The Effect of Cement Viscosity in Total Knee Arthroplasty

2012 ◽  
Author(s):  
Kevin Abbruzzese ◽  
Richard O’Laughlin ◽  
Daniel Lee ◽  
D. Gordon Allan ◽  
Manish Paliwal
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Sagittal Plane ◽  
Mechanical Tests ◽  
Lateral View ◽  
Superior Performance ◽  
Posterior View ◽  
Total Knee

Aseptic loosening of the tibial implant remains one of the major reasons of failure in Total Knee Arthroplasty (TKA). Currently, there is no consensus on the role that cement viscosity at the time of application to the bone plays in ensuring the long-term success of the arthroplasty. The purpose of this study was to investigate the relationship between cement viscosity and aseptic loosening of tibial implants. Three cements (Depuy 2, Palacos R (high viscosity cements) and Simplex-P, a medium viscosity cement) were compared during TKA through radiographic analysis and mechanical loading tests using surrogate tibia. Cement penetration was measured from radiographs of the constructs and analyzed according to the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation System. Simplex-P had the maximum cumulative penetration in seven zones in the mediolateral view, and three zones in antero-posterior view. Simplex exhibited maximum penetration in zone 7 in the antero-posterior view, and in zone 3 in the lateral view. For the mechanical tests the TKA constructs were subjected to cyclic compressive loading in the sagittal plane. Simplex-P had the smallest micro-motion in sagittal plane, the results were significant when compared to Palacos R. The consistently superior performance of Simplex-P suggests that cement viscosity does indeed play a role in arthroplasty success. These results have direct clinical relevance for TKA patients suffering from aseptic loosening.

Is Gelsolin a Biomarker for Aseptic Loosening After Total Knee Arthroplasty?

2015 ◽  
Vol 25 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Clayton C. Bettin ◽  
William B. Sisson ◽  
Anita L. Kerkhof ◽  
William M. Mihalko
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Total Knee

The Epidemiology of Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
John M. Tarazi ◽  
Zhongming Chen ◽  
Giles R. Scuderi ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Polyethylene Wear ◽  
Failure Mechanisms ◽  
Surgical Techniques ◽  
Index Procedure ◽  
Total Knee ◽  
Modern Era ◽  
Causes Of Failure

AbstractWith an expected increase in total knee arthroplasty (TKA) procedures, revision TKA (rTKA) procedures continue to be a burden on the United States health care system. The evolution of surgical techniques and prosthetic designs has, however, provided a paradigm shift in the etiology of failure mechanisms of TKA. This review can shed light on the current reasons for revision, which may lead to insights on how to improve outcomes and lower future revision risks. We will primarily focus on the epidemiology of rTKA in the present time, but we will also review this in the context of various time periods to see how the field has evolved. We will review rTKAs: 1) prior to 1997; 2) between 1997 and 2000; 3) between 2000 and 2012; and 3) in the modern era since 2012. We will further subdivide each of the sections into reasons for early (first 2 years after index procedure) versus late revisions (greater than 2 years after index procedure). In doing so, it was determined that prior to 1997, the most prevalent causes of failure were infection, patella failure, polyethylene wear, and aseptic loosening. After a major shift of failure mechanisms was described by Sharkey et al, polyethylene wear and aseptic loosening became the leading causes for revision. However, with the improved manufacturing technology and implant design, polyethylene wear was replaced with aseptic loosening and infection as the leading causes of failure between 2000 and 2012. Since that time, in the modern era of TKA, mechanical loosening and infection have taken over the most prevalent causes for failure. Hopefully, with continued developments in component design and surgical techniques, as well as increased focus on infection reduction methods, the amount of rTKA procedures will decline.

Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

2019 ◽  
Vol 101-B (11) ◽  
pp. 1356-1361 ◽  
Author(s):  
Brian P. Chalmers ◽  
Kapil G. Mehrotra ◽  
Rafael J. Sierra ◽  
Mark W. Pagnano ◽  
Michael J. Taunton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Cox Regression Analysis ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

Total knee arthroplasty after distal femoral osteotomy long-term survivorship and clinical outcomes

2019 ◽  
Vol 101-B (6) ◽  
pp. 660-666 ◽  
Author(s):  
B. P. Chalmers ◽  
A. K. Limberg ◽  
A. G. Athey ◽  
K. I. Perry ◽  
M. W. Pagnano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Aseptic Loosening ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Femoral Osteotomy ◽  
Posterior Stabilized ◽  
Distal Femoral Osteotomy ◽  
Total Knee ◽  
The Mean

Aims There is little literature about total knee arthroplasty (TKA) after distal femoral osteotomy (DFO). Consequently, the purpose of this study was to analyze the outcomes of TKA after DFO, with particular emphasis on: survivorship free from aseptic loosening, revision, or any re-operation; complications; radiological results; and clinical outcome. Patients and Methods We retrospectively reviewed 29 patients (17 women, 12 men) from our total joint registry who had undergone 31 cemented TKAs after a DFO between 2000 and 2012. Their mean age at TKA was 51 years (22 to 76) and their mean body mass index 32 kg/m2 (20 to 45). The mean time between DFO and TKA was ten years (2 to 20). The mean follow-up from TKA was ten years (2 to 16). The prostheses were posterior-stabilized in 77%, varus-valgus constraint (VVC) in 13%, and cruciate-retaining in 10%. While no patient had metaphyseal fixation (e.g. cones or sleeves), 16% needed a femoral stem. Results The ten-year survivorship was 95% with aseptic loosening as the endpoint, 88% with revision for any reason as the endpoint, and 81% with re-operation for any reason as the endpoint. Three TKAs were revised for instability (n = 2) and aseptic tibial loosening (n = 1). No femoral component was revised for aseptic loosening. Patients under the age of 50 years were at greater risk of revision for any reason (hazard ratio 7; p = 0.03). There were two additional re-operations (6%) and four complications (13%), including three manipulations under anaesthetic (MUA; 10%). The Knee Society scores improved from a mean of 50 preoperatively (32 to 68) to a mean of 93 postoperatively (76 to 100; p < 0.001). Conclusion A cemented posterior-stabilized TKA has an 88% ten-year survivorship with revision for any reason as the endpoint. No femoral component was revised for aseptic loosening. Patients under the age of 50 years have a greater risk of revision. The clinical outcome was significantly improved but balancing the knee was challenging in 13% of TKAs requiring VVC. Overall, 10% of TKAs needed an MUA, and 6% of TKAs were revised for instability. Cite this article: Bone Joint J 2019;101-B:660–666.

Aseptic Loosening of Porous Metaphyseal Sleeves and Tantalum Cones in Revision Total Knee Arthroplasty: A Systematic Review

2020 ◽  
Author(s):  
Ryan P. Roach ◽  
Andrew J. Clair ◽  
Omar A. Behery ◽  
Savyasachi C. Thakkar ◽  
Richard Iorio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Search Terms ◽  
Mesh Terms ◽  
Total Knee ◽  
Meta Analyses ◽  
Revision Tkas

AbstractBone loss often complicates revision total knee arthroplasty (TKA). Management of metaphyseal defects varies, with no clearly superior technique. Two commonly utilized options for metaphyseal defect management include porous-coated metaphyseal sleeves and tantalum cones. A systematic review was conducted according to the international Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We combined search terms “Total knee arthroplasty” AND/OR “Sleeve,” “Cone” as either keywords or medical subject heading (MeSH) terms in multiple databases according to PRISMA recommendations. All retrieved articles were reviewed and assessed using defined inclusion and exclusion criteria. A total of 27 studies (12 sleeves and 15 cones) of revision TKAs were included. In the 12 studies on sleeve implantation in revision TKAs, 1,617 sleeves were implanted in 1,133 revision TKAs in 1,025 patients. The overall rate of reoperation was 110/1,133 (9.7%) and the total rate of aseptic loosening per sleeve was 13/1,617 (0.8%). In the 15 studies on tantalum cone implantation in revision TKAs, 701 cones were implanted into 620 revision TKAs in 612 patients. The overall rate of reoperation was 116/620 (18.7%), and the overall rate of aseptic loosening per cone was 12/701 (1.7%). Rates of aseptic loosening of the two implants were found to be similar, while the rate of reoperation was nearly double in revision TKAs utilizing tantalum cones. Variability in the selected studies and the likely multifactorial nature of failure do not allow for any definitive conclusions to be made. This review elucidates the necessity for additional literature examining revision TKA implants.

scholarly journals Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment

Joints ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 001-007 ◽  
Author(s):  
Andrea Cozzi Lepri ◽  
Matteo Innocenti ◽  
Fabrizio Matassi ◽  
Marco Villano ◽  
Roberto Civinini ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Lower Limb ◽  
Sagittal Plane ◽  
Frontal Plane ◽  
Control Group ◽  
Navigation Systems ◽  
Level Of Evidence ◽  
Total Knee

Abstract Purpose Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 5.0° (range 3–7). The alignment of the femoral component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 3.0° (range 0–5). Conclusion The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence This is an observational study without a control group, Level III.

Intra and Inter-Rater Reliability of brief balance Evaluation system test in Patients with total Knee Arthroplasty

2018 ◽  
Vol 12 (1) ◽  
pp. 144
Author(s):  
B Mital Shah ◽  
A Thangamani Ramalingam ◽  
D Bid Dibyendunarayan ◽  
Patel KeniK ◽  
S Patel Krishna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Rater Reliability ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document