The effect of the posterior slope of the tibial plateau osteotomy with a rotational error on tibial component malalignment in total knee replacement

SummaryObjectives: This study investigated cemented fixation of the tibial component from a canine total knee replacement preclinical model. The objective was to determine the local morphology at the material interfaces (implant, cement, bone) and the local relative micro-motion due to functional loading following in vivo service.Methods: Five skeletally mature research dogs underwent unilateral total knee replacement using a cemented implant system with a polyethylene (PE) monobloc tibial component. Use of the implanted limb was assessed by pressure-sensitive walkway analysis. At 60 weeks post-surgery, the animals were euthanatized and the tibia sectioned en bloc in the sagittal plane to create medial and lateral specimens. High resolution imaging was used to quantify the morphology under the tray and along the keel. Specimens were loaded to 50% body weight and micro-motions at the PE-cement and cement-bone interfaces were quantified.Results: There was significantly (p = 0.002) more cement-bone apposition and interdigitation along the central keel compared to the regions under the tray. Cavitary defects were associated with the perimeters of the implant (60 ± 25%). Interdigitation fraction was negatively correlated with cavitary defect fraction, cement crack fraction, and total micro-motion.Clinical significance: Achieving good inter-digitation of cement into subchondral bone beneath the tibial tray is associated with improved interface morphology and reduced micro-motion; features that could result in a reduced incidence of aseptic loosening. Multiple drill holes distributed over the cut tibial surface and adequate pressurization of the cement into the subchondral bone should improve fixation and reduce interface micro-motion and cavitary defects.

Download Full-text

Performance of the Tibial Component in Total Knee Replacement

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-198365030-00031 ◽

1983 ◽

Vol 65 (3) ◽

pp. 422

Author(s):

George J. Fipp

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Tibial Component ◽

Total Knee

Download Full-text

The Effects of Resection Technique on Implant Migration in Single Radius Posterior-Stabilized Total Knee Replacement

The Journal of Knee Surgery ◽

10.1055/s-0038-1676462 ◽

2018 ◽

Vol 33 (01) ◽

pp. 078-083

Author(s):

Matthew G. Teeter ◽

Kevin Perry ◽

Xunhua Yuan ◽

James L. Howard ◽

Brent A. Lanting

Keyword(s):

Total Knee Replacement ◽

Femoral Component ◽

Knee Replacement ◽

Tibial Component ◽

Posterior Stabilized ◽

Gap Balancing ◽

Measured Resection ◽

Total Knee ◽

Single Radius ◽

Component Migration

AbstractThe purpose of the present study was to measure the effects of gap balancing and resection techniques on migration of a single total knee replacement implant design. A total of 23 patients (24 knees) were recruited on referral to either a surgeon performing gap balancing or a surgeon performing measured resection and followed prospectively. All patients received a fixed bearing, posterior stabilized total knee replacement implant of a single radius femoral component design with cement fixation, and all aspects of care outside of resection technique were identical. Patients underwent radiostereometric analysis (RSA) at 2 weeks (baseline), 6 weeks, 3 months, 6 months, 1 year, and 2 years. Migration of the tibial and femoral components was compared between groups. Tibial component migration was greater at 2 years in the gap balancing group (mean difference = 0.336 mm, p = 0.036), but there was no difference at 1 year. One measured resection and three gap balancing tibial components demonstrated continuous migration > 0.2 mm between years 1 and 2. There was no difference in femoral component migration. Small differences in tibial component migration were found between the gap balancing and measured resection techniques. However, comparing the migration to established predictive thresholds for long-term loosening risk, implants performed with both techniques were found to have equally low revision risk.

Download Full-text

Prospective, observational study to evaluate the relation between patient-reported outcomes and component rotation in total knee replacement: protocol for the CRACK study

BMJ Open ◽

10.1136/bmjopen-2019-031166 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031166

Author(s):

Hans-Peter van Jonbergen ◽

Ellie Landman ◽

Maarten Horst ◽

Robin Westerbeek ◽

Ydo Kleinlugtenbelt

Keyword(s):

Total Knee Replacement ◽

Clinical Outcomes ◽

Outcome Measures ◽

Knee Replacement ◽

Tibial Component ◽

Patient Reported Outcomes ◽

Persistent Pain ◽

Component Rotation ◽

Patient Reported ◽

Total Knee

IntroductionTotal knee replacement (TKR) for osteoarthritis results in a satisfactory outcome in the majority of patients, although up to one in five patients may be dissatisfied with the outcome. Persistent pain is a main contributor to patient dissatisfaction, and femoral and tibial component malrotation have been identified as a potential cause for both persistent pain and patellofemoral problems. Based on the assumption that component malrotation is the causative factor for persistent pain, early revision for patients with symptomatic malrotated components has been advocated in the literature. However, convincing evidence that component malrotation indeed results in less than optimal outcomes is lacking. This study aims to assess the relation between knee prosthesis component rotation and patient-reported outcomes in a large group of patients and to determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Methods and analysisIn this single-centre, prospective observational cohort study, a total of 500 patients will undergo TKR. All patients will have a 3D-CT assessment of femoral and tibial component rotation within 8 weeks after surgery. Outcome measures will include the Oxford Knee Score, the Knee Injury and Osteoarthritis Outcome Score, EQ-5D, visual analogue scale for pain, the American Knee Society Score and the knee joint range of motion. We will assess the relation between femoral, tibial and combined component rotation and patient-reported outcome measures at 8 weeks and 1 year of follow-up, and we will determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Ethics and disseminationEthical approval for this study has been granted by the Isala Hospital ethics committee. The results will be published in a peer-reviewed journal and presented at relevant meetings.Trial registration numberNL7635.

Download Full-text