus on improving the fixation at the implant-cement interface.
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Affiliation(s)
- Zach C Cox
- OrthoCarolina Hip and Knee Center, Charlotte, NC, 250 N Caswell Rd Suit 200A, Charlotte, NC 28207, USA
| | - Stephen M Engstrom
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - Andrew A Shinar
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - Gregory G Polkowski
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - J Bohannon Mason
- OrthoCarolina Hip and Knee Center, Charlotte, NC, 250 N Caswell Rd Suit 200A, Charlotte, NC 28207, USA
| | - J Ryan Martin
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA.
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Han HS, Song SJ, Chang CB, Park CH, Won S, Lee MC. Comparison of Clinical Outcomes for Patients Treated With Gradually Reducing Radius Versus Single-Radius Total Knee Arthroplasty Systems. Orthopedics 2022; 45:367-372. [PMID: 35858180 DOI: 10.3928/01477447-20220706-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The choice of implant used for primary total knee arthroplasty (TKA) may have an impact on clinical outcomes. Clinical outcomes after TKA with gradually reducing radius implants (group G) vs single-radius implants (group S) were evaluated among Asian patients. This study included 541 patients (754 knees) in group G and 187 patients (275 knees) in group S. Range of motion (ROM), flexion contracture, American Knee Society Knee and American Knee Society Function scores (KSKS and KSFS, respectively), and mechanical and anatomic tibiofemoral angles (MTFA and ATFA, respectively) were evaluated with electronic medical records. In univariate analysis, improvements in ROM, KSKS, and KSFS were significantly better in group G compared with group S at 1-year follow-up. Multivariable analyses showed greater ROM (4.52°, P=.002), decreased flexion contracture (-2.80°, P=.011), and improved KSKS (15.57, P<.001) at 1 year for group G vs group S. No significant differences in KSFS, MTFA, or ATFA were observed. Implant-related complications and radiologic loosening were not identified in either group at 2-year follow-up. The TKA implants with a gradually reducing radius showed greater 1-year improvements in ROM, flexion contracture, KSKS, and similar implant-related safety outcomes compared with a single-radius system. [Orthopedics. 2022;45(6):367-372.].
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18
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Grupp TM, Schilling C, Fritz B, Puente Reyna AL, Rusch S, Taunt C, Mihalko WM. Endurance Behavior of Cemented Tibial Tray Fixation Under Anterior Shear and Internal-External Torsional Shear Testing: A New Methodological Approach. J Arthroplasty 2022; 37:2272-2281. [PMID: 35588902 DOI: 10.1016/j.arth.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early total knee arthroplasty failures continue to surface in the literature. Cementation technique and implant design are two of the most important scenarios that can affect implant survivorship. Our objectives were to develop a more suitable preclinical test to evaluate the endurance of the implant-cement-bone interface under anterior shear and internal-external (I/E) torsional shear testing condition in a biomechanical sawbones. METHODS Implants tested included the AS VEGA System PS and the AS Columbus CR/PS (Aesculap AG, Germany), with zirconium nitride (ZrN) coating. Tibial implants were evaluated under anterior shear and I/E torsional shear conditions with 6 samples in 4 test groups. For the evaluation of the I/E torsional shear endurance behavior, a test setup was created allowing for clinically relevant I/E rotation with simultaneous high axial/tibio-femoral load. The test was performed with an I/E displacement of ±17.2°, for 1 million cycles with an axial preload of 3,000 N. RESULTS After the anterior shear test an implant-cement-bone fixation strength for the AS VEGA System tibial tray of 2,674 ± 754 N and for the AS Columbus CR/PS tibial tray of 2,177 ± 429 N was determined (P = .191). After I/E rotational shear testing an implant-cement-bone fixation strength for the AS VEGA System PS tray of 2,561 ± 519 N and for the AS Columbus CR/PS tray of 2,824 ± 515 N was resulted (P = .39). CONCLUSION Both methods had varying degrees of failure modes from debonding to failure of the sawbones foam. These two intense biomechanical loading tests are more strenuous and more representative of clinical activity.
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Affiliation(s)
- Thomas M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich, Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | | | | | | | - Sabine Rusch
- Aesculap AG Research & Development, Tuttlingen, Germany
| | | | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Eng., University of Tennessee Health Science Center, Memphis, Tennessee
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19
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Klasan A, Rainbird S, Peng Y, Holder C, Parkinson B, Young SW, Lewis PL. No Difference in Revision Rate Between Low Viscosity and High Viscosity Cement Used in Primary Total Knee Arthroplasty. J Arthroplasty 2022; 37:2025-2034. [PMID: 35525417 DOI: 10.1016/j.arth.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Loosening remains one of the most common reasons for revision total knee arthroplasty (TKA). Cement viscosity has a potential role in reducing revision rates for loosening. The aim of this study was to assess the outcome for loosening of the 5 most used cemented knee prostheses by constraint type, based on the cement viscosity type used. METHODS There were 214,708 TKA procedures performed between 1999 and 2020 for a diagnosis of osteoarthritis using the 5 most commonly used minimally stabilized, posterior stabilized, and medial pivot design cemented tibial components. Only procedures with a cemented tibial component were included. Outcomes for two different cement viscosities, 140,060 high viscosity and 74,648 low viscosity cement, were compared for each fixation type within each of the three stability groups. RESULTS There was no difference in a risk of all-cause revision when high viscosity cement was used compared to low viscosity cement for minimally stabilized prostheses (hazards ratio [HR] 1.07 [95% CI 0.99-1.15], P = .09), posterior stabilized prostheses (HR 1.03 [95% CI 0.95-1.11], P = .53), and medial pivot design prostheses (HR 1.06 [95% CI 0.80-1.41], P = .67). No difference was observed between cement viscosity types for any of the prosthesis constraint types when aseptic loosening was assessed. CONCLUSIONS We found no difference in the risk of revision for any reason, or for loosening, with cement viscosity for the most commonly used minimally stabilized, posterior stabilized, and medial pivot TKA. The role of cement viscosity in the risk of TKA revision remains unclear and further research is required. LEVEL OF EVIDENCE Level III Retrospective comparative study.
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Affiliation(s)
- Antonio Klasan
- Kepler University Hospital, Linz, Austria; Johannes Kepler University, Linz, Austria
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | | | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
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20
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Torino D, Damsgaard C, Kolessar DJ, Hayes DS, Foster B, Constantino J, Graham J. Tibial Baseplate-Cement Interface Debonding in the ATTUNE Total Knee Arthroplasty System. Arthroplast Today 2022; 17:165-171. [PMID: 36164312 PMCID: PMC9508148 DOI: 10.1016/j.artd.2022.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acrylic bone cement is the most common method of fixation for primary total knee arthroplasty (TKA). Several studies have described good short-term outcomes; however, there have been reports of early failures due to tibial baseplate debonding at the implant-cement interface of The ATTUNE Knee System (DePuy Synthes, West Chester, PA). We examined the causes and rates of revision in patients who underwent TKA with this system to identify factors associated with this mode of early failure. Methods A retrospective review of electronic health records between 2013 and 2018 identified all patients undergoing TKA with the ATTUNE Knee System with a minimum 2-year follow-up. Cause of revision, patient, implant, instrumentation, cement, and surgeon variables were collected. A descriptive analysis was used to identify characteristics of surgeon (fellowship-trained, surgical volume), implant (baseplate, bearing), and cement (brand, viscosity) that were associated with aseptic loosening. Results A total of 668 patients representing 742 knees were identified. Eighteen (2.4%) required a revision surgery. Aseptic loosening was the leading cause of revision surgery (n = 10, 55.6%). All failures due to aseptic loosening involved debonding of the tibial implant-cement interface. A multivariate analysis identified low-volume surgeons (9.0%, P < .0001) and 1 specific brand of high-viscosity cement (14.3%, P < .0001) as risk factors for aseptic loosening. Conclusions This study represents the largest nonregistry review of the original ATTUNE Knee System. Surgeon case volume and cement viscosity were factors associated with an increased rate of early failure due to tibial baseplate implant-cement interface debonding.
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Mikashima Y, Imamura H, Shirakawa Y, Yano K, Ikari K, Okazaki K. Modern cementless posterior stabilized mobile-bearing total knee arthroplasty shows comparable clinical and radiographical results to its cemented predecessor at 1-year follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:3131-3137. [PMID: 35781580 DOI: 10.1007/s00167-022-07047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate perioperative and short-term clinical and radiographical results of a modern PS mobile-bearing cementless TKA system. METHODS A retrospective review of a consecutive series of TKAs was performed by a single surgeon using a cementless or cemented TKA of the same design (Attune, DePuy Synthes, Massachusetts, USA). The 2011 Knee Society Score, Forgotten Joint Score-12, Hip-Knee-Ankle angle, and the presence of radiolucent lines (RLLs) were reviewed 1-year postoperatively with 1:1 matching performed for age, gender, body mass index, and preoperative UCLA score. Fisher's exact test or independent Student's t-test were used for statistical analyses. RESULTS Forty-five cementless and 45 cemented TKAs were reviewed after 1:1 matching. The mean operative time was 8.8 min shorter (P < .01), and the mean amount of drainage was 40.0 ml greater (P = .04) in the cementless cohort. At 1-year postoperatively, there were no significant differences in both cohorts in 2011 Knee Scores and Forgotten Joint Scores-12, with no patients requiring revision surgery (NS). The incidence of RLLs was significantly higher in cementless TKAs (51%) than that in cemented TKAs (22%, P < .01). However, the mean width of RLLs in the cementless TKAs (0.2 mm) was significantly smaller (P < .01) than that in the cemented TKAs (0.8 mm) at 1-year postoperatively with no progression. CONCLUSION A recently introduced cementless PS mobile-bearing TKA design demonstrated comparable postoperative and radiographical results to its cemented predecessor at 1-year follow-up. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Yoshinori Mikashima
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan.
| | - Hitoshi Imamura
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan
| | - Yoshiko Shirakawa
- Oume Knee Surgery Center, Takagi Hospital, Imadera 5-18-19, Oume City, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan
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22
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Mathis DT, Schmidli J, Amsler F, Henckel J, Hothi H, Hart A, Hirschmann MT. Comparative retrieval analysis of a novel anatomic tibial tray backside: alterations in tibial component design and surface coating can increase cement adhesions and surface roughness. BMC Musculoskelet Disord 2022; 23:474. [PMID: 35590296 PMCID: PMC9118733 DOI: 10.1186/s12891-022-05446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the Persona® knee system a novel anatomic total knee design was developed, which has no pre-coating, whereas the predecessor knee system is pre-coated with polymethylmethacrylate (PMMA). Joint registry data have shown no decrease in risk of aseptic revision of PMMA pre-coated tibial components compared with non-pre-coated implants. The aim of this retrieval study was to compare the amount of cement adhesions, geometry and surface features between the two knee designs and to correlate them with the underlying reason for revision surgery. METHODS Retrieval analysis was performed of 15 NexGen® and 8 Persona® fixed-bearing knee implants from the same manufacturer retrieved from two knee revision centres. A photogrammetric method was used to grade the amount of cement attached to the tibial tray backside. The geometry and dimensions of the tibial trays, tray projections and peripheral lips were measured using digital callipers and compared between the two different designs. To measure the surface roughness on the backside of the tibial tray, a contact profilometer was used. To investigate differences between the two designs statistical analyses (t-test) were performed. RESULTS All Persona® trays showed evidence of cement adhesion with a % area of 75.4%; half of the NexGen® trays had cement adhesions, with a mean value of 20%. There was a significant difference in the percentage of area covered by cement between the two designs (p < 0.001). Results from the contact profilometer revealed that Persona® and NexGen® tray backsides showed a similar lateral (1.36 μm and 1.10 μm) and medial (1.39 μm and 1.12 μm) mean surface roughness with significant differentiation (p < 0.05) of the lateral and medial roughness values between the two designs. Persona® stems showed a significantly higher mean surface roughness (1.26) compared to NexGen® stems (0.89; p < 0.05). CONCLUSION The novel anatomic knee system showed significantly more cements adhesions and a higher surface roughness which was most likely attributed to the most obvious design and coating alteration of the tibial tray. This study provides first retrieval findings of a novel TKA design recently introduced to the market.
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Affiliation(s)
- Dominic T Mathis
- University of Basel, Basel, Switzerland.
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland.
| | | | | | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Harry Hothi
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Alister Hart
- Royal National Orthopaedic Hospital, Stanmore, England, UK
| | - Michael T Hirschmann
- University of Basel, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
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23
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Jaeger S, Eissler M, Schwarze M, Schonhoff M, Kretzer JP, Bitsch RG. Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study. Bone Joint Res 2022; 11:229-238. [PMID: 35400170 PMCID: PMC9057524 DOI: 10.1302/2046-3758.114.bjr-2021-0169.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aims One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations. In an existing implant system, the tibial component was modified by adding cement pockets. The aim of this experimental in vitro study was to investigate whether additional cement pockets on the underside of the tibial component could improve implant stability. The relative motion between implant and bone, the maximum pull-out force, the tibial cement mantle, and a possible path from the bone marrow to the metal-cement interface were determined. Methods A tibial component with (group S: Attune S+) and without (group A: Attune) additional cement pockets was implanted in 15 fresh-frozen human leg pairs. The relative motion was determined under dynamic loading (extension-flexion 20° to 50°, load-level 1,200 to 2,100 N) with subsequent determination of the maximum pull-out force. In addition, the cement mantle was analyzed radiologically for possible defects, the tibia base cement adhesion, and preoperative bone mineral density (BMD). Results The BMD showed no statistically significant difference between both groups. Group A showed for all load levels significantly higher maximum relative motion compared to group S for 20° and 50° flexion. Group S improved the maximum failure load significantly compared to group A without additional cement pockets. Group S showed a significantly increased cement adhesion compared to group A. The cement penetration and cement mantle defect analysis showed no significant differences between both groups. Conclusion From a biomechanical point of view, the additional cement pockets of the component have improved the fixation performance of the implant. Cite this article: Bone Joint Res 2022;11(4):229–238.
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Affiliation(s)
- Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marvin Eissler
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany.,ATOS Clinic Heidelberg, Heidelberg University, Heidelberg, Germany
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24
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Song SJ, Lee HW, Kang SG, Bae DK, Park CH. Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate. J Knee Surg 2022; 35:434-442. [PMID: 32838461 DOI: 10.1055/s-0040-1715085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent literature has implicated a thick cobalt chromium baseplate as a potential source of stress shielding and medial tibial bone resorption after total knee arthroplasty (TKA) in a Western population. The purpose was to calculate the incidence of various types and severity of medial tibial bone resorption utilizing a novel classification system after TKA with a thick cobalt chromium baseplate in Asian patients. Five hundred TKAs using Attune prostheses with mean follow-up of 3.4 years were evaluated, using the prospective radiographic data. The mean age was 71.3 years. The preoperative mechanical axis was varus, 11.2 degrees. The type and severity of medial tibial bone resorption were categorized as type U (resorption under the tibial baseplate up to 50% [U1] or beyond 50% [U2] of medial tibial tray width), C (resorption around the penetrated cement under the baseplate), and M (resorption on the medial tibial cortex without extension to the baseplate). Bone resorption of medial proximal tibia was observed in 96 knees (19.2%). Types U1 and U2 were seen in 46 and 28 knees, respectively. Type C was observed in 12 knees and type M in 10 knees. The type U resorption group had significantly more preoperative varus deformity (varus 12.9 vs. 10.9 degrees, p = 0.017). Medial tibial bone resorption after TKAs using a thick cobalt chromium baseplate is not uncommon and has various locations, types, and severities. The medial tibial bone resorption might be related to various causes, including stress shielding, thermal necrosis from cement in the bony hole, and bony devascularization. The type-U resorption has to be closely observed in patients with preoperative severe varus deformity. This is a Level IV study.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea (the Republic of)
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
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25
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van Otten TJM, van Loon CJM. Early aseptic loosening of the tibial component at the cement-implant interface in total knee arthroplasty: a narrative overview of potentially associated factors. Acta Orthop Belg 2022; 88:103-111. [PMID: 35512160 DOI: 10.52628/88.1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Total knee arthroplasty (TKA) is a highly effective surgical procedure, but in some patients TKAs fail early due to a variety of underlying factors. About 11% of revision TKAs within one year of primary TKA are the result of aseptic loosening of the tibial component at the cement-implant interface. Literature regarding the most important factors associated with this type of loosening is scarce. The objective is to give an overview of the literature regarding factors associated with aseptic loosening of the tibia component at the cement-implant interface in total knee arthroplasty. A narrative literature review based on publications identified through PubMed and CINAHL databases. Twelve studies were identified, which describe a total of 299 cases of early aseptic loosening of the tibia component at the cement-implant interface. The main associated factors reported were cementa- tion factors. These factors included the use of high viscosity cement (HVC), cement application methods and cement thickness. Other main reported associated factor related to implant design factors, which included component shape and surface roughness. The least frequently reported associated factors related to the patient characteristics of body mass index (BMI). Several factors associated with early aseptic loosening of the tibial component at the cement-implant interface in total knee arthroplasty were identified in this review. The most frequently reported associated factors related to cementation factors and implant design factors. Because the literature in this area is scarce, further research is warranted in an effort to prevent early aseptic loosening in future TKAs.
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26
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Murphy JD, Braunlich PR, Judson IV WR, Harker JN, Baumann PA. Early Aseptic Failure of the Tibial Component-Cement Interface in ATTUNE® Total Knee Arthroplasty: A Report of Three Cases. Cureus 2021; 13:e20582. [PMID: 35103160 PMCID: PMC8776517 DOI: 10.7759/cureus.20582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
Total knee arthroplasty (TKA) systems are designed to maximize the longevity of the implant. However, an unusually high rate of aseptic tibial tray loosening was observed in the DePuy ATTUNE® total knee arthroplasty system (DePuy Synthes, Warsaw, USA). Affected patients noted symptoms of instability and reproducible pain at the bone-implant interface. However, there was no radiographic evidence of lucency or implant failure. Intra-operatively, the tibial component was grossly loose and lacked adhered cement. We hypothesize that the loosening is due to the smooth architecture of the undersurface of the tibial component, lacking either grit blasting or porous coating.
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27
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Bhalekar RM, Nargol ME, Shyam N, Nargol AVF, Wells SR, Collier R, Pabbruwe M, Joyce TJ, Langton DJ. Tibial tray debonding from the cement mantle is associated with deformation of the backside of polyethylene tibial inserts. Bone Joint J 2021; 103-B:1791-1801. [PMID: 34474593 DOI: 10.1302/0301-620x.103b.bjj-2020-2555.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs). METHODS At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays. RESULTS A total of 114 explanted fixed-bearing TKAs were examined. This included 76 used with contemporary PE inserts which were compared with 15 used with older generation PEs. The Attune and NexGen (central locking) trays were found to have significantly less cement cover than Triathlon and PFC trays (peripheral locking group) (p = 0.001). The median planicity values of the PE inserts used with central locking trays were significantly greater than of those with peripheral locking inserts (205 vs 85 microns; p < 0.001). Attune and NexGen inserts had a characteristic pattern of backside deformation, with the outer edges of the PE deviating inferiorly, leaving the PE margins as the primary areas of articulation. CONCLUSION Explanted TKAs with central locking mechanisms were significantly more likely to debond from the cement mantle. The PE inserts of these designs showed characteristic patterns of deformation, which appeared to relate to the manufacturing process and may be exacerbated in vivo. This pattern of deformation was associated with PE wear occurring at the outer edges of the articulation, potentially increasing the frictional torque generated at this interface. Cite this article: Bone Joint J 2021;103-B(12):1791-1801.
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Affiliation(s)
| | | | | | | | | | - Ryan Collier
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Moreica Pabbruwe
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
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28
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Rodríguez-Collell JR, Mifsut D, Ruiz-Sauri A, Rodríguez-Pino L, González-Soler EM, Valverde-Navarro AA. Improving the cementation of the tibial component in knee arthroplasty : a study of four techniques in the cadaver. Bone Joint Res 2021; 10:467-473. [PMID: 34340533 PMCID: PMC8414436 DOI: 10.1302/2046-3758.108.bjr-2020-0524.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The main objective of this study is to analyze the penetration of bone cement in four different full cementation techniques of the tibial tray. METHODS In order to determine the best tibial tray cementation technique, we applied cement to 40 cryopreserved donor tibiae by four different techniques: 1) double-layer cementation of the tibial component and tibial bone with bone restrictor; 2) metallic cementation of the tibial component without bone restrictor; 3) bone cementation of the tibia with bone restrictor; and 4) superficial bone cementation of the tibia and metallic keel cementation of the tibial component without bone restrictor. We performed CT exams of all 40 subjects, and measured cement layer thickness at both levels of the resected surface of the epiphysis and the endomedular metaphyseal level. RESULTS At the epiphyseal level, Technique 2 gave the greatest depth compared to the other investigated techniques. At the endomedular metaphyseal level, Technique 1 showed greater cement penetration than the other techniques. CONCLUSION The best metaphyseal cementation technique of the tibial component is bone cementation with cement restrictor. Additionally, if full tibial component cementation is to be done, the cement volume used should be about 40 g of cement, and not the usual 20 g. Cite this article: Bone Joint Res 2021;10(8):467-473.
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Affiliation(s)
| | - Damian Mifsut
- Department of Surgery, University of Valencia, Valencia, Spain
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29
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Lachiewicz PF, Steele JR, Wellman SS. Unexpected high rate of revision of a modern cemented fixed bearing modular posterior-stabilized knee arthroplasty. Bone Joint J 2021; 103-B:137-144. [PMID: 34053294 DOI: 10.1302/0301-620x.103b6.bjj-2020-1956.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. METHODS This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending. RESULTS In total, 19 (11.5%) ATTUNE study TKAs have been revised at a mean 30.3 months (SD 15), and loosening of the tibial component was seen in 17 of these (90%). Revision is pending in 12 (7%) knees. There was no difference between the 31 knees revised or with revision pending and the remaining 135 study knees in terms of patient characteristics, type of bone cement (p = 0.988), or individual surgeon (p = 0.550). In the reference cohort, there were significantly fewer knees revised (n = 13, 2.6%) and with revision pending (n = 8, 1.5%) (both p < 0.001), and only two had loosening of the tibial component as the reason for revision. CONCLUSION This new TKA design had an unexpectedly high early rate of revision compared with our reference cohort of TKAs. Debonding of the tibial component was the most common reason for failure. Additional longer-term follow-up studies of this specific component and techniques for implantation are warranted. The version of the ATTUNE tibial component implanted in this study has undergone modifications by the manufacturer. Cite this article: Bone Joint J 2021;103-B(6 Supple A):137-144.
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Affiliation(s)
- Paul F Lachiewicz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - John R Steele
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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30
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Yang J, Heckmann ND, Nahhas CR, Salzano MB, Ruzich GP, Jacobs JJ, Paprosky WG, Rosenberg AG, Nam D. Early outcomes of a modern cemented total knee arthroplasty : is tibial loosening a concern? Bone Joint J 2021; 103-B:51-58. [PMID: 34053274 DOI: 10.1302/0301-620x.103b6.bjj-2020-1972.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design. METHODS All patients who received a primary, cemented TKA between 2012 and 2017 with a minimum two-year follow-up were included. The implant investigated features an asymmetrical tibial baseplate and shortened keel. Patient demographic details, Knee Society Scores (KSS), component alignment, and the presence of radiolucent lines at final follow-up were recorded. Kaplan-Meier analyses were performed to estimate survivorship. RESULTS A total of 720 of 754 primary TKAs (95.5%) were included with a mean follow-up of 3.9 years (SD 1.3); 562 (78.1%) were cruciate-retaining and 158 (21.9%) were posterior-stabilized. A total of 11 (1.5%) required reoperation for periprosthetic joint infection and seven (1.0%) for aseptic tibial loosening (five cruciate-retaining, two posterior-stabilized). Loosening occurred at a mean of 3.3 years (0.9 to 6.5). There were no cases of loosening in the 33 patients who received a 14 mm × 30 mm tibial stem extension. All-cause survivorship was 96.6% at three years (95% confidence interval (CI) 95.3% to 98.0%) and 96.2% at five years (95% CI 94.8% to 97.7%). Survivorship with revision for aseptic loosening was 99.6% at three years (95% CI 99.1% to 100.0%) and 99.1% at five years (95% CI 98.4% to 99.9%). Tibial components were in significantly more varus in those with aseptic loosening (mean 3.4° (SD 3.7°) vs 1.3° (SD 2.0°); p = 0.015). There were no other differences in demographic, radiological, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p = 0.293 to 1.00). Mean KSS improved significantly from 57.3 (SD 9.5) preoperatively to 92.6 (SD 8.9) at the final follow-up (p < 0.001). CONCLUSION This is the largest series to date of this design of implant. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. Further observation is required to determine if there will be an abnormal rate of loosening at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(6 Supple A):51-58.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine, Los Angeles, California, USA
| | - Cindy R Nahhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael B Salzano
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory P Ruzich
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua J Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Aaron G Rosenberg
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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31
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Affiliation(s)
| | - Shiraz A Sabah
- Royal National Orthopaedic Hospital, Stanmore, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Alister J Hart
- Royal National Orthopaedic Hospital, Stanmore, UK.,University College London, London, UK
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32
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Early tibial loosening of the cemented ATTUNE knee arthroplasty - Just a question of design? Knee 2021; 30:170-175. [PMID: 33933907 DOI: 10.1016/j.knee.2021.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty is a very successful standard treatment for severe osteoarthritis. Nevertheless, the literature reports tibial debonding between implant and bone cement as well as radiolucent lines related to the tibial components of different knee systems. Regardless of cementing techniques and the influences during surgery, we examined the design of a newly developed knee system and its predecessors (Attune, Attune S+, P.F.C. Sigma, P.F.C. Sigma RP/M.B.T., all DePuy). METHODS We investigated the dimensions of the tibial components and the fit between them and their bone bed after instrumentation in a foam material. RESULTS Our results showed considerable differences for the used knee prostheses as well as their tibial instrumentation options with a corresponding risk for incomplete seating. CONCLUSION The orthopedic surgeons need to be aware of these design features and the resulting increased seating resistance especially in hard and sclerotic bone. ARTICLE FOCUS Comparison of the tibial instruments and the different design options of the Attune knee system and its predecessor knee prostheses. KEY MESSAGES The Attune implant showed incomplete seating because of too much press fit and an uneven bone quality or sclerosis can result in tilting of the tibial component. STRENGTHS AND LIMITATIONS This is the first study investigating the Attune knee and its predecessor in terms of implant seating and press fit. The foam material is a limitation.
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Grupp TM, Schilling C, Schwiesau J, Pfaff A, Altermann B, Mihalko WM. Response to Letter to the Editor on "Tibial implant Fixation Behavior in Total Knee Arthroplasty - A Study With Five Different Types of Bone Cements". J Arthroplasty 2021; 36:e32-e33. [PMID: 33931148 DOI: 10.1016/j.arth.2020.11.022] [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: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Thomas M Grupp
- AESCULAP AG Research & Development, Tuttlingen, Germany; Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig Maximilians University Munich, Campus Grosshadern, Munich, Germany
| | | | - Jens Schwiesau
- AESCULAP AG Research & Development, Tuttlingen, Germany; Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig Maximilians University Munich, Campus Grosshadern, Munich, Germany
| | - Andreas Pfaff
- AESCULAP AG Research & Development, Tuttlingen, Germany
| | | | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee Health Science Center, TN, USA
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A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption. PLoS One 2021; 16:e0246866. [PMID: 33566856 PMCID: PMC7875353 DOI: 10.1371/journal.pone.0246866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Implant material is a more important factor for periprosthetic tibial bone resorption than implant design after total knee arthroplasty (TKA). The virtual perturbation study was planned to perform using single case of proximal tibia model. We determined whether the implant materials' stiffness affects the degree of periprosthetic tibial bone resorption, and whether the effect of material change with the same implant design differed according to the proximal tibial plateau areas. MATERIALS AND METHODS This three-dimensional finite element analysis included two cobalt-chromium (CoCr) and two titanium (Ti) tibial implants with different designs. They were implanted into the proximal tibial model reconstructed using extracted images from computed tomography. The degree of bone resorption or formation was measured using the strain energy density after applying axial load. The same analysis was performed after exchanging the materials while maintaining the design of each implant. RESULTS The degree of periprosthetic tibial bone resorption was not determined by the type of implant materials alone. When the implant materials were changed from Ti to CoCr, the bone resorption in the medial compartment increased and vice versa. The effect of material composition's change on anterior and posterior areas varied accordingly. CONCLUSIONS Although the degree of bone resorption was associated with implant materials, it differed depending on the design of each implant. The effect on the degree of bone resorption according to the materials after TKA should be evaluated while concomitantly considering design.
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Ryan SP, Steele JR, Plate JF, Attarian DE, Seyler TM, Bolognesi MP, Wellman SS. All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives. Orthopedics 2021; 44:e114-e118. [PMID: 33141229 DOI: 10.3928/01477447-20201009-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/09/2020] [Indexed: 02/03/2023]
Abstract
Surgeons play a critical role in making cost-effective decisions that maintain high-quality patient outcomes, which is the current focus of the Centers for Medicare & Medicaid Services. All-polyethylene tibial (APT) components often cost less during total knee arthroplasty (TKA). The authors sought to determine the relative cost savings of APT, as well as their effect on 90-day quality outcome metrics. This was a retrospective review of primary TKAs performed at a single tertiary referral center participating in the Comprehensive Care for Joint Replacement model, by 2 surgeons, from 2015 to 2017. Patient demographic data and direct hospital costs were collected, and patients were stratified by APTs vs metal-backed components. Univariable and multivariable analyses were performed for all outcome metrics. A total of 188 primary TKAs were included (92 APT, 96 metal-backed). Patients receiving APT components were older (P<.001) and had a lower body mass index (P<.001), but there was no difference in sex or American Society of Anesthesiologists score between groups. Operative time was significantly less (mean, 13 minutes) and direct surgery costs were significantly lower for APTs (P<.001). A multivariable regression model for surgical costs demonstrated significant savings (P<.001), and total hospital cost demonstrated a 6.2% average savings with APT. There was no difference in 90-day emergency department visits or re-admissions. This study demonstrates that the use of an APT is able to significantly affect not only the surgical cost but also the total hospital admission cost while maintaining equivalent 90-day outcome metrics. Strategies like this should be considered in appropriately selected patients as the incidence of TKA continues to expand. [Orthopedics. 2021;44(1):e114-e118.].
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Kelly BC, Owen JR, Shah SC, Johnson AJ, Golladay GJ, Kates SL. A Biomechanical Comparison of the Effect of Baseplate Design and Bone Marrow Fat Infiltration on Tibial Baseplate Pullout Strength. J Arthroplasty 2021; 36:356-361. [PMID: 32829970 DOI: 10.1016/j.arth.2020.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early clinical results of a new total knee arthroplasty (TKA) implant design show promise for improved outcomes and patellofemoral function scores. However, reports of early tibial component-cement interface debonding requiring revision have been published. This study investigated the biomechanical properties of three different tibial baseplates to understand potential causes of failure. METHODS PFC Sigma (control), Attune (1st generation) and Attune S+ (2nd generation) tibial baseplates were implanted into 4th generation sawbone tibia models using a standardized technique. Three of each baseplate were cemented with and without additional bovine bone marrow fat. All models were tested to failure with measured axial distraction force. Implant type, presence or absence of bovine marrow and load to failure were all recorded and compared. Two-way ANOVA followed by post-hoc pairwise comparisons were used to determine statistical significance, which was set to P < .05. RESULTS The 2nd generation tibial baseplates required significantly more force to failure. The presence of bovine marrow significantly reduced the pullout force of the implant designs overall. No significant difference was detected between the 1st generation and control baseplates. Failure mode for each model was also noted to be different irrespective of the presence or absence of bone marrow fat. CONCLUSION The 2nd generation baseplates required significantly more force to failure compared with older designs. The presence of bone marrow during cementation of a tibial base plate significantly decreased axial pullout strength of a tibial baseplate in this laboratory model. All 1st generation baseplates exhibited debonding at the cement-implant interface.
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Affiliation(s)
- Blane C Kelly
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - John R Owen
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Shalin C Shah
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Aaron J Johnson
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
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Behrend H, Hochreiter B, Potocnik P, El Baz Y, Zdravkovic V, Tomazi T. No difference in radiolucent lines after TKA: a matched-pair analysis of the classic implant and its evolutional design. Knee Surg Sports Traumatol Arthrosc 2020; 28:3962-3968. [PMID: 32062683 DOI: 10.1007/s00167-020-05894-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) designs evolve continuously to improve patient outcomes. However, incidences of radiolucent lines (RLL) in the latest TKA system have recently been reported, raising concerns. The purpose of the current study was to compare radiographic outcomes of this new TKA implant to its predecessor design. METHODS A group of 100 patients undergoing TKA using the newer design (Attune) was matched by age and gender to 191 patients with the classic design (LCS). All patients underwent computer-navigated primary TKA by the same surgeon using the same technique. Radiographs were taken before discharge, and 2 and 12 months postoperatively. Radiographic analysis was performed independently by three assessors, using the Modern Knee Society Radiographic Evaluation System and Methodology (MKSRES). RESULTS At 12 months postoperatively, the incidence of RLL did not statistically differ between the two implants (14%, n = 14 Attune vs. 8% n = 17 LCS, n.s.). The posterior femoral flange was most commonly affected (12%; n = 12 Attune vs. 7.9%; n = 15 LCS, n.s.) followed by the anterior flange (1%; n = 1 Attune vs. 3.1%; n = 6 LCS, n.s.). The tibial baseplate was only affected in 1% (n = 1) of the Attune and 2.6% (n = 5) of the LCS (n.s.). CONCLUSION At 12 months follow-up we found no significant difference in RLL between the two implants. Both Attune and LCS TKA systems showed RLL predominantly at the posterior femoral flange. The reasons for the RLL remain a matter of speculation; however, shortcomings in surgical and cementing techniques seem to be more important than implant-related factors. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Henrik Behrend
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Bettina Hochreiter
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Primoz Potocnik
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Yassir El Baz
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Vilijam Zdravkovic
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Thiago Tomazi
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Kaptein BL, den Hollander P, Thomassen B, Fiocco M, Nelissen RGHH. A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design. Bone Joint J 2020; 102-B:1158-1166. [PMID: 32862688 PMCID: PMC7468556 DOI: 10.1302/0301-620x.102b9.bjj-2020-0096.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS The primary objective of this study was to compare migration of the cemented ATTUNE fixed bearing cruciate retaining tibial component with the cemented Press-Fit Condylar (PFC)-sigma fixed bearing cruciate retaining tibial component. The secondary objectives included comparing clinical and radiological outcomes and Patient Reported Outcome Measures (PROMs). METHODS A single blinded randomized, non-inferiority study was conducted including 74 patients. Radiostereometry examinations were made after weight bearing, but before hospital discharge, and at three, six, 12, and 24 months postoperatively. PROMS were collected preoperatively and at three, six, 12, and 24 months postoperatively. Radiographs for measuring radiolucencies were collected at two weeks and two years postoperatively. RESULTS The overall migration (mean maximum total point motion (MPTM)) at two years was comparable: mean 1.13 mm (95% confidence interval (CI), 0.97 to 1.30) for the ATTUNE and 1.16 mm (95% CI, 0.99 to 1.35) for the PFC-sigma. At two years, the mean backward tilting was -0.43° (95% CI, -0.65 to -0.21) for the ATTUNE and 0.08° (95% CI -0.16 to 0.31), for the PFC-sigma. Overall migration between the first and second postoperative year was negligible for both components. The clinical outcomes and PROMs improved compared with preoperative scores and were not different between groups. Radiolucencies at the implant-cement interface were mainly seen below the medial baseplate: 17% in the ATTUNE and 3% in the PFC-sigma at two weeks, and at two years 42% and 9% respectively (p = 0.001). CONCLUSION In the first two postoperative years the initial version of the ATTUNE tibial component was not inferior with respect to overall migration, although it showed relatively more backwards tilting and radiolucent lines at the implant-cement interface than the PFC-sigma. The version of the ATTUNE tibial component examined in this study has subsequently undergone modification by the manufacturer. Level of Evidence: 1 (randomized controlled clinical trial) Cite this article: Bone Joint J 2020;102-B(9):1158-1166.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Peter den Hollander
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, Netherlands
| | - Bregje Thomassen
- Faculty Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Martha Fiocco
- Mathematical Institute, Leiden University, Leiden, The Netherlands.,Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
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Jin QH, Lee WG, Song EK, Kim WJ, Jin C, Seon JK. No difference in the anteroposterior stability between the GRADIUS and multi-radius designs in total knee arthroplasty. Knee 2020; 27:1197-1204. [PMID: 32711882 DOI: 10.1016/j.knee.2020.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/22/2020] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This retrospective study aimed to compare stability and clinical and radiological outcomes of total knee arthroplasty (TKA) for the GRADIUS and multi-radius femoral designs after minimum of two-year follow-up. METHODS A total of 142 patients who underwent TKA using ATTUNE posterior stabilized (PS) implants (68 patients, GRADIUS group) or Persona PS implants (74 patients, multi-radius group) for degenerative osteoarthritis were included. After an average of 2-year follow-up, the anteroposterior (AP) stability at 30°, 60°, and 90° was measured using KT 2000 device and compared between the two groups. The clinical outcome measurements included range of motion (ROM) of the knee, patient-reported outcomes and anterior knee pain (AKP). For the clinical evaluation of mid-flexion instability, pain was evaluated using the visual analog scale (VAS) score recorded during climbing up or going down stairs. The radiolucent lines on knee radiographs obtained at final follow-up were evaluated and compared between two groups. RESULTS The average AP stability at 30° knee flexion was 5.7 mm in the GRADIUS group and 5.9 mm in the multi-radius group; however, the difference was not significant. The AP stability at 60° and 90° knee flexion was also similar in both groups. There were no significant differences in the ROM, patient-reported outcomes at follow-up, incidence of AKP and VAS scores between the two groups. There were no differences in the incidence of radiolucency around the components between the two groups. CONCLUSION The GRADIUS design did not show any advantage with respect to the stability or clinical outcomes compared with the multi-radius design in TKA.
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Affiliation(s)
- Quan He Jin
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Won-Gyun Lee
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Eun-Kyoo Song
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Woo-Jong Kim
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Cheng Jin
- Department of Orthopaedic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang, China
| | - Jong-Keun Seon
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.
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Garceau SP, Harris NH, Felberbaum DL, Teo GM, Weinblatt AI, Long WJ. Reduced Aseptic Loosening With Fully Cemented Short-Stemmed Tibial Components in Primary Cemented Total Knee Arthroplasty. J Arthroplasty 2020; 35:1591-1594.e3. [PMID: 32098738 DOI: 10.1016/j.arth.2020.01.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, the use of short tibial stems in the obese population undergoing total knee arthroplasty (TKA) has been proposed. Thus, we designed a study to assess tibial component survivorship after primary TKA using a single implant both with and without a fully cemented stem extension performed by a single surgeon. METHODS A search of our institutional research database was performed. A minimum 2-year follow-up was selected. Cohorts were created according to patient body mass index (BMI; >40 kg/m2 and <40 kg/m2) and the presence (stemmed tibia [ST]) or absence (non-stemmed tibia [NST]) of a short tibial stem extension. Kaplan-Meier survival analyses for aseptic loosening and log-rank tests were performed. RESULTS A total of 236 patients were identified (ST = 162, NST = 74). Baseline patient characteristics were statistically similar between cohorts with the exception of BMI which was greater in the ST cohort (32.9 kg/m2, 30.6 kg/m2; P = .01). Kaplan-Meier survival analysis at 5 years was superior for the BMI < 40 kg/m2 cohort (98.9%, 93.1%; P = .045), the ST cohort (100%, 94.5%; P = .006), and the BMI > 40 kg/m2 with ST cohort at 4 years (71.4%, 100%; P = .008). CONCLUSION Morbid obesity and a short native tibial stem design appear to be associated with aseptic loosening in primary TKA. This appears to be mitigated through the use of an ST. As such, the use of ST may be considered in at-risk patients. Alternatively, implants with longer native stem designs can be employed. Modern short-stemmed tibial components may need to be redesigned.
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Affiliation(s)
- Simon P Garceau
- NYU Langone, Division of Orthopedics - Adult Joint Reconstruction, New York University, New York, NY; Insall-Scott-Kelly Institute, New York, NY
| | - Nathan H Harris
- NYU Langone, Division of Orthopedics - Adult Joint Reconstruction, New York University, New York, NY; Insall-Scott-Kelly Institute, New York, NY
| | | | - Greg M Teo
- Insall-Scott-Kelly Institute, New York, NY
| | | | - William J Long
- NYU Langone, Division of Orthopedics - Adult Joint Reconstruction, New York University, New York, NY; Insall-Scott-Kelly Institute, New York, NY
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Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements. J Arthroplasty 2020; 35:579-587. [PMID: 31653466 DOI: 10.1016/j.arth.2019.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objectives of this study are to (1) evaluate if there is a potential difference in cemented implant fixation strength between tibial components made out of cobalt-chromium (CrCoMo) and of a ceramic zirconium nitride (ZrN) multilayer coating and to (2) test their behavior with 5 different bone cements in a standardized in vitro model for testing of the implant-cement-bone interface conditions. We also analyzed (3) whether initial fixation strength is a function of timing of the cement apposition and component implantation by an early, mid-term, and late usage within the cement-specific processing window. METHODS An in vitro study using a synthetic polyurethane foam model was performed to investigate the implant fixation strength after cementation of tibial components by a push-out test. A total of 20 groups (n = 5 each) was used: Vega PS CrCoMo tibia and Vega PS ZrN tibia with the bone cements BonOs R, SmartSet HV, Cobalt HV, Palacos R, and Surgical Simplex P, respectively, using mid-term cement apposition. Three different cement apposition times-early, mid-term, and late usage-were tested with a total of 12 groups (n = 5 each) with the bone cements BonOs R and SmartSet HV. RESULTS There was no significant difference in implant-cement-bone fixation strength between CrCoMo and ZrN multilayer-coated Vega tibial trays tested with 5 different commonly used bone cements. CONCLUSION Apposition of bone cements and tibial tray implantation in the early to mid of the cement-specific processing window is beneficial in regard to interface fixation in TKA.
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Giaretta S, Berti M, Micheloni GM, Ceccato A, Marangoni F, Momoli A. Early experience with the ATTUNE Total Knee Replacement System. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:98-103. [PMID: 31821292 PMCID: PMC7233713 DOI: 10.23750/abm.v90i12-s.8997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modern TKA implants promise to improve functional outcomes, stability, patient satisfaction and operating room efficiency. The purpose of this retrospective study is to evaluate our short-term clinical and radiological results and survival using the ATTUNE Total Knee Replacement System. METHODS The authors reviewed 228 primary cemented TKAs using ATTUNE Total Knee Replacement System which were implanted between 2014 and 2018 concerning short-term clinical and radiographical outcomes and survival. Clinical evaluation was performed using the Knee injury Osteoarthritis Outcome Score (KOOS), the Oxford Score and a Numeric Rating Scale (NRS) for pain. Radiographic analysis was performed using the Modern Knee Society Score Evaluation System. RESULTS The means of the clinical results as measured with KOOS score were Pain 82,7, Symptoms 79, ADL 78,3, Sport and recreation 51,8 and QOL 78,6. The mean Oxford score was 35 and NRS 2. The mean ROM was 113,4 (SD 9,4 range 90-130). Radiographically mean mechanical axis was 1,97° of Varus and radiolucent lines were detected in 43 knees (22,4%). The survival rate is 98.4% at 2 years and 97.4% at 5 years. CONCLUSION At short-term follow-up the ATTUNE Knee Replacement System provide excellent clinical and radiographical outcomes and good results regarding revision rate. Due to high incidence of radiolucent lines, those patients should be closely monitored even though they show no clinical evidence for loosening.
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Affiliation(s)
- Stefano Giaretta
- Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy.
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