Tibial Tray Thickness Significantly Increases Medial Tibial Bone Resorption in Cobalt–Chromium Total Knee Arthroplasty Implants

AbstractRecent 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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Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-5309-4 ◽

2018 ◽

Vol 27 (4) ◽

pp. 1270-1279 ◽

Cited By ~ 5

Author(s):

ShiZhong Gu ◽

Shinichi Kuriyama ◽

Shinichiro Nakamura ◽

Kohei Nishitani ◽

Hiromu Ito ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Bone Resorption ◽

Knee Arthroplasty ◽

Tibial Component ◽

Tibial Bone ◽

Total Knee

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Medial Tibial Periprosthetic Bone Resorption and Its Effect on Clinical Outcomes After Total Knee Arthroplasty: Cobalt-Chromium vs Titanium Implants

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.04.025 ◽

2018 ◽

Vol 33 (9) ◽

pp. 2835-2842 ◽

Cited By ~ 8

Author(s):

Chan Yoon ◽

Moon Jong Chang ◽

Chong Bum Chang ◽

Min Kyu Song ◽

Jae Hoon Shin ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Bone Resorption ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Titanium Implants ◽

Cobalt Chromium ◽

Periprosthetic Bone ◽

Total Knee

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Accelerometer-Based Portable Navigation System Is Useful for Tibial Bone Cutting in Modified Kinematically Aligned Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-3402481 ◽

2019 ◽

Cited By ~ 1

Author(s):

Masanori Tsubosaka ◽

Tomoyuki Kamenaga ◽

Yuichi Kuroda ◽

Koji Takayama ◽

Shingo Hashimoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Navigation System ◽

Slope Angle ◽

Posterior Slope ◽

Tibial Bone ◽

Significant Difference ◽

Portable Navigation ◽

Total Knee

AbstractSeveral studies have reported better clinical outcomes following kinematically aligned total knee arthroplasty (KA-TKA) than mechanically aligned TKA. Consistent reproduction of a KA-TKA is aided by accurate tibial bone resections using computer navigation systems. This study compares an accelerometer-based portable navigation system with a conventional navigation system on tibial bone resection and clinical outcomes in KA-TKA. This study included 60 knees of patients who underwent primary KA-TKA between May 2015 and September 2017. They were randomly assigned to the OrthoPilot and iASSIST groups. A tibial bone cut was performed with 3 degree varus and 7 degree posterior slope in relation to the mechanical axis in all cases. The tibial component angle (TCA) and posterior slope angle (PSA) were evaluated by postoperative radiography, and those that deviated more than 2 degree were set as outliers. The clinical outcomes were the knee range of motion (ROM) and 2011 Knee Society Score (KSS) evaluated at 1 year postoperation. The groups were compared in terms of the TCA, PSA, number of outliers, ROM, and 2011 KSS (p < 0.05). No significant difference was observed between the groups in terms of the mean TCA, PSA, number of outliers, ROM, and categories of the 2011 KSS (objective knee indicators, symptoms, satisfaction, expectations, and functional activities). Although tibial bone cuts were performed with 3 degree varus and 7 degree posterior slope, no significant difference was observed between the OrthoPilot and iASSIST groups in terms of the accuracy of cuts or postoperative clinical result. The iASSIST was found to be a simple and useful navigation system for KA-TKA.

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Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

Knee Surgery and Related Research ◽

10.5792/ksrr.16.023 ◽

2017 ◽

Vol 29 (3) ◽

pp. 189-194

Author(s):

Ju-Hyung Yoo ◽

Chang-Dong Han ◽

Hyun-Cheol Oh ◽

Sang-Hoon Park ◽

Se-Han Jung ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Bone ◽

Total Knee

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Titanium-Nitride Coating Does Not Result in a Better Clinical Outcome Compared to Conventional Cobalt-Chromium Total Knee Arthroplasty after a Long-Term Follow-Up: A Propensity Score Matching Analysis

Coatings ◽

10.3390/coatings10050442 ◽

2020 ◽

Vol 10 (5) ◽

pp. 442 ◽

Cited By ~ 1

Author(s):

Georg Hauer ◽

Lukas Leitner ◽

Marc C. Ackerl ◽

Sebastian Klim ◽

Ines Vielgut ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Propensity Score ◽

Knee Arthroplasty ◽

Cobalt Chromium ◽

Tin Coating ◽

Long Term Follow Up ◽

Total Knee ◽

Cocr Alloy

Background: The impact of titanium nitride (TiN) coating on implant components is controversial. TiN coating is proposed as having superior biomechanical properties compared to conventional cobalt-chromium (CoCr) alloy. This study compared long-term clinical data as well as meteoro-sensitivity in patients who underwent total knee arthroplasty (TKA), with either CoCr alloy or TiN coating. Methods: In this retrospective observational study, the clinically approved cemented “low contact stress” (LCS) TKA with conventional CoCr coating, was compared to un-cemented TiN-coated “advanced coated system” (ACS) TKA. Propensity score matching identified comparable patients based on their characteristics in a one-to-one ratio using the nearest-neighbor method. The final cohort comprised 260 knees in each cohort, with a mean follow-up of 10.1 ± 1.0 years for ACS patients and 14.9 ± 3.0 years for the LCS group. Physical examinations, meteoro-sensitivity, and knee scoring were assessed. Results: The clinical and functional Knee Society Score (KSS) (82.6 vs. 70.8; p < 0.001 and 61.9 vs. 71.1; p = 0.011), the postoperative Visual Analogue Scale (VAS) (2.9 vs. 1.4; p = 0.002), and the postoperative Tegner Score (2.6 vs. 2.2; p = 0.001) showed significant intergroup differences. The postoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was similar (79.9 vs. 81.3; p = 0.453) between groups. Meteoro-sensitivity of the artificial joint was significantly more prevalent in the ACS patient cohort (56% vs. 23%; p < 0.001). Conclusion: This study suggests that TiN coating does not provide improved clinical outcomes in this patient cohort after a long-term follow-up. Interestingly, sensitivity to weather changes were more correlated with un-cemented ACS implants.

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The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1678536 ◽

2019 ◽

Vol 33 (05) ◽

pp. 466-473

Author(s):

Chao-Hua Fang ◽

Cheng-Kung Cheng ◽

Tie-Bing Qu ◽

Jun-Hui Zhang ◽

Bo Zhang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Chinese Population ◽

Posterolateral Corner ◽

Tibial Tubercle ◽

Tibial Osteotomy ◽

Tibial Tray ◽

Total Knee ◽

Asymmetrical Design

AbstractRotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterior (AP) axis of the tibial tray was marked. The angles between the TEA and these lines were calculated, and the statistical differences were analyzed. The angle between the TEA and the Akagi line and between the TEA and the line connecting the medial third of the tibial tubercle with the midpoint of the PCL were 96.90 ± 5.57 and 107.31 ± 5.95 degrees, respectively. The angles between the TEA and the AP axis of the symmetrical and the asymmetrical design tibial trays were 94.01 ± 4.21 and 96.65 ± 4.70 degrees, respectively. Except for the Akagi line and AP axis of the asymmetrical tibial tray, statistical differences were found between all lines (p < 0.05). The PLCL technique is principally suitable for Chinese patients requiring TKA when using the tibial component referred to in this study, although it may result in slight external rotation.

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