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Bülhoff M, Sonntag N, Trefzer R, Hirt B, Jäger S, Schonhoff M, Renkawitz T, Kasten P. Bone support correlation of X-Ray and CT for a new PE-glenoid. Arch Orthop Trauma Surg 2024; 144:4499-4504. [PMID: 39313641 DOI: 10.1007/s00402-024-05556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/04/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION The radiographic evaluation of novel cementless anatomic polyethylene (PE) glenoid components featuring a titanium-coated back is still unclear. This study explores potential radiolucent lines (RLL) between the radiopaque titanium layer and sclerotic convex reamed bone in an intermodal comparison analysis with computed tomography (CT) scans. MATERIALS AND METHODS Eight RM pressfit vitamys glenoids (Mathys®) were implanted into cadaveric scapulae. In the CT scans, glenoids were quantified by evaluating ideal complete bony support (NO GAP) and gap between bone and titanium coating (GAP). X-rays were in perfect 0-degree projection and tilted in ± 10° and ± 20° mediolateral (ml) and craniocaudal (cc) directions. Radiographs evaluated were graded as NO RLL, RLL (gap > 1 mm) or DL (double line, gap < 1 mm) in an intermodal comparison of CT and X-ray findings. RESULTS The inter-rater (Cohen's = 0.643) and intra-rater reliability (Cohen's = 0.714) were good. The overall evaluation showed a significant agreement between (NO) RLL on X-ray and (NO) GAP on CT (p < 0.001). The - 10-degree ml projection showed good agreement between CT and X-ray (Cohen's = 0.628). Adequate agreement was shown at 0 degrees (Cohen's = 0.386), + 10 degrees ml (Cohen's = 0.338), and + 20 degrees cc (Cohen's = 0.327). Compared to the scenario DL = NO RLL, the true a.p. view showed better sensitivity when the DL is classified as RLL. Conversely, the true a.p. view demonstrated both better specificity and significant agreement between the X-ray and CT findings in scenario when DL = No RLL. CONCLUSION Standard true a. p. projections are reliable in ruling out gaps when no RLL or DL is visible and the detection of RLL shows high intermodal agreement. Varying agreement across tilting angles emphasizes the importance of a comprehensive approach in evaluating bone support and CT is indispensable for a scientifically reliable assessment. LEVEL OF EVIDENCE Level III Treatment Study.
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Affiliation(s)
- Matthias Bülhoff
- Department of Orthopaedics, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany.
| | - Nikolai Sonntag
- Department of Orthopaedics, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Raphael Trefzer
- Department of Orthopaedics, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Bernhard Hirt
- Institute for Clinical Anatomy and Cell Analysis, University of Tübingen, Elfriede-Aulhorn-Straße 8, Tübingen, 72076, Germany
| | - Sebastian Jäger
- Department of Orthopaedics Section of Biomechanics and Implant Research, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Mareike Schonhoff
- Department of Orthopaedics Section of Biomechanics and Implant Research, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Philip Kasten
- Orthopaedic Surgery Center (OCC), Wilhelmstr. 134, Tübingen, 72074, Germany
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Sasaki R, Nagashima M, Tanaka K, Takeshima K. Relationship between cement penetration and incidence of a radiolucent line around the tibia 2 years after total knee arthroplasty: A retrospective study. J ISAKOS 2024; 9:609-614. [PMID: 38825183 DOI: 10.1016/j.jisako.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Cement penetration (CP) plays a key role in implant stability for cemented total knee arthroplasty (TKA), and the radiolucent line (RLL) >2 mm is a preliminary sign for loosening of components. However, the direct relationship between CP and the frequency of RLL >2 mm is unclear, and the best cut-off value for CP to prevent RLL >2 mm also remains unclear. This study aimed to investigate this relationship between CP and RLL and to determine the clinical cut-off value for tibial CP in patients 2 years after TKA. METHODS This retrospective study investigated 157 knees from 123 patients with osteoarthritis who underwent cemented TKA. The CP and RLL immediately after TKA and the RLL 2 years after TKA were measured for the medial, lateral, anterior, and posterior tibial baseplate zones. Receiver operating characteristic (ROC) curves were constructed to determine the best cut-off values for CP. RESULTS RLL >2 mm was not observed just after TKA. An RLL >2 mm was observed in any tibial baseplate zone in 22 knees from 20 patients (RLL+ group) and was not observed in the remaining (RLL- group) 2 years after TKA. The mean CP for all zones was significantly higher in the RLL- group (2.5 ± 1.1 mm) than in the RLL+ group (1.7 ± 0.6 mm; P < 0.001). An RLL >2 mm was seen in 21 knees in the medial zone, 9 knees in the lateral zone, 8 knees in the anterior zone, and 3 knees in the posterior zone. CP values with RLL >2 mm were significantly lower than those without the RLL at the medial, anterior, and posterior tibial baseplate zones. The best cut-off values from the ROC curve of CP in each zone were between 1.1 mm and 2.1 mm. CONCLUSIONS The depth of the CP directly affects the incidence of an RLL >2 mm. The best cut-off value for tibial CP to prevent an RLL >2 mm is 2.1 mm.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852, Hatakeda, Narita City, Chiba 286-8520, Japan; Department of Orthopaedic Surgery, NHO Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852, Hatakeda, Narita City, Chiba 286-8520, Japan.
| | - Kentaro Tanaka
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852, Hatakeda, Narita City, Chiba 286-8520, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852, Hatakeda, Narita City, Chiba 286-8520, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita City, Chiba 286-8520, Japan
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Di Maria F, Das S, Abermann E, Hoser C, Fink C. Pulsed lavage is associated with better quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review. J Exp Orthop 2024; 11:e12027. [PMID: 38774578 PMCID: PMC11106550 DOI: 10.1002/jeo2.12027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose The purpose of this systematic review is to analyse the available literature to ascertain the optimal method of bone preparation to improve the quality of bone-cement-implant interface with either pulsed lavage or syringe lavage in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Methods A comprehensive search was conducted across MEDLINE, Scopus and Embase databases until July 2023. Both inclusion and exclusion criteria were clearly stated and used to identify all the published studies. Subsequent screening throughout the title, abstract and full text was made, followed by complete critical appraisal and data extraction. This sequential process was performed by two reviewers independently and summarised following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). A quality assessment of the systematic review was performed according to the Quality Appraisal for Cadaveric Studies scale (QUACS), reaching a quality level ranging from 69% to 85%. Results A total of 10 articles, out of 47, nine biomechanical cadaveric studies and one human clinical study were analysed. A total of 196 UKA tibial components, 74 patellar components, 36 TKA tibial components and 24 UKA femoral components were retrieved, and a high level of heterogeneity resulted overall. The pulsed lavage group showed better cement penetration and higher pull-out force than the syringe lavage group; a higher interface temperature was also found in the pulsed lavage group. No differences were found regarding tension ligament forces between the groups. Conclusion Our systematic review suggests that pulsed lavage is superior to syringe lavage in terms of the quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA). However, translation of these results from cadaveric studies to individual clinical settings may be hazardous; therefore, clinical in vivo prospective studies are highly needed. PROSPERO CRD PROSPERO CRD number CRD42023432399. Level of Evidence Level III.
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Affiliation(s)
- Fabrizio Di Maria
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Saubhik Das
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Elisabeth Abermann
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Christian Hoser
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Christian Fink
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
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Daher M, Haykal G, Aoun M, Moussallem M, Ghoul A, Tarchichi J, Sebaaly A. Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis. World J Orthop 2024; 15:293-301. [PMID: 38596185 PMCID: PMC10999965 DOI: 10.5312/wjo.v15.i3.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the surgical management of choice in these articulations. Heterotopic ossification and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively. Some studies show that the usage of pulsed lavage may prevent their formation. AIM To compare pulsed lavage to standard lavage in joint arthroplasty. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. Only comparative studies were included. The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements, radiolucent lines formation, and functional knee scores in knee replacements. RESULTS Four studies met the inclusion criteria and were included in this meta-analysis. Pulsed lavage was shown to reduce the formation of radiolucent lines (P = 0.001). However, no difference was seen in the remaining outcomes. CONCLUSION Pulsed lavage reduced the formation of radiolucent lines in knee replacements. No difference was seen in the remaining outcomes. Furthermore, the clinical significance of these radiolucent lines is poorly understood. Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Gaby Haykal
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marven Aoun
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marc Moussallem
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Ali Ghoul
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Jean Tarchichi
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Amer Sebaaly
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
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Eckert JA, Bitsch RG, Schroeder S, Schwarze M, Jaeger S. Pulsatile Lavage Improves Tibial Cement Penetration and Implant Stability in Medial Unicompartmental Arthroplasty: A Cadaveric Study. J Knee Surg 2023; 36:417-423. [PMID: 34507360 DOI: 10.1055/s-0041-1735310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cemented unicompartmental knee arthroplasty (UKA) shows good survivorship and function. However, implant failure, causing the need for revision, can occur. Aseptic loosening is still among the most common reasons for revision. The purpose of this study was to assess the influence of preimplantation lavage technique on tibial cement penetration depth, tibial cement volume, and load to fracture in the tibial component of mobile-bearing UKA. In 10 pairs of fresh frozen human tibiae, cemented UKA was implanted by an experienced surgeon. Tibial components were then implanted, left and right tibiae were randomly allocated to group A or B. Prior to implantation, irrigation was performed with either syringe lavage or pulsatile jet lavage in a standardized manner. Cement surface was 4170.2 mm2 (3271.6-5497.8 mm2) in the syringe lavage group, whereas the jet lavage group showed 4499.3 mm2 (3354.3-5809.1 mm2); cement volume was significantly higher as well (4143.4 mm3 (2956.6-6198.6 mm3) compared with 5936.9 mm3 (3077.5-8183.1 mm3)). Cement penetration depth was 2.5 mm (1.7-3.2 mm) for the jet lavage, and 1.8 mm (1.2-2.4 mm) for the syringe lavage. The mean fracture load was 4680 N in the jet lavage group and 3800 N in the syringe lavage group (p = 0.001). Subsidence was significantly higher for syringe lavage. This study suggests a correlation of cement penetration depth and cement volume to implant failure in the tibial component of a UKA using a cadaveric model. The type of bone lavage most likely influences these two key parameters.
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Affiliation(s)
- Johannes A Eckert
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Gelenkzentrum in der ATOS Klinik Heidelberg GmbH & Co. KG, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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Schonhoff M, Beckmann NA, Schwarze M, Eissler M, Kretzer JP, Renkawitz T, Jaeger S. Is TKA femoral implant stability improved by pressure applied cement? a comparison of 2 cementing techniques. BMC Musculoskelet Disord 2023; 24:51. [PMID: 36670400 PMCID: PMC9863212 DOI: 10.1186/s12891-023-06151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The majority of knee endoprostheses are cemented. In an earlier study the effects of different cementing techniques on cement penetration were evaluated using a Sawbone model. In this study we used a human cadaver model to study the effect of different cementing techniques on relative motion between the implant and the femoral shaft component under dynamic loading. METHODS Two different cementing techniques were tested in a group of 15 pairs of human fresh frozen legs. In one group a conventional cementation technique was used and, in another group, cementation was done using a pressurizing technique. Under dynamic loading that simulated real life conditions relative motion at the bone-implant interface were studied at 20 degrees and 50 degrees flexion. RESULTS In both scenarios, the relative motion anterior was significantly increased by pressure application. Distally, it was the same with higher loads. No significant difference could be measured posteriorly at 20°. At 50° flexion, however, pressurization reduced the posterior relative motion significantly at each load level. CONCLUSION The use of the pressurizer does not improve the overall fixation compared to an adequate manual cement application. The change depends on the loading, flexion angle and varies in its proportion in between the interface zones.
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Affiliation(s)
- Mareike Schonhoff
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Nicholas A. Beckmann
- grid.5253.10000 0001 0328 4908Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Martin Schwarze
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Marvin Eissler
- grid.5253.10000 0001 0328 4908Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Philippe Kretzer
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Tobias Renkawitz
- grid.5253.10000 0001 0328 4908Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Sebastian Jaeger
- grid.5253.10000 0001 0328 4908Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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Pulsatile lavage systems and their potential to penetrate soft tissue. Eur J Trauma Emerg Surg 2023; 49:327-333. [PMID: 36098797 PMCID: PMC9925541 DOI: 10.1007/s00068-022-02067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In orthopedic and trauma surgery, pulsatile lavage systems are used to clean soft tissue. This may be necessary in septic surgeries or in case of contaminated wounds after trauma. Positive features such as reduction of bacterial contamination and removal of foreign particles are counterbalanced by negative aspects such as bacterial seeding in deeper tissue layers, damage to various tissues and even cases of air embolism. PURPOSE The aim of this prospective experimental in vitro study was to compare impact pressure and flow rate in three different pulsatile lavage systems and to determine, whether these parameters alter their ability to reach deeper soft tissue layers. METHODS To test the penetration of soft tissue, the muscle tissue was flushed with contrast medium instead of saline fluid and afterwards scanned by computed tomography. RESULTS Impact pressure and flow rate showed significant differences between the different systems. There were no significant differences between the three devices in terms of total penetration volume, but there were significant differences in penetration depth. CONCLUSION In this study, we found that higher impact pressure leads to deeper penetration and therefore bacteria are likely to be transferred to deeper tissue layers.
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Guo W, Wan T, Tan H, Fan G, Gao X, Liu P, Jiang C. Anterior cruciate ligament deficiency versus intactness for outcomes in patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. Front Bioeng Biotechnol 2022; 10:890118. [PMID: 36082162 PMCID: PMC9445614 DOI: 10.3389/fbioe.2022.890118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: The unicondylar knee arthroplasty (UKA) procedure is primarily indicated for osteoarthritis of the knee. Anterior cruciate ligament (ACL) defects have long been considered a contraindication to UKA. However, recent clinical studies have found that ACL defects do not affect postoperative outcomes in UKA. To elucidate whether ACL defects affect postoperative outcomes in UKA, we performed a systematic review and Meta-analysis of observational cohort studies comparing the effects of ACL defects and intactness on surgical outcomes in UKA. Methods: In this study, we used “Anterior Cruciate Ligament”, “Anterior Cruciate Ligament Injuries” and “Arthroplasty, Replacement, Knee” as the subject terms according to PICOS principles. These subject terms and the corresponding free texts were used to conduct a systematic search in the three major databases PubMed, Embase and Cochrane on December 9, 2021. The main study variables included age, gender, region, definition of ACL defect and diagnosed diseases. The study used a random effect model to pool the effect of 95% CIs. To explore the sources of heterogeneity and to test the stability of the results, a sensitivity analysis was performed. Results: The systematic review found no significant differences in postoperative clinical outcomes in the elderly population when unicondylar replacement was performed in the setting of multiple factors such as injury, defects, longitudinal tear, and synovial bursa injury defined as ACL deficiency. The primary clinical outcomes included postoperative revision, Tegner activity score, and Oxford Knee Score (OKS). After statistical meta-analysis, postoperative outcomes such as postoperative revision (OR, 1.174; 95% CIs, 0.758–1.817) and Tegner activity score (OR, -0.084; 95% CIs, -0.320–0.151) were not statistically different. Conclusion: There was no difference in postoperative revision rates and functional outcomes such as Tegner activity score between the ACL-deficient group compared with the ACL-intact group. For the present results, it is not advisable to consider ACL deficiency as a contraindication of UKA.
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Affiliation(s)
- Weiming Guo
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Teng Wan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Haifeng Tan
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Gang Fan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xiaoyu Gao
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Pan Liu
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
| | - Changqing Jiang
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
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Sasaki R, Nagashima M, Otani T, Okada Y, Aibara N, Takeshima K, Ishii K. Pressurized carbon dioxide lavage reduces the incidence of a radiolucent line around the tibial component two years after total knee arthroplasty. J Orthop Surg Res 2022; 17:349. [PMID: 35841041 PMCID: PMC9284780 DOI: 10.1186/s13018-022-03204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
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.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan.
| | - Toshiro Otani
- Department of Orthopaedic Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kōnodai, Ichikawa City, Chiba, 272-0827, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Noriyuki Aibara
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
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Knappe K, Bitsch RG, Schonhoff M, Walker T, Renkawitz T, Jaeger S. Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty. J Clin Med 2021; 11:88. [PMID: 35011832 PMCID: PMC8745275 DOI: 10.3390/jcm11010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
In cemented joint arthroplasty, state-of-the-art cementing techniques include high-pressure pulsatile saline lavage prior to cementation. Even with its outstanding importance in cementation, there are surprisingly few studies regarding the physical parameters that define pulsatile lavage systems. To investigate the parameters of impact pressure, flow rate, frequency and the cleaning effect in cancellous bone, we established a standardized laboratory model. Standardized fat-filled carbon foam specimens representing human cancellous bone were cleaned with three different high-pressure pulsatile lavage systems. Via CT scans before and after cleaning, the cleaning effect was evaluated. All systems showed a cleaning depth of at least 3.0 mm and therefore can be generally recommended to clean cancellous bone in cemented joint arthroplasty. When comparing the three lavage systems, the study showed significant differences regarding cleaning depths and volume, with one system being superior to its peer systems. Regarding the physical parameters, high impact pressure in combination with high flow rate and longer distance to the flushed object seems to be the best combination to improve the cleaning of cancellous bone and therefore increase the chances of a deeper cement penetration that is required in cemented joint arthroplasty. In summary, this study provides the first standardized comparison of different lavage systems and thus gives initial guidance on how to optimally prepare cancellous bone for cemented joint arthroplasty.
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Affiliation(s)
- Kevin Knappe
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | | | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Tilman Walker
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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11
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Knappe K, Stadler C, Innmann MM, Schonhoff M, Gotterbarm T, Renkawitz T, Jaeger S. Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty? J Clin Med 2021; 10:5361. [PMID: 34830643 PMCID: PMC8620516 DOI: 10.3390/jcm10225361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone-cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads. After a standardized cleaning procedure, the test implants were cemented onto the cancellous bone. Subsequently, the maximum failure load of the bone-cement interface was determined using a material testing machine to pull off the implant, and the cement penetration was determined using computed tomography. Neither the maximum failure load nor cement penetration into the cancellous bone revealed significant differences between the groups. In conclusion, according to our experiments, the additive use of the carbon dioxide lavage after the high-pressure pulsatile lavage has no additional benefit for the cleaning of the cancellous bone and, therefore, cannot be recommended without restrictions.
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Affiliation(s)
- Kevin Knappe
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Christian Stadler
- Department of Orthopedic and Trauma Surgery, Linz University, 4020 Linz, Austria; (C.S.); (T.G.)
| | - Moritz M. Innmann
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Tobias Gotterbarm
- Department of Orthopedic and Trauma Surgery, Linz University, 4020 Linz, Austria; (C.S.); (T.G.)
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.M.I.); (T.R.)
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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12
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Janssen SJ, van Oost I, Breugem SJM, van Geenen RCI. A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA). EFORT Open Rev 2021; 6:850-860. [PMID: 34760285 PMCID: PMC8559574 DOI: 10.1302/2058-5241.6.200105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) has several advantages over total knee arthroplasty; however, in many reports, the risk of revision remains higher after UKA.Many reasons for failure of UKA exist.Successful treatment starts with accurate assessment of the symptomatic UKA as a specific mode of failure requires a specific solution.A structured and comprehensive evaluation aids assessment of the symptomatic UKA.This review provides an overview of the causes for a symptomatic medial UKA, its risk factors, diagnostic modalities that can be used, and briefly discusses treatment options. Cite this article: EFORT Open Rev 2021;6:850-860. DOI: 10.1302/2058-5241.6.200105.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Iris van Oost
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
| | - Stefan J M Breugem
- Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
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13
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Xue L, Xue H, Wen T, Guan M, Yang T, Ma T, Tu Y. Assessment of radiolucent lines in patients with lateral unicompartmental knee arthroplasty and the relationship between these lines and the outcome. INTERNATIONAL ORTHOPAEDICS 2021; 45:2017-2023. [PMID: 34173848 DOI: 10.1007/s00264-021-05115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the radiolucent lines (RLLs) around both tibial and femoral components in patients following lateral unicompartmental knee arthroplasty (UKA). METHODS We performed a retrospective review of the records of a consecutive series of patients who had undergone lateral UKA. The RLLs were assessed with standard anteroposterior and lateral radiographs post-operatively. The patient-reported outcome measures included the Hospital for Special Surgery (HSS) score and Oxford knee score (OKS). The femoral component position (FCP) and femoral-tibial angle (FTA) were also recorded. RESULTS A total of 198 UKAs that had appropriate radiographs and outcome scores were reviewed with a median follow-up of 33 (range, 12-71) months. The results suggested that 69 cases (34.8%) had RLLs on the standard radiographs. The incidence rates of femoral and tibial physiological RLLs were 11.6% (23/198) and 26% (52/198), respectively, of which 3% (6/198) concerned both components. All RLLs were considered "physiologic lines" that developed within one year after surgery. There were no significant differences among the types of RLLs in any of the outcome measures. No differences in FCP (P = .359) or FTA (P = .111) at the last follow-up were seen. CONCLUSIONS It was found that one-third of UKAs had RLLs on radiographs following lateral UKA. All RLLs developed within one year after surgery. As a clinical consequence, the development of RLLs does not affect the short-term outcomes after lateral UKA.
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Affiliation(s)
- Long Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Huaming Xue
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Wen
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Mengying Guan
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tao Yang
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Tong Ma
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China
| | - Yihui Tu
- Department of Orthopaedics, Yangpu Hospital Affiliated to Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090, China.
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14
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Kizilkurt T, Bayram S, Ekinci M, Ayik Ö, Ergin ÖN, Öztürk İ. Comparing the effect of tourniquet and tranexamic acid on the tibial cement mantle thickness in total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:263-268. [PMID: 33811527 DOI: 10.1007/s00590-021-02961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to determine the efficacy of both tranexamic acid (TXA) and tourniquet on the tibial cement mantle thickness in total knee arthroplasty (TKA). METHODS We retrospectively reviewed the recorded data of patients with primary end-stage knee osteoarthritis who underwent TKA procedure during 2014-2016 at a single institution to evaluate the tibial cement mantle. Patients were categorized in two groups based on the use of tourniquet (groups 1 and 2). In addition, these groups were categorized into two different subgroups based on the use of TXA in groups 1 and 2 (group 1-A, B and group 2-A, B). Four zones at the tibial baseplate on the anteroposterior view and two zones on the lateral view were measured at the 4-6-week postoperative visit. RESULTS A total of 28 patients (30 knees) were operated using tourniquet and TXA (group 1-A), 29 (30 knees) using tourniquet without TXA (group 1-B), 24 (28 knees) using TXA without tourniquet (group 2-A), and 38 (42 knees) without using TXA and tourniquet (group 2-B). Although a significant difference was found in the cumulative cement mantle penetration on postoperative X-rays between groups 1 and 2, no significant differences were found between groups A and B in both groups. CONCLUSIONS This study reports that tourniquet use in TKA increased cement mantle penetration of the tibial component in primary TKA. The main strength of this study was that the TXA use alone exhibited no significant effect on the cement thickness.
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Affiliation(s)
- Taha Kizilkurt
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey.
| | - Mehmet Ekinci
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey
| | - Ömer Ayik
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey
| | - İrfan Öztürk
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih Istanbul, 34093, Istanbul, Turkey
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15
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Huang F, Wu D, Chang J, Zhang C, Qin K, Liao F, Yin Z. A Comparison of Mobile- and Fixed-Bearing Unicompartmental Knee Arthroplasties in the Treatment of Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis of 1,861 Patients. J Knee Surg 2021; 34:434-443. [PMID: 31569258 DOI: 10.1055/s-0039-1697901] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many studies have compared mobile-bearing (MB) and fixed-bearing (FB) unicompartmental knee arthroplasties (UKAs) in patients with unicompartmental knee osteoarthritis (OA). The present systematic review and meta-analysis examined the differences in the clinical and radiological outcomes of MB UKA and FB UKA. PubMed, EMBASE, and Cochrane databases, as well as Google Scholar were searched for relevant studies. Randomized controlled trials (RCTs) and cohort studies that compared MB UKA and FB UKA were included. The weighted mean difference in the knee scores and range of motion (ROM) as well as the summary odds ratio of postoperative mechanical axis alignment, radiolucency, revision rate, and complications were calculated in the MB UKA and FB UKA groups. Finally, 2 RCTs and 11 cohort studies that involved 1,861 patients (1,996 knees) were included. The FB UKA group showed better postoperative Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM than the MB UKA group. However, the MB UKA group had more knees with a neutral limb alignment and a lower incidence of polyethylene wear than the FB UKA group. No significant differences were observed between the groups with respect to radiolucency, revision rate, and complications, such as arthritis progression, aseptic loosening, and postoperative pain. This meta-analysis has demonstrated that both prostheses provided excellent clinical outcomes and survivorship in patients with unicompartmental knee OA. The MB UKA group achieved the expected postoperative neutral limb alignment as compared with the FB UKA group, while the FB UKA group showed higher knee scores and superior ROM than the MB UKA group. Limited evidence is currently available; therefore, the results of our meta-analysis should be interpreted with caution.
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Affiliation(s)
- Fei Huang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Dan Wu
- Department of Outpatient, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jun Chang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Chi Zhang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Kunpeng Qin
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Faxue Liao
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Zongsheng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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16
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Schwarze M, Schonhoff M, Beckmann NA, Eckert JA, Bitsch RG, Jäger S. Femoral Cementation in Knee Arthroplasty-A Comparison of Three Cementing Techniques in a Sawbone Model Using the ATTUNE Knee. J Knee Surg 2021; 34:258-266. [PMID: 31434146 DOI: 10.1055/s-0039-1694795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Femoral component loosening is a rare but severe complication in total knee arthroplasty. Former studies have repeatedly demonstrated radiolucent lines behind the ventral and dorsal anchoring shields of the femoral components, which has led us to investigate this matter further. Therefore, three different cementing techniques were tested in a group of nine Sawbone samples each. These differed in the amount of cement applied on the femoral component as well as in the pressure application. Computed tomography was performed to evaluate and classify the cement penetration into the bone adjacent to the prosthesis according to the zones defined by the Knee Society scoring system. The results show significantly deeper cement penetration in all zones when a pressurizer is used. In the other two groups, no significant difference in the dorsal bevel cement penetration was noted. Additionally, no difference in ventral and dorsal cement penetrations (Zones 1 and 4) was delineated. In contrast, there was a significant difference in both the ventral bevel (Zone 2) as well as the distal anchoring surface (Zones 5-7). The use of a pressurizer results in greater cement penetration into all anchoring areas. Completely covering the component back surface results in a significantly higher penetration, which is mainly due to differences in volume. These data show significantly improved cementation results when using a pressurizer. Whether this improves the biomechanical properties and ultimately the revision rate requires further investigation.
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Affiliation(s)
- M Schwarze
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - M Schonhoff
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics and Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - N A Beckmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - J A Eckert
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - R G Bitsch
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,ATOS Clinic Heidelberg, Bismarckstrasse, Heidelberg, Germany
| | - S Jäger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics and Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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17
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Campi S, Kendrick BJL, Kaptein BL, Valstar ER, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Five-year results of a randomised controlled trial comparing cemented and cementless Oxford unicompartmental knee replacement using radiostereometric analysis. Knee 2021; 28:383-390. [PMID: 33408039 DOI: 10.1016/j.knee.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR). The aim of this study was to determine if cementless UKR fixation is as good as cemented by comparing the five-year migration measured radiostereometric analysis (RSA) in a randomised controlled trial. METHODS Thirty-nine patients were randomised to receive either a cemented or a cementless Oxford UKR and were studied at intervals up to five years to assess migration with RSA and radiolucencies with radiographs. RESULTS During the first year there was a small and significant amount of migration, predominantly in an anterior direction, of both the cemented (0.24 mm, SD 0.32, p = 0.01) and cementless (0.26 mm, SD 0.31, p = 0.00) femoral components. Thereafter there was no significant migration in any direction. At no stage was there any significant difference between the migrations of the cemented or cementless femoral components. During the first year, particularly the first three months, the cementless tibial components subsided 0.28 mm (SD 0.19, p = 0.00). This was significantly (p = 0.00) greater than the subsidence of the cemented tibial component (0.09, SD 0.19, p = 0.28). Between the second and fifth years there was no significant migration of either cemented or cementless tibial components. At five years radiolucent lines occurred significantly less with cementless (one partial) compared to cemented (six partial and one complete) tibial components. CONCLUSIONS As, between two and five years, there was no significant migration of cemented or cementless components, and no significant difference between them, we conclude that cementless fixation is as reliable as cemented. It may be better as there are fewer radiolucent lines.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - B J L Kendrick
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - W F M Jackson
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK.
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18
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KAMENAGA TOMOYUKI, HIRANAKA TAKAFUMI, HIDA YUICHI, FUJISHIRO TAKAAKI, OKAMOTO KOJI. CLINICAL OUTCOMES AFTER UNICOMPARTMENTAL KNEE ARTHROPLASTY FOR OSTEONECROSIS OF THE KNEE. ACTA ORTOPEDICA BRASILEIRA 2021; 29:12-16. [PMID: 33795962 PMCID: PMC7976869 DOI: 10.1590/1413-785220212901233328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although the mobile-bearing Oxford unicompartmental knee arthroplasty (OUKA) seems an appropriate procedure to treat spontaneous osteonecrosis of the knee (SONK), aseptic tibial component loosening was the leading cause for medial UKA failure. This study aimed to observe short-term and midterm clinical outcomes following OUKA and determine whether tibial lesion affects the procedure clinical and radiographic outcomes. METHODS Sixty patients (mean age 73.1 ± 6.6 years) diagnosed with SONK in the medial femoral condyle and treated with OUKA were separated into two groups using T1-weighted preoperative magnetic resonance imaging (MRI): group F (necrotic lesion confined to the femur) and group T (necrotic lesion spread to the tibia). The Oxford Knee Score (OKS), maximum flexion angle (MFA), and radiographic findings (radiolucent line and subsidence) were compared between the two groups using unpaired t-test. RESULTS Both groups showed significant improvement in OKS and MFA values at the final follow-up, but without significant differences in the clinical and radiographic outcomes. CONCLUSION OUKA is a reliable treatment procedure for SONK in the short and midterm. The presence of tibial lesions on preoperative MRI does not affect postoperative radiographic and clinical outcomes. Level of Evidence IV, Case Series.
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19
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Herndon CL, Grosso MJ, Sarpong NO, Shah RP, Geller JA, Cooper HJ. Tibial cement mantle thickness is not affected by tourniquetless total knee arthroplasty when performed with tranexamic acid. Knee Surg Sports Traumatol Arthrosc 2020; 28:1526-1531. [PMID: 31190247 DOI: 10.1007/s00167-019-05559-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Evidence exists that tourniquet use leads to increased cement penetration in total knee arthroplasty (TKA) due to decreased blood and fat in the bone during cementation. The use of tranexamic acid (TXA) has led to decreased blood loss and transfusion rates. The purpose of this study was to determine if the use of a tourniquet while utilising modern TXA protocols affects the tibial cement mantle penetration. METHODS 140 patients who underwent primary TKA with and without a tourniquet (70 in each group) were retrospectively reviewed. All patients received a standard TXA protocol. The primary outcome measure was cumulative depth of cement mantle penetration of the tibial plateau on post-operative radiographs. Secondary outcome measures included post-operative change in haemoglobin and hematocrit levels, blood loss, and transfusion rates. RESULTS There was no significant difference in age, sex, or pre-operative haemoglobin or hematocrit levels between groups. Tourniquet use resulted in significantly lower blood loss (100.0 mL versus 154.7 mL, p < 0.001), and significantly reduced drop in haemoglobin (1.8 g/dL vs 2.5 g/dL, p < 0.001) and hematocrit (5.7% vs 7.4%, p = 0.04) levels. However, depth of tibial cement mantle penetration did not differ between the tourniquet group (15.3 mm) and non-tourniquet group (15.0 mm, p value n.s.). No patient in either group required a blood transfusion. CONCLUSIONS Tourniquet use in primary TKA results in decreased blood loss and less change in pre-operative vs post-operative haemoglobin and hematocrit levels. However, with the use of TXA, not using a tourniquet resulted in similar cement mantle penetration around the tibial component as with a tourniquet.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA.
| | - Matthew J Grosso
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA
| | - Roshan P Shah
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA
| | - H John Cooper
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY, 10032, USA
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20
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Scheele CB, Pietschmann MF, Schröder C, Lenze F, Grupp TM, Müller PE. Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty. Knee 2020; 27:587-597. [PMID: 32024609 DOI: 10.1016/j.knee.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. METHODS Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. RESULTS Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). CONCLUSIONS Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Florian Lenze
- Technical University Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany; Aesculap AG Research & Development, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
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Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements. J Arthroplasty 2020; 35:579-587. [PMID: 31653466 DOI: 10.1016/j.arth.2019.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objectives of this study are to (1) evaluate if there is a potential difference in cemented implant fixation strength between tibial components made out of cobalt-chromium (CrCoMo) and of a ceramic zirconium nitride (ZrN) multilayer coating and to (2) test their behavior with 5 different bone cements in a standardized in vitro model for testing of the implant-cement-bone interface conditions. We also analyzed (3) whether initial fixation strength is a function of timing of the cement apposition and component implantation by an early, mid-term, and late usage within the cement-specific processing window. METHODS An in vitro study using a synthetic polyurethane foam model was performed to investigate the implant fixation strength after cementation of tibial components by a push-out test. A total of 20 groups (n = 5 each) was used: Vega PS CrCoMo tibia and Vega PS ZrN tibia with the bone cements BonOs R, SmartSet HV, Cobalt HV, Palacos R, and Surgical Simplex P, respectively, using mid-term cement apposition. Three different cement apposition times-early, mid-term, and late usage-were tested with a total of 12 groups (n = 5 each) with the bone cements BonOs R and SmartSet HV. RESULTS There was no significant difference in implant-cement-bone fixation strength between CrCoMo and ZrN multilayer-coated Vega tibial trays tested with 5 different commonly used bone cements. CONCLUSION Apposition of bone cements and tibial tray implantation in the early to mid of the cement-specific processing window is beneficial in regard to interface fixation in TKA.
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Refsum AM, Nguyen UV, Gjertsen JE, Espehaug B, Fenstad AM, Lein RK, Ellison P, Høl PJ, Furnes O. Cementing technique for primary knee arthroplasty: a scoping review. Acta Orthop 2019; 90:582-589. [PMID: 31452416 PMCID: PMC6844414 DOI: 10.1080/17453674.2019.1657333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).Patients and methods - A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria.Results - The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration.Interpretation - There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.
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Affiliation(s)
- Anders M Refsum
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
| | - Uy V Nguyen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen
| | - Anne M Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Regina K Lein
- Medical Library, University of Bergen, Bergen, Norway
| | - Peter Ellison
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Paul J Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
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23
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Scheele CB, Pietschmann MF, Schröder C, Suren C, Grupp TM, Müller PE. Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2019; 20:539. [PMID: 31722711 PMCID: PMC6854632 DOI: 10.1186/s12891-019-2929-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to evaluate the impact of a single- vs. double-layer cementing technique on morphological cementation and the generation of microscopic cement layers or loose cement fragments in unicompartmental knee arthroplasty (UKA). Methods UKAs were implanted in 12 cadaver knees. The specimens were divided into two groups of comparable bone mineral density. Six UKAs were implanted using a single-layer cementing technique (group A) and six UKAs were implanted using a double-layer cementing technique (group B). Morphological cementation was assessed on nine cuts through the implant–cement–bone interface in the frontal plane. Loose bone cement fragments and the microscopically quality of layer formation were evaluated. Results Contact between bone and prosthesis was observed in 45.4% of interfaces in group A and 27.8% in group B (p = 0.126). The significant increase of areas without visible cement interlocking in the anteroposterior direction in group A (p = 0.005) was not evident in group B (p = 0.262). Penetration around the peg tended to occur more frequently in group B (67.5% vs. 90.6% p = 0.091). Scanning electron microscopy identified no evidence of fissure formations within the bilaminar cement mantle. Free bone cement fragments were documented in 66.7% in both groups with no difference concerning mass (p = 1.0). Conclusions This in-vitro study showed a tendency towards a more homogenous cementation of tibial UKAs using a double-layer cementing technique, although most of the differences did not reach the level of significance. However, theoretical downsides of the double-layer cementing technique such as an increased formation of free bone fragments or a microscopically fissure formation within the cement layer could not be detected either.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Schröder
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Aesculap AG Research & Development, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Ismaninger Str. 22, 81675, Munich, Germany
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24
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Scheele CB, Müller PE, Schröder C, Grupp T, Jansson V, Pietschmann MF. Accuracy of a non-invasive CT-based measuring technique for cement penetration depth in human tibial UKA. BMC Med Imaging 2019; 19:9. [PMID: 30665370 PMCID: PMC6341644 DOI: 10.1186/s12880-019-0312-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Aseptic loosening of the tibial component remains a major cause of failure in unicompartmental knee arthroplasty (UKA) and may be related to micro-motion at the cement-bone interface due to insufficient cement penetration depth. Cement penetration is therefore taken as an indicator of solid fixation strength and primary stability. However, its non-invasive clinical assessment remains difficult in vivo as conventional x-ray is prone to distortion and CT-scans (computed tomography) are difficult to assess due to metal artifacts. The purpose of this study was to develop and validate a reliable in vivo measuring technique of cement penetration depth in human tibial UKA. Methods In an experimental setting, twelve UKA were implanted in fresh-frozen human cadaver knees using a minimal-invasive medial approach. Cement penetration depth was then measured via 1) virtual 3D-models based on metal artifact reduced CT-scans and 2) histological evaluation of nine serial cross-section cuts through the implant-cement-bone-interface. Subsequently, a concordance analysis between the two measuring techniques was conducted. Results The average cement penetration depth was 1) 2.20 mm (SD 0.30 mm) measured on metal artifact reduced CT-scans and 2) 2.21 mm (SD = 0.42) measured on serial cuts (p = 0.956). The mean difference between both techniques was 0.01 mm (SD 0.31 mm) and the Person correlation coefficient was r = 0.686 (p = 0.014). All differences were within the upper and lower limit of agreement. There was no evidence of any significant proportional bias between both techniques (p = 0.182). Conclusions CT-based non-invasive measurement of cement penetration depth delivers reliable results in measuring the penetration depth in tibial UKA. Thereby, it enables clinicians and researchers to assess the cement penetration for in vivo diagnostics in the clinical setting as well as in vitro biomechanical research with subsequent application of load to failure on the implant-cement-bone-interface.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Peter E Müller
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schröder
- Ludwig Maximilians University Laboratory for Biomechanics and Experimental Orthopaedics, Campus Grosshadern, Feodor-Lynen-Straße, 19 81377, Munich, Germany
| | - Thomas Grupp
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.,Aesculap AG Research & Development, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Volkmar Jansson
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias F Pietschmann
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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25
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Kamenaga T, Hiranaka T, Hida Y, Fujishiro T, Okamoto K. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the medial tibial plateau. Knee 2018; 25:715-721. [PMID: 29776813 DOI: 10.1016/j.knee.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There have been very few reports on isolated medial tibial plateau osteonecrosis, and the condition has not been clearly described. Unicompartmental knee arthroplasty (UKA) may be an appropriate treatment method for this condition. The aims of this study were to report our experience of using mobile-bearing knee implants for osteonecrosis of the medial tibial plateau and to discuss the etiology and treatment of this type of osteonecrosis. METHODS This study included six consecutive patients with isolated medial tibial plateau osteonecrosis treated with an Oxford mobile-bearing knee implant. The average age was 71.0 years. We preoperatively graded the tibial necrosis lesion using radiographic findings. We also assessed the area and size of necrosis, extent of the surrounding high-density area, and the presence of any meniscal lesions by preoperative magnetic resonance imaging (MRI), and pre- and postoperative Oxford Knee Scores (OKS) were evaluated. RESULTS MRI findings revealed that all patients had meniscal lesions in addition to a necrotic lesion. All patients significantly improved in their OKS. No knees required revision for either infection or loosening. CONCLUSIONS The etiology of these cases of necrosis is still unclear, but the current study suggested an association with medial meniscal lesions. The results of the study were promising, showing a good short-term clinical outcome of Oxford mobile-bearing UKA for this type of osteonecrosis.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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von Knoch F, Munzinger U. Mediale unikondyläre Kniearthroplastik mit fixiertem Polyethylen. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sun Y, Jiang W, Cory E, Caffrey JP, Hsu FH, Chen AC, Wang J, Sah RL, Bugbee WD. Pulsed lavage cleansing of osteochondral grafts depends on lavage duration, flow intensity, and graft storage condition. PLoS One 2017; 12:e0176934. [PMID: 28464040 PMCID: PMC5413053 DOI: 10.1371/journal.pone.0176934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Osteochondral allograft (OCA) transplantation is generally effective for treating large cartilage lesions. Cleansing OCA subchondral bone to remove donor marrow elements is typically performed with pulsed lavage. However, the effects of clinical and experimental parameters on OCA marrow removal by pulsed lavage are unknown. The aim of the current study was to determine the effects on marrow cleansing in human osteochondral cores (OCs) of (1) lavage duration, (2) lavage flow intensity, and (3) OC sample type and storage condition. Methods OCs were harvested from human femoral condyles and prepared to a clinical geometry (cylinder, diameter = 20 mm). The OCs were from discarded remnants of Allograft tissues (OCA) or osteoarthritis patients undergoing Total Knee Replacement (OCT). The experimental groups subjected to standard flow lavage for 45 seconds (430 mL of fluid) and 120 seconds (1,150 mL) were (1) OCT/FROZEN (stored at -80°C), (2) OCT/FRESH (stored at 4°C), and (3) OCA/FRESH. The OCA/FRESH group was subsequently lavaged at high flow for 45 seconds (660 mL) and 120 seconds (1,750 mL). Marrow cleansing was assessed grossly and by micro-computed tomography (μCT). Results Gross and μCT images indicated that marrow cleansing progressed from the OC base toward the cartilage. Empty marrow volume fraction (EMa.V/Ma.V) increased between 0, 45, and 120 seconds of standard flow lavage, and varied between groups, being higher after FROZEN storage (86–92% after 45–120 seconds) than FRESH storage of either OCT or OCA samples (36% and 55% after 45 and 120 seconds, respectively). With a subsequent 120 seconds of high flow lavage, EMa.V/Ma.V of OCA/FRESH samples increased from 61% to 78%. Conclusions The spatial and temporal pattern of marrow space clearance was consistent with gradual fluid-induced extrusion of marrow components. Pulsed lavage of OCAs with consistent time and flow intensity will help standardize marrow cleansing and may improve clinical outcomes.
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Affiliation(s)
- Yang Sun
- Division of Orthopaedic Surgery, the Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Weibo Jiang
- Division of Orthopaedic Surgery, the Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Esther Cory
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Jason P. Caffrey
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Felix H. Hsu
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Albert C. Chen
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
| | - Jincheng Wang
- Division of Orthopaedic Surgery, the Second Hospital of Jilin University, Changchun, Jilin, China
- * E-mail: (RLS); (WDB); (JW)
| | - Robert L. Sah
- Department of Bioengineering, University of California San Diego, La Jolla, CA, United States of America
- Center for Musculoskeletal Research, Institute of Engineering in Medicine, University of California San Diego, La Jolla, CA, United States of America
- * E-mail: (RLS); (WDB); (JW)
| | - William D. Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, United States of America
- * E-mail: (RLS); (WDB); (JW)
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28
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Scheele C, Pietschmann MF, Schröder C, Grupp T, Holderied M, Jansson V, Müller PE. Effect of lavage and brush preparation on cement penetration and primary stability in tibial unicompartmental total knee arthroplasty: An experimental cadaver study. Knee 2017; 24:402-408. [PMID: 27760695 DOI: 10.1016/j.knee.2016.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/22/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant-cement-bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study. METHODS Cemented UKAs were performed in 18 human cadaver knees after the bone bed was cleaned using pulsed lavage (Group A), conventional brush (Group B) or no cleaning at all (Group C, control). Morphologic cement penetration and primary stability were measured. RESULTS The area proportion under the tibial component without visible cement penetration was significantly higher in Group C (21.9%, SD 11.9) than in both Group A (7.1%, SD 5.8), and Group B (6.5%, SD 4.2) (P=0.007). The overall cement penetration depth did not differ between groups. However, in the posterior part, cement penetration depth was significantly higher in Group B (1.9mm, SD 0.3) than in both Group A (1.3mm, SD 0.3) and Group C (1.4mm, SD 0.3) (P=0.015). The mode of preparation did not show a substantial effect on primary stability tested under dynamic compression-shear test conditions (P=0.910). CONCLUSION Bone preparation significantly enhances cement interdigitation. The application of a brush shows similar results compared with the application of pulsed lavage.
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Affiliation(s)
- Christian Scheele
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany.
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany
| | - Thomas Grupp
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany; Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Melanie Holderied
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Volmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig Maximilians University (LMU), Campus Großhadern, Marchioninistraße 15, 81377 Munich, Germany
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Kerens B, Schotanus MGM, Boonen B, Boog P, Emans PJ, Lacroix H, Kort NP. Cementless versus cemented Oxford unicompartmental knee arthroplasty: early results of a non-designer user group. Knee Surg Sports Traumatol Arthrosc 2017; 25:703-709. [PMID: 27161197 DOI: 10.1007/s00167-016-4149-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Although fewer tibial radiolucent lines are observed in cementless Oxford unicompartmental knee arthroplasty (UKA) compared with cemented Oxford UKA, an independent comparative study on this topic is lacking. METHODS In this multicentre retrospective study, a cohort of 60 consecutive cases of cementless Oxford UKA is compared with a cohort of 60 consecutive cases of cemented Oxford UKA. Radiolucent lines, survival, perioperative data and clinical results were compared. RESULTS No complete tibial radiolucent lines were observed in either group. Seventeen per cent of partial tibial radiolucent lines were observed in the cementless group versus 21 % in the cemented group (n.s.). The percentage of tibial radiolucent zones was 4 versus 9 %, respectively (p = 0.036). Survival rates were 90 % at 34 months for the cementless group and 84 % at 54 months for the cemented group (n.s.). Mean operation time was 10 min shorter in the cementless group (p < 0.001), and clinical results were not significantly different. CONCLUSIONS Although no significant differences in radiolucent lines were found between both groups, they appear to be more common in the cemented group. This confirms previous results from reports by prosthesis designers. The presence of radiolucent lines after cemented Oxford UKA does not correlate with clinical outcome or survival. LEVEL OF EVIDENCE III.
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Affiliation(s)
- B Kerens
- AZ St Maarten, Leopoldstraat 2, Mechelen, Belgium.
| | | | - B Boonen
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P Boog
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - P J Emans
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Lacroix
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - N P Kort
- Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Lisowski LA, Meijer LI, van den Bekerom MPJ, Pilot P, Lisowski AE. Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Joint J 2017; 98 B:41-47. [PMID: 27694515 PMCID: PMC5047134 DOI: 10.1302/0301-620x.98b10.bjj-2016-0474.r1] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
Aims The interest in unicompartmental knee arthroplasty (UKA) for
medial osteoarthritis has increased rapidly but the long-term follow-up
of the Oxford UKAs has yet to be analysed in non-designer centres.
We have examined our ten- to 15-year clinical and radiological follow-up
data for the Oxford Phase III UKAs. Patients and Methods Between January 1999 and January 2005 a total of 138 consecutive
Oxford Phase III arthroplasties were performed by a single surgeon
in 129 patients for medial compartment osteoarthritis (71 right
and 67 left knees, mean age 72.0 years (47 to 91), mean body mass
index 28.2 (20.7 to 52.2)). Both clinical data and radiographs were
prospectively recorded and obtained at intervals. Of the 129 patients,
32 patients (32 knees) died, ten patients (12 knees) were not able
to take part in the final clinical and radiological assessment due
to physical and mental conditions, but via telephone interview it
was confirmed that none of these ten patients (12 knees) had a revision
of the knee arthroplasty. One patient (two knees) was lost to follow-up. Results The mean follow-up was 11.7 years (10 to 15). A total of 11 knees
(8%) were revised. The survival at 15 years with revision for any
reason as the endpoint was 90.6% (95% confidence interval (CI) 85.2
to 96.0) and revision related to the prosthesis was 99.3% (95% CI
97.9 to 100). The mean total Knee Society Score was 47 (0 to 80)
pre-operatively and 81 (30 to 100) at latest follow-up. The mean
Oxford Knee Score was 19 (12 to 40) pre-operatively and 42 (28 to 55)
at final follow-up. Radiolucency beneath the tibial component occurred
in 22 of 81 prostheses (27.2%) without evidence of loosening. Conclusion This study supports the use of UKA in medial compartment osteoarthritis
with excellent long-term functional and radiological outcomes with
an excellent 15-year survival rate. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):41–7.
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Affiliation(s)
- L A Lisowski
- BovenIJ Hospital, Statenjachtstraat 1, 1034 CS Amsterdam, The Netherlands
| | - L I Meijer
- BovenIJ Hospital, Statenjachtstraat 1, 1034 CS Amsterdam, The Netherlands
| | | | - P Pilot
- Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A E Lisowski
- Reinaert Kliniek, Brouwerseweg 100 C 02, 6216 EG, Maastricht, The Netherlands
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Panzram B, Bertlich I, Reiner T, Walker T, Hagmann S, Weber MA, Gotterbarm T. Results after Cementless Medial Oxford Unicompartmental Knee Replacement - Incidence of Radiolucent Lines. PLoS One 2017; 12:e0170324. [PMID: 28103308 PMCID: PMC5245886 DOI: 10.1371/journal.pone.0170324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Tibial radiolucent lines (RL) are commonly seen in cemented unicompartmental knee replacement (UKR). In the postoperative course, they can be misinterpreted as signs of loosening, thus leading to unnecessary revision. Since 2004, a cementless OUKR is available. First studies and registry data have shown equally good clinical results of cementless OUKR compared to the cemented version and a significantly reduced incidence of RL in cementless implants. METHODS This single-centre retrospective cohort study includes the first 30 UKR (27 patients) implanted between 2007 and 2009 with a mean follow-up of 5 years. Clinical outcome was evaluated using the OKS, AKS, range of movement (ROM) and level of pain (VAS). Standard radiologic evaluation was performed at three months, one and five years after surgery. The results five years after implantation were compared to a group of 27 cemented Oxford UKR (OUKR) in a matched-pair-analysis. RESULTS Tibial RL were seen in 10 implants three months after operation, which significantly decreased to five after one year and to three after five years (p = 0.02). RL did not have a significant influence on revision (p = 1.0) or clinical outcome after five years. RL were always partial, never progressive and strictly limited to the tibia. There was no significant difference in the incidence of tibial RL five years after implantation between cemented and cementless implants (cemented: 4, cementless: 3, p = 1.0). CONCLUSIONS After cementless implantation RL were limited to the tibia, partial and never progressive. During short term follow-up the incidence of RL decreased significantly. RL seem to have no influence on clinical outcome and revision.
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Affiliation(s)
- Benjamin Panzram
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ines Bertlich
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Reiner
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tilman Walker
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sébastien Hagmann
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marc-André Weber
- Clinic of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
- * E-mail:
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Abstract
Cements based on polymethyl methacrylate (PMMA) can be used without any problem in a variety of clinical augmentations. Cement-related complications in surgical procedures involving PMMA cements, such as embolism, thermal necrosis, toxicity and hypersensitivity, are often due to other causes. Knowledge about the properties of the cement helps the user to safely employ PMMA cements in augmentations. High radio-opacity is required in vertebral body augmentations and this is provided in particular by zirconium dioxide. In vertebral body augmentations, a low benzoyl peroxide (BPO) content can considerably prolong the liquid dough phase. In augmentations with cement fillings in the region of a tumor, a high BPO content can specifically increase the peak temperature of the PMMA cement. In osteosynthetic augmentations with PMMA, necrosis is rare because heat development in the presence of metallic implants is low due to heat conduction via the implant. Larger cement fillings where there is no heat conduction via metal implants can exhibit substantially higher peak temperatures. The flow properties of PMMA cements are of particular importance for the user to allow optimum handling of PMMA cements. In patients with hypersensitivity to antibiotics, there is no need to avoid the use of PMMA as there are sufficient PMMA-based alternatives. The PMMA cements are local drug delivery systems and antibiotics, antiseptics, antimycotics and also cytostatics can be mixed with the cement. Attention must be paid to antagonistic and synergistic effects.
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Affiliation(s)
- K-D Kühn
- Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich,
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Pfitzner T, von Roth P, Voerkelius N, Mayr H, Perka C, Hube R. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:96-101. [PMID: 25248311 DOI: 10.1007/s00167-014-3341-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was whether the use of a tourniquet increases cement mantle thickness in primary total knee arthroplasty and influences the calculated blood loss and postoperative pain. METHODS Ninety patients with a primary total knee arthroplasty (TKA) were enroled in this prospective randomised trial and divided into a group with (n = 45) and without tourniquet (n = 45). The radiological tibial cement mantle thickness was evaluated postoperatively in four zones on anteroposterior and two zones on lateral radiographs, and values were cumulated. Additionally, the calculated blood loss and postoperative pain levels were recorded. RESULTS There was a median cumulative cement mantle thickness of 13 mm (range 8-19 mm) without tourniquet and of 14.2 mm (range 9-18 mm) with tourniquet (p = 0.009). The median calculated blood loss was 0.6 L (range 0.2-2.0 L) without and 0.9 L (range 0.3-1.5 L) (p = 0.02) with tourniquet. Patient-reported postoperative pain levels were significantly higher in the tourniquet group during mobilisation (p = 0.01) and at rest (p = 0.001). CONCLUSIONS The use of a tourniquet in primary TKA increased the tibial cement mantle thickness but also increased the postoperative calculated blood loss and postoperative pain. Surgeons might take this into consideration for decision-making whether to use a tourniquet during TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Tilman Pfitzner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Philipp von Roth
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ninja Voerkelius
- Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Hermann Mayr
- Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Hube
- Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
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Abstract
Unicompartmental arthroplasty is an efficient and approved treatment option of unicompartmental arthritis of the knee, being performed with increasing frequency worldwide. Compared to total knee replacement, there are several advantages such as faster recovery, lower blood loss, better functional outcome and lower infection rates. However, higher revision rates are a frequent argument against the use of unicompartmental arthroplasty. The following article gives an overview of failure mechanisms and strategies for revision arthroplasty. This article is based on a selective literature review including PubMed and relevant print media. Our own clinical experience is considered as well.
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Surface or full cementation of the tibial component in total knee arthroplasty: a matched-pair analysis of mid- to long-term results. Arch Orthop Trauma Surg 2015; 135:703-8. [PMID: 25739993 DOI: 10.1007/s00402-015-2190-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Despite the clinical success of cemented TKA, aseptic loosening of the tibial component remains a potential long-term complication. Considering the constantly growing revision burden, there is a need for clarification regarding controversial views on primary fixation techniques. In this retrospective analysis, surface (SC) or full cementation (FC) of tibial components was compared in a matched-pair and long-term setting. METHODS Matching pairs were identified in a patient series from 1989 to 1994. Hence, 25 primary TKA (SC) were compared to 42 TKA (FC). The study population included 34 patients with rheumatoid arthritis. Patients were matched in a 1:1.7 fashion according to age, gender and initial diagnosis. Outcome was assessed by multiple clinical parameters, detailed radiographic evaluation and survivorship analysis. RESULTS Clinical follow-up (FU) was at 10.3 years (range 1.5-15.6) for the SC and 12 years (range 0.2-16.2) for the FC group. Survivorship at 10 years was 100 % for the surface cemented trays and 93.3 % (95 % CI 80.5-100) for the fully cemented implants considering aseptic loosening as endpoint (p = 0.3918). Improvement of the AKS Score was greater in the SC group (p = 0.044) and patients in this group were more satisfied (p = 0.013). For any other clinical parameter, no difference could be observed (p > 0.05). CONCLUSION Results of this study showed no statistically significant difference regarding long-term survivorship for the two cementing techniques. This finding questions the claimed advantage of full cementation for tibial components. The presented data do not support the concern that surface cementation results in insufficient fixation in patients with rheumatoid arthritis.
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Abstract
BACKGROUND Unicondylar knee arthroplasty (UKA) is an established therapeutic option for advanced medial or lateral gonarthrosis. OBJECTIVES The cornerstones of a successful UKA, careful patient selection, preoperative planning and precise operation technique, are discussed in this overview article. IMPORTANCE In contrast to total knee arthroplasty, UKA allows preservation of the contralateral and patellofemoral compartments as well as the cruciate ligaments and is often associated with rapid postoperative recovery, improved knee kinematics and knee function. However, UKA is technically very demanding. High revision rates have been reported in particular with widespread application, according to national joint replacement registries. CONCLUSION Successful UKA relies on meticulous patient selection, preoperative planning and surgical technique. It is justified to broaden classic UKA indications. In medial and lateral UKA three types of mechanical varus-valgus deformity can be encountered: type 1 (isolated intraarticular deformity), type 2 (pronounced deformity due to extraarticular varus deformity in medial UKA or valgus deformity in lateral UKA), type 3 (reduced deformity due to extraarticular valgus deformity in medial UKA or varus deformity in lateral UKA). We believe these deformities should be addressed accordingly with surgical technique.
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Reiner T, Jaeger S, Schwarze M, Klotz MC, Beckmann NA, Bitsch RG. The stability of the femoral component in the Oxford unicompartmental knee replacement: a comparison of single and twin peg designs. Bone Joint J 2014; 96-B:896-901. [PMID: 24986942 DOI: 10.1302/0301-620x.96b7.33478] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component. Medial Oxford UKR was performed in 12 pairs of human cadaver knees. In each pair, one knee received the single peg and one received the twin peg design. Three dimensional micromotion and subsidence of the component in relation to the bone was measured under cyclical loading at flexion of 40° and 70° using an optical measuring system. Wilcoxon matched pairs signed-rank test was performed to detect differences between the two groups. There was no significant difference in the relative micromotion (p = 0.791 and 0.380, respectively) and subsidence (p = 0.301 and 0.176, respectively) of the component between the two groups at both angles of flexion. Both designs of component offered good strength of fixation in this cadaver study.
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Affiliation(s)
- T Reiner
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - S Jaeger
- Clinic for Orthopedics and Trauma Surgery, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - M Schwarze
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - M C Klotz
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - N A Beckmann
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
| | - R G Bitsch
- Heidelberg University Hospital, Department of Orthopedics and Traumatology, Schlierbacher Landstraße 200a, Heidelberg, 69118, Germany
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Schlegel UJ, Bishop NE, Püschel K, Morlock MM, Nagel K. Comparison of different cement application techniques for tibial component fixation in TKA. INTERNATIONAL ORTHOPAEDICS 2014; 39:47-54. [DOI: 10.1007/s00264-014-2468-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 07/13/2014] [Indexed: 10/25/2022]
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Grupp TM, Pietschmann MF, Holderied M, Scheele C, Schröder C, Jansson V, Müller PE. Primary stability of unicompartmental knee arthroplasty under dynamic compression-shear loading in human tibiae. Clin Biomech (Bristol, Avon) 2014; 28:1006-13. [PMID: 24161522 DOI: 10.1016/j.clinbiomech.2013.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/16/2013] [Accepted: 10/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of our study was to evaluate the impact of a single- ("implant only") versus a double-layer ("implant & bone") cementing technique on the primary stability of unicompartmental tibial plateaus under dynamic compression-shear loading conditions in human tibiae. METHODS Twelve fresh-frozen human knees of a mean donor age of 72.3 years were used to perform medial UKA under a less invasive parapatellar surgical approach. The tibiae were divided into two groups of matched pairs based on comparable trabecular bone mineral density. To assess the primary stability, a new method based on a combination of dynamic compression-shear testing, kinematic analysis of the tibial plateau migration relative to the bone and evaluation of the cement layer by CT-scans and fragments cut through the implant-cement-bone interface in the frontal plane was introduced. FINDINGS For the "implant only" cementation technique the mean load to failure was 2600 (SD 675) N and for "implant & bone" it was 2820 (SD 915) N. Between the final load level at failure and the bone mineral density a significant correlation was found for the groups "implant only" (r(s) = 0.875) and "implant & bone" (r(s) = 0.907). INTERPRETATION From our observations, we conclude that there is no significant difference between a single- ("implant only") and double-layer ("implant & bone") cementing technique in the effect on the primary stability of unicompartmental tibia plateaus, in terms of failure load, correlation between final load at failure and bone mineral density, migration characteristics, cement layer thickness and penetration depth.
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Affiliation(s)
- Thomas M Grupp
- Aesculap AG Research & Development,Tuttlingen, Germany; Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Munich, Germany.
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Pegg EC, Kendrick BJL, Pandit HG, Gill HS, Murray DW. A semi-automated measurement technique for the assessment of radiolucency. J R Soc Interface 2014; 11:20140303. [PMID: 24759544 DOI: 10.1098/rsif.2014.0303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The assessment of radiolucency around an implant is qualitative, poorly defined and has low agreement between clinicians. Accurate and repeatable assessment of radiolucency is essential to prevent misdiagnosis, minimize cases of unnecessary revision, and to correctly monitor and treat patients at risk of loosening and implant failure. The purpose of this study was to examine whether a semi-automated imaging algorithm could improve repeatability and enable quantitative assessment of radiolucency. Six surgeons assessed 38 radiographs of knees after unicompartmental knee arthroplasty for radiolucency, and results were compared with assessments made by the semi-automated program. Large variation was found between the surgeon results, with total agreement in only 9.4% of zones and a kappa value of 0.602; whereas the automated program had total agreement in 81.6% of zones and a kappa value of 0.802. The software had a 'fair to excellent' prediction of the presence or the absence of radiolucency, where the area under the curve of the receiver operating characteristic curves was 0.82 on average. The software predicted radiolucency equally well for cemented and cementless implants (p = 0.996). The identification of radiolucency using an automated method is feasible and these results indicate that it could aid the definition and quantification of radiolucency.
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Affiliation(s)
- E C Pegg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, , Oxford OX3 7LD, UK
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Jaeger S, Rieger JS, Bruckner T, Kretzer JP, Clarius M, Bitsch RG. The protective effect of pulsed lavage against implant subsidence and micromotion for cemented tibial unicompartmental knee components: an experimental cadaver study. J Arthroplasty 2014; 29:727-32. [PMID: 24184324 DOI: 10.1016/j.arth.2013.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 02/01/2023] Open
Abstract
Cemented UKAs were performed in 12 pairs of human cadaver legs and the bone bed was cleansed using pulsed lavage (group A) and conventional syringe lavage (group B). Subsidence and micromotion of the loaded tibial trays were measured. There was a significant effect of BMD on subsidence (P = 0.043) but not on micromotion. Cement penetration of group A was significantly increased (P = 0.005). Group A showed a reduced implant subsidence (P = 0.025) and micromotion (P = 0.026) compared to group B. The group differences in micromotion and implant subsidence of UKA tibial components were statistically significant but rather small and might clinically be of minor importance. Nevertheless a worse bone quality adversely affected implant subsidence and pulsed lavage had a protective effect in these specimens.
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Affiliation(s)
- Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes S Rieger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Clarius
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany; Vulpius Hospital for Orthopaedic Surgery Bad Rappenau, Rappenau, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Molt M, Harsten A, Toksvig-Larsen S. The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee 2014; 21:396-401. [PMID: 24238650 DOI: 10.1016/j.knee.2013.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 08/27/2013] [Accepted: 10/17/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND A concern that arises with any change in technique is whether it affects the long-term implant stability. The objective of this study was to evaluate the early migration, measured by radiostereometric analysis (RSA), and the functional outcome of the Triathlon™ cemented knee prosthesis, operated on with or without a tourniquet. During the last decades RSA has emerged as a way to assess prosthetic fixation and long time prognosis. The method has been used extensively in both hip and knee arthroplasty. METHOD This was a single centre prospective study including 60 patients randomized into two groups operated on either with or without tourniquet. RSA investigation was done within 2-3 days postoperatively after full weight bearing, and then at 3 months, 1 year and 2 years postoperatively. RESULTS There were no differences between the groups regarding the translation along or rotation around the three coordinal axes, or in maximum total point motion (MTPM). At 2 years the mean MTPM (SD) was 0.71 mm (0.64) for the tourniquet-group and 0.53 mm (0.21) for the non-tourniquet-group. CONCLUSIONS The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability whether operated on with or without tourniquet. LEVEL OF EVIDENCE Level I. ARTICLE SUMMARY Article focus: A safety study for total knee replacement operated on with or without perioperative tourniquet regarding the prosthetic fixation. Strengths and limitations: Strength of this study is that it is a randomized prospective trial using an objective measuring tool. The sample size of 25-30 patients is reportedly sufficient for the screening of implants using RSA (1-3). TRIAL REGISTRATION Clinical trials NCT01604382, Ethics Committee approval D-nr: 144/20085.
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Affiliation(s)
- Mats Molt
- Department of Orthopaedics, Hässleholm-Kristianstad-Ystad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Andreas Harsten
- Department of Anaesthesiology, Hässleholm Hospital, Hässleholm, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm-Kristianstad-Ystad, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
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Manzotti A, Cerveri P, Pullen C, Confalonieri N. A flat all-polyethylene tibial component in medial unicompartmental knee arthroplasty: a long-term study. Knee 2014; 21 Suppl 1:S20-S25. [PMID: 25382363 DOI: 10.1016/s0968-0160(14)50005-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study is to present the clinical and radiological results of a cemented unicompartmental knee arthroplasty (UKA) using a flat all-polyethylene tibial component at long-term follow-up, in a homogeneous group of patients with medial femoro-tibial knee arthritis. METHODS The study group included 53 knees in 51 patients who were treated between January 1998 and November 1999 using a flat all-polyethylene tibial component. The same surgical technique was used for all patients. Inclusion criteria included a diagnosis of atraumatic arthritis, pre-operative flexion greater than 100° with no flexion deformity, a varus deformity of less than 10°, and a body mass index (BMI) less than 35. A neutral mechanical axis was considered the end-point in all interventions. The patients were assessed clinically using the International Knee Society (IKS) and the functional scores at follow-up. Plain radiographs were used to determine the alignment of the mechanical axis at 5, 10 and 14.7-year follow-up. A radiographic analysis of loosening, based on the method described by the IKS, was performed and the degree of arthritic progression in the non-resurfaced compartment was also assessed. RESULTS At latest follow-up five patients had died and the data for three patients had not been collected. At final review four knees had undergone revision surgery and a further patient had declined a recommended revision TKA. The main indication for revision surgery was progressive aseptic loosening of the tibial component in female patients. No revisions were required because of arthritic progression in the lateral compartment. Over time the clinical outcomes did not show statistically significant differences. There was a significant worsening of the mechanical axis at the last follow-up compared with the results at five and ten year review. CONCLUSIONS This study demonstrated that, in primary arthritis involving the medial femoro-tibial compartment, UKA using a flat all-polyethylene component could be considered an effective surgical option. Attention should be paid to progressive worsening of the mechanical axis over time associated with progressive radiolucency especially in female patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alfonso Manzotti
- Ist Orthopedic Department, C.T.O. Hospital, via Bignami 1, 20100 Milan, Italy.
| | - Pietro Cerveri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, via Ponzio 34/5, 20133 Milan, Italy
| | - Chris Pullen
- Orthopaedic Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Alijanipour P, Karam J, Llinás A, Vince KG, Zalavras C, Austin M, Garrigues G, Heller S, Huddleston J, Klatt B, Krebs V, Lohmann C, McPherson EJ, Molloy R, Oliashirazi A, Schwaber M, Sheehan E, Smith E, Sterling R, Stocks G, Vaidya S. Operative environment. J Orthop Res 2014; 32 Suppl 1:S60-80. [PMID: 24464899 DOI: 10.1002/jor.22550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ollivier M, Abdel MP, Parratte S, Argenson JN. Lateral unicondylar knee arthroplasty (UKA): contemporary indications, surgical technique, and results. INTERNATIONAL ORTHOPAEDICS 2013; 38:449-55. [PMID: 24337799 DOI: 10.1007/s00264-013-2222-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/19/2013] [Indexed: 12/01/2022]
Abstract
Unicompartmental femoro-tibial osteoarthritis usually affects the medial compartment of the knee, but in 10%, the lateral compartment is primarily involved. Femoral osteotomy is attractive to avoid TKA in younger patients with low-grade unicompartmental osteoarthritis and a valgus deformity. However, only limited functional results can be expected for patients with Ahlback grade 2 or greater osteoarthritis. Moreover, because of previous skin incisions and hardware removal, TKA after femoral osteotomy remains a complex procedure with poor functional results. Unicompartmental knee arthroplasty for both the medial and the lateral compartments has been performed since the 1970s. In a patient with involvement of only one compartment, a medial or a lateral UKA can provide a quicker recovery and enhanced function when compared to TKA. In addition, it preserves bone stock and can be "easily" revised by a TKA. Technical improvements, combined with strict patient selection, have resulted in ten year survivorships greater than 90%. However, lateral UKA is technically more challenging than medial UKA due to the lower number of indications, as well as the functional anatomy of the lateral compartment. The goals of this article are to present up-to-date information concerning indications, patients' selection, surgical technique and results of lateral compartment UKA.
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Affiliation(s)
- Matthieu Ollivier
- Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
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Jaeger S, Seeger JB, Schuld C, Bitsch RG, Clarius M. Tibial cementing in UKA: a three-dimensional analysis of the bone cement implant interface and the effect of bone lavage. J Arthroplasty 2013; 28:191-4. [PMID: 23790498 DOI: 10.1016/j.arth.2013.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/12/2013] [Accepted: 05/09/2013] [Indexed: 02/01/2023] Open
Abstract
Loosening is a common cause for revision in cemented UKA. In a cadaver study, we analyzed the three-dimensional cement distribution under the tibial implant and the effect of bone lavage (pulsed lavage, syringe lavage) on maximum cement penetration and penetration volume. Analyses were determined by performing bone cuts in medio-lateral direction and converting this data into a 3D model. Pulsed lavage led to an increased mean maximum cement penetration 5.79 ± 2.63 mm and penetration volume 6471.34 ± 1156.43 mm(3) compared to syringe lavage 4.62 ± 2.61 mm, 5069.81 ± 1177.09 mm(3) (P<0.001; P<0.001). Our results show a complete cement mantle for both investigated lavage techniques. Cleansing the cancellous tibial bone bed using pulsed lavage is more effective than conventional syringe lavage and leads to a deeper cement penetration and lager cement penetration volume under the tibial component.
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Affiliation(s)
- Sebastian Jaeger
- Department of Orthopaedics, Traumatology and Paraplegiology, Heidelberg University Hospital, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, Heidelberg, Germany
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Faour-Martín O, Valverde-García JA, Martín-Ferrero MA, Vega-Castrillo A, de la Red Gallego MA, Suárez de Puga CC, Amigo-Liñares L. Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results. INTERNATIONAL ORTHOPAEDICS 2013; 37:833-8. [PMID: 23503637 DOI: 10.1007/s00264-013-1830-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Surgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. METHODS In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. RESULTS Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. CONCLUSIONS We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinion.
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Affiliation(s)
- Omar Faour-Martín
- Service of Traumatology and Orthopaedic Surgery, Hospital of Ávila-Sacyl, Avenida Juan Carlos Primero s/n 05071, Ávila, Spain.
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Seeger JB, Jaeger S, Bitsch RG, Mohr G, Röhner E, Clarius M. The effect of bone lavage on femoral cement penetration and interface temperature during Oxford unicompartmental knee arthroplasty with cement. J Bone Joint Surg Am 2013; 95:48-53. [PMID: 23283372 DOI: 10.2106/jbjs.k.01116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening is the most common cause for revision unicompartmental knee arthroplasty and is associated with failure of the bone-cement or cement-implant interface. The purpose of the present study was to analyze different bone lavage techniques for the bone-cement and cement-implant interfaces of the femoral component and to study the effect of these techniques on cement penetration and on interface temperature. METHODS In an experimental cadaver study, Oxford unicompartmental knee arthroplasty was performed in twenty-four matched-paired knees to study the effect of pulsed lavage compared with syringe lavage on femoral cement penetration and interface temperature. Interface temperature, cement penetration pressure, and ligament tension forces were measured continuously during the procedure, and cement penetration was determined by performing sagittal bone cuts. RESULTS Cleansing the femoral bone stock with use of pulsed lavage (Group B) led to increased femoral cement penetration (mean, 1428 mm²; 95% confidence interval, 1348 to 1508 mm²) compared with syringe lavage (Group A) (mean, 1128 mm²; 95% confidence interval, 1038 to 1219 mm²) (p < 0.001). Interface temperature was higher in Group B (mean 22.6°C; 95% confidence interval, 20.5°C to 24.1°C) than in Group A (mean, 21.0°C; 95% confidence interval, 19.4°C to 23.0°C) (p = 0.028), but temperatures never reached critical values for thermal damage to the bone. CONCLUSIONS Pulsed lavage leads to an increased femoral cement penetration without the risk of heat necrosis at the bone-cement interface.
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Affiliation(s)
- J B Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
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Clement ND, Duckworth AD, MacKenzie SP, Nie YX, Tiemessen CH. Medium-term results of Oxford phase-3 medial unicompartmental knee arthroplasty. J Orthop Surg (Hong Kong) 2012; 20:157-61. [PMID: 22933670 DOI: 10.1177/230949901202000204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review medium-term results of 49 consecutive patients who underwent Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon. METHODS Records of 28 women (mean age, 71 years) and 21 men (mean age, 68 years) who underwent minimally invasive Oxford phase-3 medial unicompartmental knee arthroplasty by a single surgeon were retrospectively reviewed. The Oxford knee score and visual analogue scale (VAS) scores for pain and satisfaction were assessed at the latest follow-up by an independent observer, as were postoperative radiographs for implant position, osteoarthritic changes in the non-replaced compartments, and radiolucent lines of >2 mm or implant subsidence. The survival rate was calculated using Kaplan-Meier survival analysis. Patient demographics, postoperative alignment (varus/ valgus), Oxford knee scores, and the progression of osteoarthritis in the other compartments were included in a multiple logistic regression (MLR) analysis to identify significant factors affecting the probability of being satisfied (VAS scores for satisfaction of ≤2). RESULTS The mean follow-up duration was 7.2 years. No patient was lost to follow-up. Two patients with no knee symptoms died (unrelated to surgery) before the 5-year follow-up. The cumulative survival rate at the 9-year follow-up was 91.2% (95% confidence interval, 87.6-94.5%). There were 4 early failures (before 4 years). One patient early in the series developed avascular necrosis of the lateral femoral condyle with an over-corrected tibiofemoral valgus of 12º at 8 months; the other 3 complained of anterior knee pain, without signs of osteoarthritis. All 4 patients underwent revision with total knee arthroplasty. There were 43 patients with more than 5 years of follow-up and without revision of the prosthesis. Patients who were not satisfied (n=6) were more likely to be <65 years old (n=4, adjusted odds ratio [OR], 3.1; MLR p=0.002) and male (n=4; adjusted OR, 2.3; MLR p=0.02). Six of the 43 patients had lucent lines on radiographs, all of which were partial and under the tibial component. Progression of the arthritis in the patellofemoral and/or lateral compartments was worse in 5 patients. CONCLUSION Careful patient selection and good surgical technique contributed to good outcome. Younger male patients should be counselled regarding the higher chance of limited satisfaction.
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Affiliation(s)
- Nicholas David Clement
- Department of Orthopaedics and Trauma, Borders General Hospital, Melrose, United Kingdom.
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