Loosening of tibia baseplates after total knee arthroplasty: Evaluation of pull-out strength of tibia baseplate-cement Interface

Abstract Background In cemented primary total knee arthroplasty (TKA), aseptic loosening remains a major cause for failure. Cementing techniques and characteristics of a chosen cement play a key role for good fixation and implant survival. A pastry bone cement was developed to facilitate the cement preparation and to rule out most of preparation-associated application errors. The pastry bone cement was compared to a conventional polymethyl methacrylate cement in a TKA setting. Methods Standardized implantations of total knee endoprostheses were performed in bilateral knee cadavers to investigate handling properties, variables of cement application, working time, and temperature development. Mechanical aspects and cementation quality were assessed by pull-out trials and microscopic interface analysis. Results Both cements expressed similar characteristics during preparation and application, only the curing time of the pastry cement was about 3 min longer and the temperature peak was lower. Fractures of the conventional cement specimens differed from the pastry cement specimens in the tibial part, while no differences were found in the femoral part. Penetration depth of the pastry cement was similar (tibia) or deeper (femur) compared to the conventional cement. Conclusions The pastry cement facilitates the feasibility of cemented TKA. The pre-clinical tests indicate that the pastry bone cement fulfills the requirements for bone cement in the field of knee arthroplasty. A clinical trial is needed to further investigate the approach and ensure patient safety.

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Cement Mantle Thickness at the Bone Cement Interface in Total Knee Arthroplasty: Comparison of PS150 RP and LPS-Flex Knee Implants

Knee Surgery and Related Research ◽

10.5792/ksrr.16.013 ◽

2017 ◽

Vol 29 (2) ◽

pp. 115-121 ◽

Cited By ~ 1

Author(s):

Dong Oh Ko ◽

Song Lee ◽

Kyung Tae Kim ◽

Jae Il Lee ◽

Jin Woo Kim ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Cement Mantle ◽

Cement Interface ◽

Total Knee ◽

Mantle Thickness

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Cementless Tritanium Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 5-Year Minimum Follow-Up

The Journal of Knee Surgery ◽

10.1055/s-0040-1712983 ◽

2020 ◽

Vol 33 (09) ◽

pp. 862-865

Author(s):

John M. Tarazi ◽

Hytham S. Salem ◽

Joseph O. Ehiorobo ◽

Nipun Sodhi ◽

Michael A. Mont ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Porous Titanium ◽

Septic Loosening ◽

Cement Interface ◽

Implant Survivorship ◽

Total Knee ◽

Highly Porous

Abstract Background Newer generation cementless total knee arthroplasty (TKA) designs have provided stronger osteointegration between the implant and bone. Despite excellent survivorship and outcomes with cemented TKAs, areas of concern within the bone–cement interface remain a concern and necessitate studies on alternative constructs. This study assesses: (1) implant survivorship; (2) clinical outcomes; and (3) complications with radiographic outcomes at a 5-year minimum follow-up of cementless highly porous titanium-coated baseplates in TKAs. Methods Part of this study has been reported. We retrospectively reviewed a prospectively collected database at a single high-volume institution between July 1, 2013 and June 30, 2014 for patients who underwent a primary TKA using cementless highly porous titanium-coated baseplate implants. Patients were evaluated clinically at postoperative follow-up visits at a minimum of 5 years. To calculate the survivorship, Kaplan–Meier analysis was performed to determine all-cause, aseptic, and septic implant survivorship at each final follow-up for all patients. Results A total of 228 TKAs were performed and followed for a minimum of 5 years (range, 5–6 years). As of the latest follow-up, one case of septic loosening of the patellar button and one case of patellar dislodgment secondary to physical manipulation were recorded and revised. Overall, the cohort displayed implant survivorship of 99.5% at 5-year minimum follow-up. Improvements were seen in both Knee Society pain and function scores and were 37 points (range, 17–60 points) and 28 points (range, 15–47 points), respectively. The mean improvement in flexion was 17.8 (range, –20 to 40 degrees) and mean improvement in extension was –5.5 (range, –30 to 5 degrees). Discussion Cementless TKAs serve as strong alternative choice to cemented TKAs. Although cemented fixation is commonly known as the gold standard, results of this study confirm the findings of previous investigations on the survivorship of cementless TKA implants. Therefore, patients who undergo primary TKA with a cementless tritanium baseplate can expect excellent clinical outcomes at a 5-year minimum follow-up.

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Obtaining an Optimal Bone–Cement Interface in Total Knee Arthroplasty

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2006.88.3.317b ◽

2006 ◽

Vol 88 (3) ◽

pp. 317-319 ◽

Cited By ~ 2

Author(s):

Stephen M Blake ◽

Peter J Cox

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Cement Interface ◽

Total Knee

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Influence of preparation techniques to the strength of the bone–cement interface behind the flange in total knee arthroplasty

The Knee ◽

10.1016/j.knee.2012.08.002 ◽

2013 ◽

Vol 20 (3) ◽

pp. 186-190 ◽

Cited By ~ 8

Author(s):

S.A.W. van de Groes ◽

M.C. de Waal Malefijt ◽

N. Verdonschot

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Cement Interface ◽

Total Knee ◽

Preparation Techniques

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Unusually High Rate of Early Failure of Tibial Component in ATTUNE Total Knee Arthroplasty System at Implant–Cement Interface

The Journal of Knee Surgery ◽

10.1055/s-0037-1603756 ◽

2017 ◽

Vol 30 (05) ◽

pp. 435-439 ◽

Cited By ~ 17

Author(s):

Anton Khlopas ◽

Morad Chughtai ◽

Connor Cole ◽

Chukwuweike Gwam ◽

Steven Harwin ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Rare Complication ◽

Weight Bearing ◽

High Rate ◽

Radiographic Evaluation ◽

Rotating Platform ◽

Cement Interface ◽

Total Knee

AbstractA novel design total knee arthroplasty (TKA) system has been introduced to improve patient outcomes and increase longevity. However, we have encountered a high rate of debonding of tibial implant–cement interface. In addition, multiple reports have been filed in Manufacturer and User Facility Device Experience database (MAUDE) with the same mechanism of failure. Therefore, we evaluated: clinical, radiographic, and intraoperative findings of patients who received this system and required a revision surgery, and findings from MAUDE database compiled to this date. We reviewed three hospital databases for patients who had revision TKA for tibial loosening at the implant–cement interface. This yielded 15 cases with a mean age of 61 years (range, 47–84). All patients received a novel knee system at another institution. Radiographic analysis was performed by treating orthopaedist. The MAUDE database was reviewed for reports of aseptic failure. Patients presented with pain on weight bearing, effusion, and decreased range of motion (ROM) within 2 years after surgery. Radiographic evaluation demonstrated loosening of the tibial components in 2 of 15 knees. This included cruciate retaining, posterior stabilized, fixed bearing, and rotating platform bearing designs. Intraoperative findings demonstrated gross loosening of the tibial component at the implant–cement interface. Femoral and patellar components were well fixed. There were 21 reports of tibial loosening at the implant–cement interface in MAUDE database in the past 2 months alone. Numerous other tibial failures were reported; however, the mechanisms of failures were not specified. Tibial component loosening is a rare complication of cemented TKA at short-term follow-up. Several possible reasons include increased constraint, reduced cement pockets, and reduced keel rotational stabilizers. The tibial component, which has greater torsional loads, has lower surface roughness than femoral component. We believe that this complication is underreported due to failure of radiographs to assess loosening. In addition, MAUDE database reporting is not consistent and competing companies cannot provide data on the revised components. In patients who have negative workup for a painful joint, one must consider the diagnosis of debonding.

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Pressurized Carbon Dioxide Lavage Reduces the Incidence of a Radiolucent Line Around the Tibial Component Two Years After Total Knee Arthroplasty

10.21203/rs.3.rs-1071360/v1 ◽

2021 ◽

Author(s):

Ryo Sasaki ◽

Masaki Nagashima ◽

Toshiro Otani ◽

Yoshifumi Okada ◽

Noriyuki Aibara ◽

...

Keyword(s):

Carbon Dioxide ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Radiolucent Line ◽

Implant Loosening ◽

Clinical Factors ◽

Preliminary Diagnosis ◽

Cement Interface ◽

Cement Penetration ◽

Total Knee

Abstract Introduction: In cemented total knee arthroplasty (TKA), pressurized carbon dioxide (CO2) lavage prior to cement fixation can eliminate debris at the bone-cement interface and is considered effective for increasing cement penetration and preventing aseptic loosening. Regarding the risk of a preliminary diagnosis of implant loosening, a radiolucent line (RLL) is a valuable sign. The purpose of this study was to compare the incidence of a tibial RLL at 2 years after TKA with and without pressurized CO2 lavage.Methods: This is a retrospective study. One hundred knees from 98 patients were enrolled in this study. TKA was performed without pressurized CO2 lavage (CO2- group) for the first 47 knees, and with pressurized CO2 lavage (CO2+ group) for the next 53 knees. The depth of cement penetration was measured just after surgery, and the incidence of tibial RLL >2 mm, at 2 years after TKA was determined. Results: Significant differences between groups were not seen regarding pre- and postoperative clinical factors. The depth of cement penetration in each area was significantly higher in the CO2+ group. The frequency of knees with RLL >2 mm was significantly lower in the CO2+ group than in the CO2- group (p<0.001).Conclusions: Pressurized CO2 lavage improved cement penetration and decreased the incidence of tibial RLL >2 mm at 2 years after TKA. Since the RLL has been reported as a valuable sign for preliminary diagnosis of loosening, pressurized CO2 lavage appears effective for preventing loosening.

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Early Aseptic Failure of the Tibial Component-Cement Interface in ATTUNE® Total Knee Arthroplasty: A Report of Three Cases

Cureus ◽

10.7759/cureus.20582 ◽

2021 ◽

Author(s):

John D Murphy ◽

Phillip R Braunlich ◽

William R Judson IV ◽

John N Harker ◽

Patricia A Baumann

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Cement Interface ◽

Total Knee ◽

Aseptic Failure

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A Model-Free Feature-Based Bi-Planar RSA Method for Kinematic Analysis of Total Knee Arthroplasty

Journal of Biomechanical Engineering ◽

10.1115/1.4006198 ◽

2012 ◽

Vol 134 (3) ◽

Cited By ~ 3

Author(s):

Shahram Amiri ◽

Carolyn Anglin ◽

Kenard Agbanlog ◽

Bassam A. Masri ◽

David R. Wilson

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Kinematic Analysis ◽

3D Models ◽

Cement Interface ◽

Model Based ◽

Feature Based ◽

Total Knee ◽

The Mean

Fluoroscopic imaging is commonly used for assessing relative motions of orthopaedic implants. One limiting factor to in vivo model-based roentgen stereophotogrammetric analysis of total knee arthroplasty is the need for 3D models of the implants.The 3D models of the implant components must be reverse-engineered, if not provided by the company, which makes this method impractical for a clinical study involving many types or sizes of implants. This study introduces a novel feature-based methodology that registers the features at the implant-bone or implant-cement interface of the components that have elementary shapes. These features include pegs with hemispherical heads, and straight, circular or curved edges located on flat faces of the box of the femoral component or the stem geometry of the tibial component. Software was developed to allow easy registration of these features through a graphical user interface. The accuracy and precision of registration for multiple flexion angles from 0 to 120 deg was determined with reference to registered poses of the implants through experiments on bone replica models and also on a cadaver specimen implanted with total knee prostheses. When compared to an equivalent bi-planar model-based registration, the results were comparable: The mean accuracy of this feature-based method was 1.45 deg and 1.03 mm (in comparison to 0.95 deg and 1.32 mm for the model-based approach), and the mean precision was 0.57 deg and 0.26 mm (in comparison to 0.42 deg and 0.44 mm for the model-based approach).The methodology and the developed software can easily accommodate different design of implants with various fixation features. This method can facilitate in vivo kinematic analysis of total knee arthroplasty by eliminating the need for 3D models of the implant components.

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