scholarly journals Isolated Tibial Component Failure in Total Knee Arthroplasty: A Case Series Evaluating Inflammatory Response versus Mechanical Failure

2018 ◽  
Vol 32 (07) ◽  
pp. 659-666 ◽  
Author(s):  
Sanar S. Yokhana ◽  
Christopher Bergum ◽  
Weiping Ren ◽  
David C. Markel
Keyword(s):  
Tibial Component ◽  
Mechanical Failure ◽  
Failure Pattern ◽  
Implant Failure ◽  
Inflammatory Biomarkers ◽  
Component Failure ◽  
Radiographic Findings ◽  
Tnf Α ◽  
Biologic Response ◽  
Total Knee

AbstractTotal knee prostheses are routinely redesigned to improve performance, longevity, and to closer mimic the native kinematics of the knee. Despite continued improvements, all knee implants, even those with proven design features, have failures. We identified a cohort of patients with isolated tibial component failures that occurred in a popular and successful knee system. Our purpose was to (1) characterize the observed radiographic failure pattern; (2) investigate the biologic response that may have contributed to the failure; and (3) to determine if the failure mechanism was of a biological or a mechanical nature. Twenty-one knees from 19 patients met the inclusion criteria of isolated tibial component failure in a single knee implant system. Radiographs from the primary and revision knee surgery were analyzed for implant positioning and the failure pattern. Inflammatory biomarkers interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were available in 16/21 knees and peripheral CD14+/16+ monocytes were measured in 14 of the aforementioned 16 knee revisions. Serum CD3, CD4, and CD19 were measured in 10 of the aforementioned 14 knees. Additionally, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured to rule out infection as a cause of the cytokine upregulation. Radiographic findings demonstrated that all of the 21 tibial components were implanted in either neutral or 2 to 3 degrees varus in the coronal plane, and none of the revisions was implanted in valgus. All tibias showed obvious radiographic loosening and the implant failed into varus. The inflammatory biomarkers IL-1β, IL-6, and TNF-α were negative. WBC, ESR, and CRP were normal. Serum CD3, CD4, and CD19 flow cytometry analyses were found to be in the normal range. Peripheral CD14+/16+ and total CD16+ monocytes measurements were consistent with previous findings of patients with osteoarthritis, rather than particulate-induced inflammatory loosening. The findings support the implant failure observed in our study occurred by a different mechanism than the wear debris–induced aseptic loosening. We believe that a mechanical failure can occur based on our findings. The loosening, collapse, and debonding from the cement may have been related to the implantation technique, stresses due to favorable rotational freedoms of the implant, or patient characteristics/behavior. Continued exploration into implant failure mechanisms and particularly into the biologic response associated with failure is ongoing.

Tibial component failure mechanisms in total knee replacement

2004 ◽  
Vol 19 (2) ◽  
pp. 262 ◽  
Author(s):  
Michael E. Berend ◽  
Merrill A. Ritter ◽  
E.Michael Keating ◽  
Philip M. Faris ◽  
John B. Meding
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Tibial Component ◽  
Failure Mechanisms ◽  
Component Failure ◽  
Total Knee

The Chetranjan Ranawat Award: Tibial Component Failure Mechanisms in Total Knee Arthroplasty

2004 ◽  
Vol 428 ◽  
pp. 26-34 ◽  
Author(s):  
Michael E Berend ◽  
Merrill A Ritter ◽  
John B Meding ◽  
Philip M Faris ◽  
E Michael Keating ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Failure Mechanisms ◽  
Component Failure ◽  
Total Knee

scholarly journals Intravenous iron therapy and circulating biomarkers of inflammation in men with heart failure with reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Drozd ◽  
M Tkaczyszyn ◽  
K Wegrzynowska-Teodorczyk ◽  
M Kasztura ◽  
M Dziegala ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intravenous Iron ◽  
Inflammatory Biomarkers ◽  
Iron Therapy ◽  
Reduced Ejection Fraction ◽  
Tnf Α ◽  
Inflammatory State ◽  
Iv Iron ◽  
Hs Crp ◽  
Intravenous Iron Therapy

Abstract Background Large randomized clinical trials have demonstrated that intravenous (IV) iron therapy in iron-deficient patients with heart failure with reduced ejection fraction (HFrEF) brings clinical benefits related to symptoms of the disease and exercise capacity. Mechanisms underlying beneficial effects of such repletion are still the subject of interest as this is not solely related to improved haematopoiesis (IV iron works also in non-anaemic subjects). In patients with chronic heart failure iron deficiency (ID) is linked with inflammatory processess but data regarding the impact of IV iron on inflammation is scarce. Purposes We evaluated whether IV iron therapy affects circulating biomarkers of pro-inflammatory state in men with HFrEF and concomitant ID. Methods This is the sub-analysis of the study to investigate the effects of IV ferric carboxymaltose (FCM) on the functioning of skeletal muscles in men with HFrEF. For the purposes of current research we analyzed data of 20 men with HFrEF (median age 68 (62, 75 – in brackets interquartile ranges, respectively) years, LVEF: 30 (25, 35) %, ischaemic HF aetiology: 85%, NYHA class I/II/III: 30%/50%/20%) and ID (definition according to ESC guidelines - ferritin <100 ng/mL, or ferritin 100–299 ng/mL with transferrin saturation [TSAT] <20%) who were randomized in a 1:1 ratio to receive either the 24-week therapy with IV FCM (dosing scheme as in the CONFIRM-HF trial) or saline (controls). The study was double-blinded. We used ELISA to evaluate different circulating pro-inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP], tumor necrosis factor alpha [TNF-α], interleukin 6 [IL-6], interleukin 1 beta [IL-1β], interleukin 22 [IL-22]) at baseline and week 24. Results IV FCM therapy repleted iron stores in men with HFrEF as reflected by an increase in serum ferritin and TSAT, which was not seen in a control group. IV FCM therapy (as well as the saline administration) affected neither haemoglobin concentration nor parameters reflecting iron stores in red cells. Baseline serum ferritin was not related to hs-CRP, TNF-α, IL-6, IL-1β, and IL-22 (all p>0.23). Baseline TSAT was related to hs-CRP (r=−0.47, p=0.02) but not other inflammatory biomarkers. Levels of hs-CRP, TNF-α, IL-6, IL-1β, and IL-22 at week 0 were similar in subjects who received IV iron and controls (all p>0.22). Change from week 0 to week 24 adjusted for baseline value (delta W24-W0 as the percentage of W0) regarding IL-22 was lower in an active treatment arm as compared with saline (p=0.049) and there was a trend towards lower delta TNF-α in FCM group compared to saline (p=0.067). These findings were not valid for other measured pro-inflammatory biomarkers. Conclusions In men with HFrEF and concomitant ID intravenous iron therapy with FCM affects biomarkers of pro-inflammatory state. Clinical relevance of this finding requires further translational research. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This research was funded by the National Science Centre (Poland) grant allocated on the basis of the decision number DEC-2012/05/E/NZ5/00590

scholarly journals Circulating IL-10 is compromised in patients predisposed to developing and in patients with severe knee osteoarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tyler Barker ◽  
Victoria E. Rogers ◽  
Vanessa T. Henriksen ◽  
Roy H. Trawick ◽  
Nathan G. Momberger ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Cruciate Ligament ◽  
Ligamentous Injury ◽  
Radiographic Evidence ◽  
X Ray ◽  
Tnf Α ◽  
Total Knee ◽  
Anterior Cruciate ◽  
Anterior Cruciate Ligament Surgery ◽  
Necrosis Factor

AbstractThe purpose of this investigation was to identify if serum interleukin (IL)-10 and tumor necrosis factor (TNF)-α concentrations and their ratio (IL-10/TNF-α) are altered in subjects predisposed to developing knee osteoarthritis following ligamentous injury and in those with severe knee osteoarthritis. Serum IL-10 and TNF-α concentrations were measured in four groups of subjects (n = 218): (1) reportedly-healthy and non-injured control subjects (CON; n = 92), (2) subjects scheduled to undergo anterior cruciate ligament surgery (ACL; n = 42), (3) non-surgical subjects with knee osteoarthritis (OA; n = 60), and (4) subjects with knee osteoarthritis scheduled to undergo total knee arthroplasty (TKA; n = 24). X-ray images were used to grade the severity of knee osteoarthritis. Serum IL-10 and the serum IL-10/TNF-α ratio were significantly lower while serum TNF-α was not significantly perturbed with severe compared to moderate knee osteoarthritis (i.e., Kellgren-Lawrence grade 4 vs. 3, respectively). Serum IL-10 was significantly lower in the absence of serum TNF-α alterations in the ACL group. We conclude that serum IL-10 concentrations are compromised in subjects predisposed to developing knee osteoarthritis following ligamentous trauma and in subjects with radiographic evidence of severe knee osteoarthritis.

scholarly journals The 3-Year Effect of the Mediterranean Diet Intervention on Inflammatory Biomarkers Related to Cardiovascular Disease

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 862
Author(s):  
Mireia Urpi-Sarda ◽  
Rosa Casas ◽  
Emilio Sacanella ◽  
Dolores Corella ◽  
Cristina Andrés-Lacueva ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mediterranean Diet ◽  
Virgin Olive Oil ◽  
Extra Virgin Olive Oil ◽  
Inflammatory Biomarkers ◽  
Year Effect ◽  
Tnf Α ◽  
The Mediterranean ◽  
Anti Inflammatory

The intervention with the Mediterranean diet (MD) pattern has evidenced short-term anti-inflammatory effects, but little is known about its long-term anti-inflammatory properties at molecular level. This study aims to investigate the 3-year effect of MD interventions compared to low-fat diet (LFD) on changes on inflammatory biomarkers related to atherosclerosis in a free-living population with a high-risk of cardiovascular disease (CD). Participants (n = 285) in the PREDIMED trial were randomly assigned into three intervention groups: MD with extra-virgin olive oil (EVOO) or MD-Nuts, and a LFD. Fourteen plasma inflammatory biomarkers were determined by Luminex assays. An additional pilot study of gene expression (GE) was determined by RT-PCR in 35 participants. After 3 years, both MDs showed a significant reduction in the plasma levels of IL-1β, IL-6, IL-8, TNF-α, IFN-γ, hs-CRP, MCP-1, MIP-1β, RANTES, and ENA78 (p < 0.05; all). The decreased levels of IL-1β, IL-6, IL-8, and TNF-α after MD significantly differed from those in the LFD (p < 0.05). No significant changes were observed at the gene level after MD interventions, however, the GE of CXCR2 and CXCR3 tended to increase in the control LFD group (p = 0.09). This study supports the implementation of MD as a healthy long-term dietary pattern in the prevention of CD in populations at high cardiovascular risk.

Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty

2021 ◽  
Author(s):  
Francisco Antonio Miralles-Muñoz ◽  
Marta Rubio-Morales ◽  
Laiz Bello-Tejada ◽  
Santiago González-Parreño ◽  
Alejandro Lizaur-Utrilla ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Varus Alignment ◽  
Long Term Outcomes ◽  
Total Knee

Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position

2021 ◽  
Author(s):  
Pablo Besa ◽  
Rafael Vega ◽  
Gerardo Ledermann ◽  
Claudio Calvo ◽  
Manuela Angulo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Anatomical Landmark ◽  
Mechanical Alignment ◽  
Longus Tendon ◽  
Extensor Hallucis Longus ◽  
Tibial Cut ◽  
Total Knee

AbstractThis study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.

Lymphedema: A Significant Risk Factor for Infection and Implant Failure After Total Knee Arthroplasty

2020 ◽  
Vol 28 (23) ◽  
pp. 996-1002 ◽  
Author(s):  
Joshua M. Kolz ◽  
William G. Rainer ◽  
Cody C. Wyles ◽  
Matthew T. Houdek ◽  
Kevin I. Perry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Factor ◽  
Knee Arthroplasty ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Implant Failure ◽  
Total Knee
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