Is cementing technique the cause of early aseptic loosening of the tibial component in total knee arthroplasty? A report of 22 failed tibial components

Despite excellent results of bicondylar knee resurfacing when both the tibial and femoral components are cemented, loosening of the cemented tibial component (surface cementing) occurs in approximately 10% of the implants within a 4-year interval after the procedure. Based on our own experience, we want to report of early failed tibial components in 22 patients after a mean follow up of 51 months, necessitating a revision procedure. We analysed retrospectively 22 cases of failed tibial components in patients after a mean follow up of 51 months, necessitating a revision procedure. This raised the question of whether the cementing technique was implicated in the loosening. Every correlation between early loosening and clinically relevant covariates were investigated. All patients were evaluated for radiolucency and osteolytic lesions at the bone–cement interfaces by radiographic assessment according to Rossi et al. (a.p. view and lateral view divided into two zones). The mean radiographic cement penetration in anterior-posterior view was 1.2 mm (SD 0.8) in zone 1 and 1.6 mm (SD 0.9) in zone 2. The mean radiographic cement penetration in lateral view was 1.1 mm (SD 0.4) in zone 1 and 1.3 mm (SD 0.3) in zone 2. Osteolytic lesions were seen in all cases around the implant after a mean of 51 months. In all cases a revision procedure was done. Based on clinical presentation, haematological screening, joint aspiration (synovial fluid diagnostic, microbiological analyses) and histological evaluation of intraoperative samples an infection was excluded. The authors have a critical attitude toward a loosening rate of almost 10% as stated by the recent literature within the first 4 to 5 years and consider that a reduction of the loosening rate when using the full cementation technique /cementing the stem) will mean a greater benefit for patients than the possible advantage of a better bone stock in case of revision surgery. Apart from this aspect, the question of whether early aseptic loosening is still acceptable nowadays from the medical economic aspects also warrants discussion.

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Minimum Ten-Year Outcome of a Triple-Tapered Femoral Stem Implanted With Line-To-Line Cementing Technique

10.21203/rs.3.rs-258121/v1 ◽

2021 ◽

Author(s):

Hirotsugu Ohashi ◽

Satoshi Iida ◽

Izumi Minato

Keyword(s):

Retrospective Study ◽

Aseptic Loosening ◽

Clinical Outcomes ◽

Femoral Stem ◽

Neutral Position ◽

Cementing Technique ◽

Stem Subsidence ◽

The Mean ◽

Loosening Rate

Abstract Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum ten-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.9 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to aseptic loosening. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.41 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 9.2 points preoperatively to 92.9 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum ten-year results were excellent without any failures related to the stem.Trial registration: Retrospectively registered

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Minimum ten-year outcome of a triple-tapered femoral stem implanted with line-to-line cementing technique

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04484-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hirotsugu Ohashi ◽

Satoshi Iida ◽

Izumi Minato

Keyword(s):

Retrospective Study ◽

Clinical Outcomes ◽

Femoral Stem ◽

Trial Registration ◽

Neutral Position ◽

Cementing Technique ◽

Stem Subsidence ◽

The Mean ◽

Loosening Rate

Abstract Background A triple-tapered polished femoral stem was implanted with line-to-line cementing technique. The purpose of this study was to determine the survivorship, loosening rate, stem subsidence, radiologic changes and clinical outcomes in the minimum 10-year follow-up. Methods This was a retrospective study done in three institutes. Finally, 118 hips in 97 patients could be followed-up at the mean follow-up period of 126.3 months. The survivorship, radiological and clinical outcomes were investigated. Results Radiologically, 107 hips (90.7%) were categorized to Barrack cementing grade A, and 108 stems (91.5%) were inserted in neutral position. All hips were not loose and were not revised due to any reason. Survival with revision for any reason as the endpoint was 100% after 10 years. At the last follow-up, the mean subsidence was 0.43 mm, and the subsidence was less than 1 mm in 110 hips (93.2%). JOA hip score improved from 42.7 ± 8.9 points preoperatively to 92.8 ± 6.8 points at the last follow-up. No patient complained thigh pain. Conclusions Line-to-line cementing technique with use of a triple-tapered polished stem was effective to achieve good cementation quality and centralization of the stem. The subsidence was small, and the minimum 10-year results were excellent without any failures related to the stem. Trial registration Retrospectively registered.

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Hydroxyapatite-Coated Threaded Acetabular Prostheses. A Five-Year Follow-Up Radiographic Study

Hip International ◽

10.1177/112070009700700102 ◽

1997 ◽

Vol 7 (1) ◽

pp. 11-16 ◽

Cited By ~ 2

Author(s):

G. Loupasis ◽

S.J. Birtwistle ◽

I.D. Hyde

Keyword(s):

Aseptic Loosening ◽

Bone Ingrowth ◽

Radiographic Study ◽

Positive Evidence ◽

Bone Interface ◽

Large Size ◽

The Mean ◽

Acetabular Components ◽

Loosening Rate

We have reviewed 83 consecutive cementless Furlong hydroxyapatite (HA)-coated threaded acetabular components which were inserted in 75 patients. The mean age of the patients at the operation was 54 years (range 31 to 67 years) and the mean follow-up period was 61 months (range 40 to 82 months). Large size gaps at the implant -bone interface (attributed to failure to achieve bone-prosthesis contact), were present in 89% of the cases on the initial radiographs. At the last follow-up, the gaps were either no longer visible or had decreased in 95% of the cases. Radiolucencies were absent in well-fixed components. Three acetabular components were considered to be loose and are awaiting revision, giving a 3.6% aseptic loosening rate. The remainder of the cups were radiographically stable with positive evidence of bone ingrowth and no signs of impending loosening.

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DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

Journal of Musculoskeletal Research ◽

10.1142/s0218957713500073 ◽

2013 ◽

Vol 16 (02) ◽

pp. 1350007

Author(s):

P. Motwani ◽

A. Jariwala ◽

N. Valentine

Keyword(s):

Total Knee Replacement ◽

Tibial Component ◽

Sagittal Plane ◽

Computer Navigation ◽

Component Alignment ◽

Tibial Component Alignment ◽

Significant Difference ◽

Total Knee ◽

The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

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Incidence and Causes of Tibial Component Loosening Based on Level of Obesity in a Large Consecutive Cohort of Cemented Primary TKAs without Stem Extensions

Proceedings of IMPRS ◽

10.18060/24699 ◽

2020 ◽

Vol 3 ◽

Author(s):

Lilly Longawa ◽

Leonard Buller ◽

Mary Ziemba-Davis ◽

R. Michael Meneghini

Keyword(s):

Aseptic Loosening ◽

Medical Records ◽

Tibial Component ◽

Low Viscosity ◽

Primary Tkas ◽

Total Knee ◽

Potential Impact ◽

Component Loosening ◽

Component Revision

Background and Hypothesis: Aseptic loosening is one of the most common failure mechanisms of total knee arthroplasty (TKA) requiring revision. The influence of obesity on tibial component aseptic loosening remains unknown. Some surgeons advocate the addition of a tibial stem extension to reduce the risk of loosening. The purpose of this study was to quantify the incidence and causes of revision for tibial component loosening in a large consecutive cohort of cemented primary TKAs without stem extensions based upon level of obesity. Experimental Design or Project Methods: 534 consecutive cemented primary TKAs performed between 2016 and 2018 by one surgeon were retrospectively reviewed. Procedures were performed using consistent surgical, perioperative medical, and pain-control protocols. All tibial implants were tapered thin keeled designs without stem extensions and implanted with low viscosity cement. Medical records were examined and all-cause revisions of the index surgery were documented. Results: After exclusions for confounds, 525 TKAs were analyzed. Mean age and BMI were 67.8 years and 33.9kg/m2 respectively and 72% were female. Mean follow-up was 19.1 (SD 10.5) months and 48% had minimum two-year follow-up. 41.3% of patients had a BMI greater than 35kg/m2 and 21.9% above 40kg/m2. There were 11 revisions in 10 patients, 1.9% out of all TKAs performed. Five TKAs required both-component revision and three involved the femoral component only. No tibial component revisions were performed for aseptic loosening. Conclusion and Potential Impact: None of the standard tibial implants with a keeled design without stem extensions failed in a patient population with greater than 40% obesity. Despite some suggesting tibial stem extensions should be used in obese TKA patients, these findings suggest that tibial component failure in obese patients may be design specific and routinely utilizing stem extensions may not be warranted and could result in deleterious bone loss at revision if required for reasons other than aseptic loosening.

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Haglund’s disease: surgical outcome of calcaneal osteotomy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170786 ◽

2017 ◽

Vol 3 (2) ◽

pp. 278 ◽

Cited By ~ 1

Author(s):

Veerabhadra Javali ◽

Virupaksha N. Reddy

Keyword(s):

Conservative Treatment ◽

Surgical Outcome ◽

Surgical Intervention ◽

Lateral Approach ◽

Lateral View ◽

Aofas Score ◽

Postoperative Score ◽

Calcaneal Osteotomy ◽

The Mean

Background: The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy.Methods: 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.Results: 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted. Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease.

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Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head

Hip International ◽

10.1177/1120700018816011 ◽

2018 ◽

Vol 29 (6) ◽

pp. 603-608 ◽

Cited By ~ 4

Author(s):

Yingyong Suksathien ◽

Jithayut Sueajui

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Short Stem ◽

Stem Revision ◽

The Mean ◽

Bone Trabeculae ◽

Mid Term Results

Purpose: To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH). Methods: We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed and HHS was recorded at 6 months postoperatively then yearly to evaluate the clinical results. Results: The mean age of patients was 43.8 years with the mean follow-up 69.3 (60–84) months. Harris Hip Score improved significantly from 44.7 preoperatively to 99.6 at the last follow-up ( p < 0.0001). There were 4 cases (4.8%) of intraoperative femoral fractures. There was 1 case (1.2%) of distal stem perforation that had stable bone ingrowth and there was 1 case (1.2%) of 5-mm subsidence, which was then stable at 3 months postoperatively. Bone trabecular development was detected at zone 1 (65.1%), 2 (69.9%), 3 (14.4%), 4 (1.2%), 6 (97.6%) and 7 (81.9%). There was 1 case (1.2%) where radiolucent lines were observed in zones 1 and 7. There was 1 femoral stem revision from periprosthetic fracture 4 years after index surgery and 1 cup revision from aseptic loosening. Kaplan-Meier survivorship with the end point of stem revision for any reason was 98.8% and for aseptic loosening it was 100% at 7 years. Conclusions: The mid-term clinical and radiographic results of the Metha stem in patients with ONFH were promising. Its design enables preservation of the bone stock and the bone trabeculae appear to confirm the assumption of proximal force transmission.

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Aseptic Loosening Rate of the Mayo Femoral Stem With Medium-Term Follow Up

The Journal of Arthroplasty ◽

10.1016/j.arth.2014.06.023 ◽

2014 ◽

Vol 29 (11) ◽

pp. 2122-2126 ◽

Cited By ~ 6

Author(s):

Luis G.G. Martins ◽

Flávio L. Garcia ◽

Celso H.F. Picado

Keyword(s):

Aseptic Loosening ◽

Femoral Stem ◽

Medium Term ◽

Loosening Rate

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Minimum 5 Year Follow-Up Evaluation of a Third Generation Fixed Bearing Total Ankle Arthroplasty with an Intramedullary Tibial Component and a Central Suclus Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00278 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Evan M. Loewy ◽

Robert B. Anderson ◽

Bruce E. Cohen ◽

Carroll P. Jones ◽

W. Hodges Davis

Keyword(s):

Tibial Component ◽

Patient Reported Outcomes ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Third Generation ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Patient Reported ◽

The Mean

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be a viable option in the treatment of end stage ankle arthritis (ESAA). Early reports demonstrated good results with intramedullary fixation implants. Third generation implants of this kind added a central sulcus to the talar component. This is a report of clinical follow up data from a prospectively collected database at a single US institution using a third generation fixed bearing total ankle arthroplasty implant with a stemmed tibial component and a talar component with a central sulcus. To our knowledge, this is the first report of 5 year follow up data for this implant. Methods: Patients undergoing primary TAA at a single institution by one of four fellowship trained orthopedic foot and ankle surgeons with a third generation fixed bearing implant consisting of an intramedullary stemmed tibial component and a sulcus talus that were at least 5 years postoperative were reviewed from a prospectively collected database. These patients were followed at regular intervals with history, physical examination and radiographs; multiple patient reported outcomes (PRO) measures were obtained. Primary outcomes included implant survivability and PRO scores. Secondary outcomes included coronal plane radiographic alignment (Medial distal tibial articular angle (MDTA) and talar tilt angle (TTA)), evaluation for osteolysis, and failure mode when applicable. All reoperation events were recorded using the Canadian Orthopedic Foot and Ankle Society (COFAS) Reoperations Coding System (CROCS). Results: 121 TAA with this implant were performed in 119 patients between 2010 and 2013; 64 met inclusion criteria. The mean age at surgery was 61.3 ± 10.0 years (range 38.7-84.3). The mean duration of follow up for living patients that retained both initial components at final follow-up was 6.1 ± 0.9 years (range 4.7 – 8.1 years). 26.6% of ankles had a preoperative MDTA and/or TTA greater than 10 degrees. There were 6 (9.4%) failures that occurred at a mean 2.0 ± 1.4 years postoperative. Two failures were due to deep infection. Only one failure was related to tibial component subsidence. One patient is currently scheduled for revision due to talar component subsidence. Conclusion: This cohort of TAA patients with minimum 5 year follow up using a third generation fixed bearing implant demonstrates acceptable implant survival, improved patient reported outcomes scores and maintenance of coronal plane alignment. These data also suggest tolerance of a larger preoperative deformity with improved implant design. To our knowledge, this is the first report with 5 year data on this implant. Continued follow up and reporting is needed to ensure that these favorable outcomes are maintained. Additionally, further investigation on acceptable coronal plane alignment correction with TAA is needed to determine the possible limitations of this procedure.

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3rd Generation Alumina-on-Alumina in Modular Hip Prosthesis: 13 to 18 Years Follow-up Results

Hip International ◽

10.5301/hipint.5000429 ◽

2016 ◽

Vol 27 (1) ◽

pp. 8-13 ◽

Cited By ~ 18

Author(s):

Aldo Toni ◽

Federico Giardina ◽

Giovanni Guerra ◽

Alessandra Sudanese ◽

Maurizio Montalti ◽

...

Keyword(s):

Aseptic Loosening ◽

Hip Prosthesis ◽

Septic Loosening ◽

Early Experiences ◽

Clinical And Radiological Outcome ◽

The Mean ◽

Modular Hip Prosthesis ◽

Ceramic On Ceramic

Introduction Ceramic-on-ceramic (CoC) couplings are alternative bearings surfaces that have been reported to reduce osteolysis, wear debris and aseptic loosening compared to the use of polyethylene. Early experiences with ceramics had poor results, but they have led to many improvements in the manufacture and design of subsequent implants. Methods We analysed medical files of 300 CoC total hip arthroplasty (THA) with a modular neck performed during period 1995-2000 by a single surgeon for a minimum follow-up of 13 years, evaluating clinical and radiological outcome. Results The mean clinical Merle d'Aubigne and Postel hip score at the final follow-up is 17.4, against a pre-operative value of 11.4. Overall survivorship with an endpoint of revision is 93.2% (95% CI, 89.0%-97.3%) at 15 years, while considering only prosthesis failures related to aseptic loosening and ceramic breakage, survival rate at 15 years is 97.2% (95% CI, 94.8%-100%). We observed complications that led to revision surgery in 11 patients (4%) (periprosthetic fractures, liner ruptures, septic loosening of the implant, aseptic loosening of the cup, aseptic loosening of the stem). The occurrence of squeaking is low (1.6%, 4 cases) and we analysed the characteristics of these patients. Discussion Our study shows an excellent long term survivorship of third generation alumina CoC THA. We reiterate the importance to have a stable implant to maximise the advantage of ceramic and to avoid complications.

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