|
1
|
Alsheikh KA, Almahayni AO, Alqaseer SM, Alotaibi WS, Aljaafri ZA. Unusual presentation of polyethylene tibial fracture in a polio patient: a case report. J Surg Case Rep 2025; 2025:rjaf084. [PMID: 40007562 PMCID: PMC11851475 DOI: 10.1093/jscr/rjaf084] [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: 10/11/2024] [Accepted: 02/06/2025] [Indexed: 02/27/2025] Open
Abstract
The concept of posterior cruciate ligament (PCL)-substituting total knee prostheses has been widely used for total knee arthroplasty (TKA). This design provides better femoral rollback with knee flexion, as it permits more stability under flexion by preventing tibial posterior subluxation. Here, we report a case of an unusual presentation of polyethylene tibial post fracture in a polio patient. Our patient had a history of staged bilateral TKA five years prior to the new presentation. Once the diagnosis was confirmed, the patient was admitted electively for TKA revision and polyethylene exchange. The procedure went well and without complications, and the patient was satisfied upon follow-ups in the clinic.
Collapse
Affiliation(s)
- Khalid A Alsheikh
- Department of Orthopedic Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah O Almahayni
- Department of Orthopedic Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Sumaia M Alqaseer
- Department of Orthopedic Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Wafa S Alotaibi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziad A Aljaafri
- Department of Orthopedic Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
|
2
|
Baek JH, Lee SC, Ryu S, Nam CH. Tibial Post Refracture in Posterior-Stabilized Total Knee Arthroplasty Following Isolated Tibial Insert Exchange. Arthroplast Today 2022; 19:101075. [PMID: 36605495 PMCID: PMC9807858 DOI: 10.1016/j.artd.2022.101075] [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: 08/22/2022] [Revised: 10/28/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
Background We report 4 cases with a tibial post refracture following isolated tibial insert exchange in posterior-stabilized total knee arthroplasty at a single center. Methods In our institution, 27 cases (26 patients) underwent reoperation due to tibial post fracture in posterior-stabilized total knee arthroplasty between July 2008 and November 2020. Of these 27 cases, 4 (4 patients) tibial post refractures occurred at a mean follow-up period of 9.1 years. Results All 4 cases of tibial post refracture occurred in a group of 21 cases with isolated tibial insert exchange. There was no tibial post refracture in patients with a tibial revision surgery. The incidence of this complication following isolated tibial insert exchange was 19.0%. The mean elapsed time from tibial insert exchange to the diagnosis of a post refracture was 2.5 years (range: 1.1-6.6 years). Conclusions Isolated exchange of a tibial insert with excessive thickness as a treatment for tibial post fracture is associated with a high probability of tibial post refracture. The treatment method should be selected after a thorough analysis according to the cause of fracture. Level of evidence IV.
Collapse
Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Suengryol Ryu
- Department of Orthopaedic Surgery, Himnaera Hospital, Busan, Republic of Korea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea,Corresponding author. Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, Republic of Korea. Tel.: +82 2 3219 9229.
| |
Collapse
|
|
3
|
Baek JH, Lee SC, Choi K, Nam CH. High rate of tibial post-fracture in highly cross-linked polyethylene compared to conventional polyethylene in posterior-stabilized total knee arthroplasty at a minimum 12-year follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:4072-4077. [PMID: 35129642 DOI: 10.1007/s00167-022-06901-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to assess tibial post-fracture between highly cross-linked polyethylene (HXPE) and conventional polyethylene inserts in consecutive posterior-stabilized (PS) total knee arthroplasty (TKA) over a minimum 12-year follow-up period. METHODS Between January 2007 and June 2008, a consecutive series of 2446 primary TKAs was performed in 1478 patients at a single institution. The final cohort was classified into two groups (1559 in the HXPE group and 887 in the conventional group) based on the insert material used during the procedure. RESULTS The mean follow-up period was 13.1 years in the HXPE group and 13.4 years in the conventional group. All 16 cases of tibial post-fracture occurred in the HXPE group. This complication rate was 1.03%. The mean elapsed time from primary TKA to the diagnosis of post-fracture was 3.9 years (range 0.5-10.0 years). Ten cases required replacement with a thicker polyethylene insert, and six cases underwent tibial revision surgery. There were no cases of tibial post-fracture in the conventional group. CONCLUSION Tibial post-fracture is not a rare complication in PS TKA with HXPE. Therefore, the possibility of a tibial post-fracture should be considered if newly developed pain, acute subluxation, effusion, patellar clunking, or instability occurs in patients treated with PS Scorpio knee system TKA using an HXPE insert. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Ji-Hoon Baek
- Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Su Chan Lee
- Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Kyungwon Choi
- Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Chang Hyun Nam
- Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120 Sinmok-ro, Yangcheon-gu, Seoul, Republic of Korea.
| |
Collapse
|
|
4
|
Alkheraiji A, Borai S, Alfadhil R, AlJassir F. Traumatic fracture of the polyethylene tibial post and cone in a posterior-stabilized total knee arthroplasty: A case report. Int J Surg Case Rep 2022; 97:107437. [PMID: 35901551 PMCID: PMC9403208 DOI: 10.1016/j.ijscr.2022.107437] [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: 05/30/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Very few reports addressed polyethylene tibial post and cone fractures requiring revision surgery. Up to our knowledge, this particular pattern of wear, involving 2 fracture areas simultaneously, has not been previously described. CASE PRESENTATION A 70 year-old female developed a fracture involving both the tibial insert post and cone after a minor trauma after undergoing posterior-stabilized total knee replacement 4 years prior. CLINICAL DISCUSSION This unique pattern of wear may occur even after minor trauma. CONCLUSION We recommend having a low threshold to investigate minor trauma in this patient population, even years after undergoing primary knee arthroplasty.
Collapse
Affiliation(s)
- Abdulaziz Alkheraiji
- Department of Orthopedic Surgery, College of Medicine, AlMajmaah University, Saudi Arabia
| | - Sultana Borai
- Orthopedic Surgery Resident, King Saud University Medical City, Riyadh, Saudi Arabia,Corresponding author at: Orthopedic Department, King Saud University Medical City, Postal code 12372 Riyadh, Saudi Arabia.
| | - Rheema Alfadhil
- Orthopedic Surgery Resident, King Saud University Medical City, Riyadh, Saudi Arabia
| | | |
Collapse
|
|
5
|
Finite Element Analysis Contact Stresses on Tibiofemoral Joint and Post Polyethylene Components Used to Evaluated Predesign Knee Implant. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2022. [DOI: 10.4028/p-uv1qax] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
At the time of prayer, most Muslims kneel with fully extended limbs (between 150° and 165°). Meanwhile, incidents such as hyperflexion in total knee arthroplasty (TKA) implant outside their designated configuration can lead wear or fracture of the polyethylene component. In this study, polyethylene component of posterior-stabilized right knee joint implant have been developed to facilitate higher range of motion (ROM). Finite element analysis (FEA) was used to analyze contact stresses on the polyethylene component. FEA was used to simulate weight-bearing condition at 0°, 30°, 60°, 90°, 120°, and 150° of knee flexion. Modified polyethylene component results in better performance in terms of contact stresses, especially at 120° of knee flexion. Current result shows contact stresses above 120 MPa were measured at the posterior post polyethylene, when 4000 N force was applied. Minimum contact stress on the medial condyles was 630 KPa at 120° of knee flexion, while on the lateral condyles, the minimum contact stress was 250 KPa at 150° of knee flexion. With this finding, the current polyethylene component design is expected to accommodate deep knee flexion movement in daily activities and can reduce potential of wear or fracture of the polyethylene component during deep knee flexion.
Collapse
|
|
6
|
Bistolfi A, Giustra F, Bosco F, Faccenda C, Viotto M, Sabatini L, Berchialla P, Sciannameo V, Graziano E, Massè A. Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials. Knee Surg Sports Traumatol Arthrosc 2022; 30:3120-3130. [PMID: 35182171 PMCID: PMC9418273 DOI: 10.1007/s00167-022-06879-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool. RESULTS Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05). CONCLUSIONS There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Alessandro Bistolfi
- Orthopaedics and Traumatology, Ospedale Cardinal Massaia Asti, via Conte Verde 125, 14100 Asti, Italy
| | | | | | | | | | - Luigi Sabatini
- grid.432329.d0000 0004 1789 4477AO Città della Salute e della Scienza, Turin, Italy
| | - Paola Berchialla
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Veronica Sciannameo
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Eugenio Graziano
- Orthopaedics and Traumatology, Ospedale Cardinal Massaia Asti, via Conte Verde 125, 14100 Asti, Italy
| | - Alessandro Massè
- University of the Studies of Turin, Turin, Italy ,grid.432329.d0000 0004 1789 4477AO Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
|
7
|
Shu L, Sato T, Hua X, Sugita N. Comparison of Kinematics and Contact Mechanics in Normal Knee and Total Knee Replacements: A Computational Investigation. Ann Biomed Eng 2021; 49:2491-2502. [PMID: 34142278 DOI: 10.1007/s10439-021-02812-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
An objective of total knee replacement (TKR) is to restore the mechanical function of a normal knee. Joint kinematics and contact mechanics performance are two of the primary indices that indicate the success of TKR devices. The aim of this study was to compare the kinematics and contact mechanics of TKR and normal knee joints. An experimentally evaluated finite-element (FE) knee model was developed and used to investigate the performance of four TKR designs (fixed cruciate-retaining (CR), mobile CR, posterior-stabilized (PS), medial pivot design (MP)) and the normal knee joint during a gait cycle. The predicted kinematic results showed that the MP design presented similar kinematics to those of the normal knee joint and did not demonstrate paradoxical motion of the femur. A considerably larger contact area and lower contact pressure were found on the normal knee joint (1315 mm2, and 14.8 MPa, respectively) than on the TKRs, which was consistent with the previous in-vivo fluoroscopic investigation. The mobile CR and PS designs exhibited the smallest and greatest contact pressures of the four TKR designs, respectively. The results of the present study help to understand the kinematics and contact mechanics in the TKR during the gait cycle, and provide comprehensive information about the performance of the normal knee joint.
Collapse
Affiliation(s)
- Liming Shu
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.
| | | | - Xijin Hua
- Department of Engineering, Institute for Manufacturing, University of Cambridge, Cambridge, CB2 1PZ, UK
| | - Naohiko Sugita
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| |
Collapse
|
|
8
|
Lee JA, Koh YG, Kang KT. Effect of post-cam design on the kinematics and contact stress of posterior-stabilized total knee arthroplasty. Biomed Mater Eng 2021; 32:323-332. [PMID: 33967034 DOI: 10.3233/bme-201097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The post-cam mechanism in the posterior-stabilized (PS) implant plays an important role, such as durability and kinematic performances, in total knee arthroplasty (TKA). OBJECTIVE The purpose of this study was to evaluate the difference in the kinematics and contact stress of five post-cam designs, which are flat-and-flat, curve-and-curve (concave), curve-and-curve (concave and convex), helical, and asymmetrical post-cam designs, using three-dimensional finite element models. METHODS We designed the post-cam model with five different geometries. The kinematics, contact stress, and contact area were evaluated in the five post-cam designs under gait cycle loading conditions using the finite element method. RESULTS There were no differences in the contact stress and area on the tibial insert in all designs. The largest internal rotation was shown in the swing phase for the helical design, and the largest tibial posterior translation was observed for the curve-and-curve (concave) design. The curve-and-curve (concave) design showed the lowest contact stress and the largest posterior tibial translation during the gait cycle. CONCLUSIONS Considering the kinematics and contact stress, we found that the curve-and-curve (concave) design was more stable than other designs. From the results, we found the important factors of TKA implant considering stability and kinematics.
Collapse
Affiliation(s)
- Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, Republic of Korea
| |
Collapse
|
|
9
|
Marino D, Zelinski Z, Mesko D, Cochran J. Catastrophic Failures of the Tibial Post in a Bicruciate Substituting Total Knee Prosthesis. Arthroplast Today 2021; 8:231-236. [PMID: 33937464 PMCID: PMC8079333 DOI: 10.1016/j.artd.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 01/01/2023] Open
Abstract
Failure of the tibial post in a bicruciate substituting total knee prosthesis is a rare but catastrophic complication. The authors report 2 cases of a fracture of the polyethylene tibial post with subsequent episodes of knee subluxation. Prompt recognition and early revision of these complications are associated with a favorable early outcome.
Collapse
Affiliation(s)
- Dominic Marino
- Corresponding author. 2727 South Pennsylvania Avenue, Lansing, MI 48910, USA. Tel.: +1 518 744 9800.
| | | | | | | |
Collapse
|
|
10
|
Component breakage after total knee arthroplasty: a narrative review. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
11
|
Sobajima A, Okihara T, Moriyama S, Nishimura N, Osawa T, Miyamae K, Haniu H, Aoki K, Tanaka M, Usui Y, Sako KI, Kato H, Saito N. Multiwall Carbon Nanotube Composites as Artificial Joint Materials. ACS Biomater Sci Eng 2020; 6:7032-7040. [PMID: 33320600 DOI: 10.1021/acsbiomaterials.0c00916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Because ultrahigh-molecular-weight polyethylene (UHMWPE) is susceptible to frictional wear when used in sliding members of artificial joints, it is common practice to use cross-linked UHMWPE instead. However, cross-linked UHMWPE has low impact resistance; implant breakage has been reported in some cases. Hence, sliding members of artificial joints pose a major trade-off between wear resistance and impact resistance, which has not been resolved by any UHMWPE. On the other hand, multiwall carbon nanotubes (MWCNTs) are used in industrial products for reinforcement of polymeric materials but not used as biomaterials because of their unclear safety. In the present study, we attempted to solve this trade-off issue by complexing UHMWPE with MWCNTs. In addition, we assessed the safety of these composites for use in sliding members of artificial joints. The results showed the equivalence of MWCNT/UHMWPE composites to cross-linked UHMWPE in terms of wear resistance and to non-cross-linked UHMWPE in terms of impact resistance. In addition, all MWCNT/UHMWPE composites examined complied with the requirements of biosafety testing in accordance with the ISO10993-series specifications for implantable medical devices. Furthermore, because MWCNTs can occur alone in wear dust, MWCNTs in an amount of about 1.5 times that contained in the dust produced from 50 years of wear (in the worst case) were injected into rat knees, which were monitored for 26 weeks. Although mild inflammatory reactions occurred in the joints, the reactions soon became quiescent. In addition, the MWCNTs did not migrate to other organs. Furthermore, MWCNTs did not exhibit carcinogenicity when injected into the knees of mice genetically modified to spontaneously develop cancer. The MWCNT/UHMWPE composite is a new biomaterial expected to be safe for clinical applications in both total hip arthroplasty and total knee arthroplasty as the first sliding member of artificial joints to have both high wear resistance and high impact resistance.
Collapse
Affiliation(s)
- Atsushi Sobajima
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takumi Okihara
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama, Okayama 700-0082, Japan
| | - Shigeaki Moriyama
- Faculty of Engineering, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka 814-0133, Japan
| | - Naoyuki Nishimura
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takako Osawa
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Kazutaka Miyamae
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama, Okayama 700-0082, Japan
| | - Hisao Haniu
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kaoru Aoki
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Manabu Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-862, Japan
| | - Yuki Usui
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Ken-Ichi Sako
- Clinical Pharmacology Educational Center, Nihon Pharmaceutical University, 10281 Komuro, Ina, Kita-Adachi, Saitama 362-0806, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-862, Japan
| | - Naoto Saito
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| |
Collapse
|
|
12
|
Sequeira SB, Scott J, Novicoff W, Cui Q. Systematic review of the etiology behind patellar clunk syndrome. World J Orthop 2020; 11:184-196. [PMID: 32280608 PMCID: PMC7138860 DOI: 10.5312/wjo.v11.i3.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/24/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is one of the most successful operations performed worldwide today. Patellar clunk syndrome (PCS) is a postoperative complication that arises due to the development of a fibrous nodule along the undersurface of the quadriceps tendon. The current literature on PCS has not yet come to a consensus regarding its etiology. To date, this is the first study that analyzes the existing literature on PCS in order to generate a conclusion regarding its etiology. It is hypothesized that prosthesis design is the main component behind the development of PCS.
AIM To determine the etiology of PCS and its association with pre and post-operative characteristics of the prosthesis and native knee.
METHODS We conducted a systematic review according to the PRISMA guidelines by searching through PubMed, Cochrane, and Google Scholar from May-July 2018 for cases of PCS using search MeSH terms “patella OR patellar” AND “clunk” OR “catch” OR “crepitus”. The search included case series and clinical trials and excluded review articles, yielding 30 articles from the original search and 3 additional articles from reference lists. We extracted data upon the outcomes in patients afflicted with PCS to determine the etiology of PCS. We performed additional bias assessments to validate our search algorithm and results.
RESULTS Prosthesis design was the metric most frequently implicated in the incidence of PCS, though several other metrics were contributory toward its pathogenesis. Later prosthetic designs incorporate a reduced intercondylar box ratio and box width to reduce contact between the proximal patellar pole and the intercondylar box, thereby reducing incidence of PCS.
CONCLUSION The etiology of PCS is multifactorial, owing to the growing metrics that have associations with its incidence. This conclusion is validated by the significance of prosthesis design as the most likely parameter involved in developing PCS since different prosthesis designs are often the result of different parameters. Future studies should be directed at isolating individual prosthetic parameters of prosthesis designs in order to determine what permutation of parameters is most closely associated with the development of PCS.
Collapse
Affiliation(s)
- Sean Bertram Sequeira
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - James Scott
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Wendy Novicoff
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Quanjun Cui
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| |
Collapse
|
|
13
|
Hsu Y, Lin CH, Shu GHF, Hsieh TJ, Chen CKH. Fracture of the polyethylene tibial post in the posterior-stabilized total knee prosthesis: arthrographic and CT arthrographic diagnosis. Skeletal Radiol 2019; 48:1145-1148. [PMID: 30729263 DOI: 10.1007/s00256-019-03173-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 02/02/2023]
Abstract
Fracture of the polyethylene tibial post in the posterior-stabilized total knee prosthesis is often delayed in diagnosis due to its nonspecific symptoms and the radiolucent characteristic of polyethylene on conventional radiography. Therefore, the diagnosis is always established by arthroscopy. Notwithstanding recent advances in imaging modalities, we are presently aware of only two related case reports on MRI and even no reports about arthrographic or CT-arthrographic diagnosis of fractured tibial post. We hereby report a case of a 58-year-old female patient who developed recurrent knee pain during the third year after total knee arthroplasty. The displaced polyethylene tibial post was clearly outlined by administered contrast material in the posterior knee. Under the diagnosis of fracture of the tibial post, the patient underwent isolated replacement of the broken polyethylene insert. Her knee pain significantly improved after the operation.
Collapse
Affiliation(s)
- Yung Hsu
- Department of Medical Imaging, Chi Mei Medical Center, Yongkang, No. 901, Zhonghua Rd Yongkang District, Tainan City, 71004, Taiwan
| | - Chien-Hung Lin
- Department of Medical Imaging, Chi Mei Medical Center, Yongkang, No. 901, Zhonghua Rd Yongkang District, Tainan City, 71004, Taiwan
| | - Ginger H F Shu
- Department of Medical Imaging, Chi Mei Medical Center, Chiali, No. 606, Jialixing Xinghua Village, Jiali District, Tainan City, 72263, Taiwan
| | - Tsyh-Jyi Hsieh
- Department of Medical Imaging, Chi Mei Medical Center, Yongkang, No. 901, Zhonghua Rd Yongkang District, Tainan City, 71004, Taiwan
| | - Clement Kuen-Huang Chen
- Department of Medical Imaging, Chi Mei Medical Center, Yongkang, No. 901, Zhonghua Rd Yongkang District, Tainan City, 71004, Taiwan.
| |
Collapse
|
|
14
|
Tiwari V, Meshram P, Park CK, Bansal V, Kim TK. New mobile-bearing TKA with unique ball and socket post-cam mechanism offers similar function and stability with better prosthesis fit and gap balancing compared to an established fixed-bearing prosthesis. Knee Surg Sports Traumatol Arthrosc 2019; 27:2145-2154. [PMID: 30810785 DOI: 10.1007/s00167-019-05430-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A mobile-bearing (MB) posterior-stabilized total knee arthroplasty (TKA) system with ball and socket post-cam mechanism has been developed with the aims of better prosthesis fit and enhanced stability. However, the data are limited to compare its clinical outcomes with an already established fixed-bearing (FB) implant design. METHODS This is a prospective randomized study comparing 260 patients in the MB group and 133 patients in FB group with a minimum 2 years of follow-up. Intraoperative variables, post-operative functional outcomes and incidence of adverse events were compared. RESULTS MB group showed better prosthesis fit as the incidence of over-hang of femoral component at junction (medial: 1% vs. 5% and lateral: 2% vs 4%, p < 0.001) and trochlea (medial: 2% vs 30%, p = 0.042 and lateral: 13% vs 21%, p = 0.015) was less than FB group. MB group also showed better gap balancing as the incidence of medio-lateral gap difference more than 2 mm was less in flexion (2.3% vs. 16%, p < 0.001) and extension (3.1% vs. 9.8%, p = 0.005). Post-operative functional outcomes and incidence of adverse events showed no difference between the two groups at 2 years. CONCLUSIONS New MB design offers similar functional outcomes and stability along with better intraoperative prosthesis fit and gap balancing compared to an established fixed-bearing design. Hence, this new MB design could be an alternative prosthesis of choice for posterior-stabilized TKA. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Vivek Tiwari
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Prashant Meshram
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Chang Kyu Park
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Vivek Bansal
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Tae Kyun Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea. .,, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
|
15
|
Watanabe T, Aoki A, Hoshi K, Muneta T, Sekiya I, Koga H. Anterior Tibial Post Impingement During Stair Climbing: A Kinematic Analysis and Clinical Outcomes. J Arthroplasty 2019; 34:379-384. [PMID: 30473229 DOI: 10.1016/j.arth.2018.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/02/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anterior tibial post impingement during gait and stair ambulation was reported in knees with posterior-stabilized prostheses. However, the link between anterior post impingement and knee kinematics and between anterior post impingement and the clinical outcome has not been well investigated. Therefore, the purpose of this study was to assess the anterior impingement to clarify the relevant kinematics and clinical results including patient-reported outcomes. METHODS We analyzed 40 well-functioning knees in 20 patients with a posterior-stabilized prosthesis due to osteoarthritis and who were followed up for 2 years or more. Dynamic lateral radiographs during stair-climbing activity were analyzed using a shape-matching technique, and anterior post impingement and the clinical outcome were assessed. RESULTS Anterior impingement of the tibial post was observed in 13 knees (33%) during the latter half of the stance phase and at the beginning of the swing phase with the average implant flexion angle of -2.4°. Implant flexion was significantly smaller, while the femoral component was located more posterior in the impingement knees. The posterior tibial slope was significantly greater in the impingement group (6.7° ± 2.0°, 5.3° ± 1.9°, respectively; P = .041); however, no significant differences were demonstrated in anteroposterior laxity and patient-derived assessments. CONCLUSION To avoid anterior post impingement, the posterior tibial slope should be made at 5° or less. Femoral notch-anterior post articulation should be designed to have good congruency in order to act as an anterior stabilizer in the case of impingement at knee extension.
Collapse
Affiliation(s)
- Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akino Aoki
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashihiroshima-shi, Japan
| | - Kenji Hoshi
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Higashihiroshima-shi, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| |
Collapse
|
|
16
|
Sirimamilla A, Rimnac CM. Crack initiation from a clinically relevant notch in a highly-crosslinked UHMWPE subjected to static and cyclic loading. J Mech Behav Biomed Mater 2018; 91:366-372. [PMID: 30658250 DOI: 10.1016/j.jmbbm.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Crosslinked Ultra High Molecular Weight Polyethylene (UHMWPE), which is used as a bearing material in total joint replacement components, is subjected to static and cyclic loads in vivo. Resistance to crack initiation from a notch as a function of static and cyclic loads is not well understood for crosslinked UHMWPE. This study estimated the resistance of crosslinked UHMWPE (crosslinked with 100 kGy gamma radiation and remelted to extinguish free radicals) to crack initiation for a clinically relevant notch under both static and cyclic loading conditions. For cyclic loading, four frequencies were applied with a sine waveform and two frequencies were applied with a square waveform to independently estimate the effect of frequency and rate of loading on crack initiation. Crack initiation time and cycles to crack initiation were determined. Crack initiation time for fatigue loading conditions was substantially lower compared to static loading conditions. Crack initiation time decreased with an increase in test frequency. A square wave resulted in shorter crack initiation time compared to a sine wave. The results suggest that crosslinked UHMWPE is more resistant to crack initiation from a notch under static loading conditions compared to fatigue loading conditions.
Collapse
Affiliation(s)
- Abhi Sirimamilla
- Microsoft Hardware Group, One Microsoft Way, Redmond, WA 98052, United States.
| | - Clare M Rimnac
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, United States.
| |
Collapse
|
|
17
|
Koh YG, Nam JH, Kang KT. Effect of geometric variations on tibiofemoral surface and post-cam design of normal knee kinematics restoration. J Exp Orthop 2018; 5:53. [PMID: 30578465 PMCID: PMC6303222 DOI: 10.1186/s40634-018-0167-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Restoration of natural knee kinematics for a designed mechanism in knee implants is required to achieve full knee function in total knee arthroplasty (TKA). In different posterior-stabilized TKAs, there are wide variations in tibiofemoral surfaces and post-cam design. However, it is not known whether these design variations preserve natural knee kinematics. The purpose of this study was to determine the most appropriate tibiofemoral surface and post-cam designs to restore natural knee kinematics of the TKA. Methods A subject-specific finite element knee modal was used to evaluate tibiofemoral surface and post-cam design. Three different posts in convex, straight, and concave geometries were considered with a fixed circular cam design in this study. In addition, this post-cam design was applied to three different surface conformities for conforming, medial pivot, and subject anatomy mimetic tibiofemoral surfaces. We evaluated the femoral rollback, internal-external rotation, and quadriceps muscle force under a deep-knee-bend condition. Results The three different tibiofemoral conformities showed that the convex post provided the most natural-knee-like femoral rollback. This was also observed in internal rotation. In surface conformity, subject anatomy mimetic tibiofemoral surfaces showed the most natural -knee-like kinematics and quadriceps force. Conclusions This study confirmed that convex post design and subject anatomy mimetic tibiofemoral surfaces provided the most natural-knee-like kinematics. This study suggested that post-cam design and tibiofemoral surface conformity should be considered in conventional and customized TKA.
Collapse
Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
|
18
|
Angerame MR, Jennings JM, Dennis DA. Fracture of the insert cone of a polyethylene liner in a failed posterior-stabilized, rotating-platform total knee arthroplasty. Arthroplast Today 2018; 4:148-152. [PMID: 29896543 PMCID: PMC5994790 DOI: 10.1016/j.artd.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/05/2017] [Indexed: 11/01/2022] Open
Abstract
Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.
Collapse
Affiliation(s)
- Marc R. Angerame
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
| | - Jason M. Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
- Department of Biomedical Engineering, University of Denver, Denver, CO, USA
| | - Douglas A. Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
- Department of Biomedical Engineering, University of Denver, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
- Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO, USA
| |
Collapse
|
|
19
|
Tanaka Y, Nakamura S, Kuriyama S, Nishitani K, Ito H, Furu M, Watanabe M, Matsuda S. Medial tilting of the joint line in posterior stabilized total knee arthroplasty increases contact force and stress. Clin Biomech (Bristol, Avon) 2018; 53:54-59. [PMID: 29448081 DOI: 10.1016/j.clinbiomech.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/17/2017] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kinematically aligned total knee arthroplasty is based on the concept to represent the premorbid joint alignment with cruciate-retaining implants, characterized by medial tilt and internal rotation. However, kinematic and kinetic effects of kinematically aligned total knee arthroplasty with posterior-stabilized implants is unknown. The purpose of this study was to examine the effect of medial tilting of the joint line with posterior-stabilized implants. METHODS A mechanical alignment model, and medial tilt 3° and 5° models were constructed. Knee kinematics and contact forces were simulated using a musculoskeletal computer simulation model. Contact stresses on the tibiofemoral joint and the post area were then calculated using finite element analysis. FINDINGS From 0° to 120° of knee flexion, greater external rotation of the femoral component was observed in medial tilt models (-0.6°, 1.8° and 4.2° in mechanical alignment, medial tilt 3° and medial tilt 5° models, respectively). The peak contact stresses on the tibiofemoral joint and the post area at 120° of knee flexion were higher in medial tilt models. The peak contact stresses on the post area in medial tilt 3° and 5° models were 2.2 and 3.8 times greater than that in mechanical alignment model, respectively. INTERPRETATION Medial tilting of the joint line causes greater axial rotation even with posterior-stabilized implants, which can represent near-normal kinematics. However, medial tilting of the joint line in total knee arthroplasty with posterior-stabilized implants may have a higher risk for polyethylene wear at the tibiofemoral joint and post area, leading to subsequent component loosening.
Collapse
Affiliation(s)
- Yoshihisa Tanaka
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Mutsumi Watanabe
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
|
20
|
Watanabe T, Koga H, Horie M, Katagiri H, Sekiya I, Muneta T. Post-Cam Design and Contact Stress on Tibial Posts in Posterior-Stabilized Total Knee Prostheses: Comparison Between a Rounded and a Squared Design. J Arthroplasty 2017; 32:3757-3762. [PMID: 28780225 DOI: 10.1016/j.arth.2017.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The post-cam mechanism in posterior stabilized (PS) prostheses plays an important role in total knee arthroplasty (TKA). The purpose of this study is to clarify the difference of the contact stress on the tibial post between a rounded post-cam design and a squared design during deep knee flexion and at hyperextension using the three-dimensional (3D) finite element models. METHODS We created 2 types of 3D, finite element models of PS prostheses (types A and B), whose surfaces were identical except for the post-cam geometries: type A has a rounded post-cam design, while type B has a squared design. Both types have a similar curved-shape intercondylar notch of the femoral component. Stress distributions, peak contact stresses, and contact areas on the tibial posts at 90°, 120°, and 150° flexion with/without 10° tibial internal rotation and at 10° hyperextension were compared between the 2 models. RESULTS Type B demonstrated more concentrated stress distribution compared to type A. The peak contact stresses were similar in both groups during neutral flexion; however, the stresses were much higher in type B during flexion with 10° rotation and at hyperextension. The higher peak contact stresses corresponded to the smaller contact areas in the tibial post. CONCLUSION A rounded post-cam design demonstrated less stress concentration during flexion with rotation and at hyperextension compared with a squared design. The results would be useful for development of implant designs and prediction of the contact stress on the tibial post in PS total knee arthroplasty.
Collapse
Affiliation(s)
- Toshifumi Watanabe
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Katagiri
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
|
21
|
Frondlike Synovitis on MRI and Correlation With Polyethylene Surface Damage of Total Knee Arthroplasty. AJR Am J Roentgenol 2017; 209:W231-W237. [DOI: 10.2214/ajr.16.17443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
22
|
Long-Term Durability of Ceramic Tri-Condylar Knee Implants: A Minimum 15-Year Follow-Up. J Arthroplasty 2017; 32:1874-1879. [PMID: 28209274 DOI: 10.1016/j.arth.2017.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/25/2016] [Accepted: 01/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic bearings are not commonly used in total knee arthroplasty (TKA). So far, little information is available about whether long-term survivorship and good clinical outcomes can be ensured with ceramic knee implants. The purposes of the present study were to evaluate the clinical and radiological outcomes, and to assess the long-term durability of a ceramic tri-condylar implant. METHODS A total of 507 consecutive TKAs were carried out using a ceramic tri-condylar femoral implant. The posterior cruciate ligament was sacrificed, and all components were fixed with bone cement. Clinical outcomes were assessed retrospectively with the Knee Society scoring system. Kaplan-Meier survivorship was calculated to determine the cumulative survival rate. RESULTS One hundred sixty-seven knees (114 patients) were available for clinical outcomes. The average range of flexion improved from 118.1° preoperatively to 123.7° at a minimum 15-year follow-up (P < .001). The average Knee Society knee score improved from 39.1 to 92.8 (P < .001). The functional score also improved from 36.0 to 47.0 (P < .001). With revision for any surgery or radiographic failure as the end point, Kaplan-Meier survivorship at 15 years was 94.0%. With revision of any component as the end point, the corresponding survivorship was 96.2%. CONCLUSION Clinically, the postoperative knee flexion range and Knee Society scores were good after long-term follow-up. The survivorship of the ceramic knee implant was excellent over the 15-year follow-up, and long-term durability was achieved, making ceramic a promising alternative material for the femoral component in TKA.
Collapse
|
|
23
|
Tanaka Y, Nakamura S, Kuriyama S, Ito H, Furu M, Komistek RD, Matsuda S. How exactly can computer simulation predict the kinematics and contact status after TKA? Examination in individualized models. Clin Biomech (Bristol, Avon) 2016; 39:65-70. [PMID: 27690304 DOI: 10.1016/j.clinbiomech.2016.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unknown whether a computer simulation with simple models can estimate individual in vivo knee kinematics, although some complex models have predicted the knee kinematics. The purposes of this study are first, to validate the accuracy of the computer simulation with our developed model during a squatting activity in a weight-bearing deep knee bend and then, to analyze the contact area and the contact stress of the tri-condylar implants for individual patients. METHODS We compared the anteroposterior (AP) contact positions of medial and lateral condyles calculated by the computer simulation program with the positions measured from the fluoroscopic analysis for three implanted knees. Then the contact area and the stress including the third condyle were calculated individually using finite element (FE) analysis. FINDINGS The motion patterns were similar in the simulation program and the fluoroscopic surveillance. Our developed model could nearly estimate the individual in vivo knee kinematics. The mean and maximum differences of the AP contact positions were 1.0mm and 2.5mm, respectively. At 120° of knee flexion, the contact area at the third condyle was wider than the both condyles. The mean maximum contact stress at the third condyle was lower than the both condyles at 90° and 120° of knee flexion. INTERPRETATION Individual bone models are required to estimate in vivo knee kinematics in our simple model. The tri-condylar implant seems to be safe for deep flexion activities due to the wide contact area and low contact stress.
Collapse
Affiliation(s)
- Yoshihisa Tanaka
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
|
24
|
Ohno H, Murata M, Ozu S, Matsuoka N, Kawamura H, Iida H. Midterm outcomes of high-flexion total knee arthroplasty on Japanese lifestyle. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:527-532. [PMID: 27681375 PMCID: PMC6197585 DOI: 10.1016/j.aott.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 11/19/2022]
Abstract
Objective To evaluate the clinical outcomes after total knee arthroplasty (TKA) using the Genesis II posterior stabilized prosthesis with a high-flex insert during the mid-term follow-up and to assess its effect on the Japanese lifestyle. Materials and methods Fifty-three consecutive patients (8 men and 45 women) underwent primary TKA. The mean follow-up time was 76 months (5–9 years). Clinical results were assessed with the Japanese Orthopedic Association osteoarthritis knee rating score (JOA knee score), range of motion, and lifestyle changes. Results The postoperative JOA knee score improved significantly compared to the preoperative JOA knee score. The mean preoperative flexion range improved from 112° to 123° postoperatively (p < 0.05). Additionally, our findings showed that 39% of patients enjoyed a floor-sitting life preoperatively, but only 30% of patients enjoyed floor-sitting life postoperatively. Conclusion The postoperative range of knee motion and JOA knee score improved after TKA using the Genesis II posterior stabilized prosthesis with a high-flex insert, but the number of patients who enjoyed floor-sitting life decreased from 39% to 30% because of feelings of fear and discomfort. Level of Evidence: Level IV, Therapeutic study
Collapse
|
|
25
|
Ansari F, Lee T, Malito L, Martin A, Gunther SB, Harmsen S, Norris TR, Ries M, Van Citters D, Pruitt L. Analysis of severely fractured glenoid components: clinical consequences of biomechanics, design, and materials selection on implant performance. J Shoulder Elbow Surg 2016; 25:1041-50. [PMID: 26775748 DOI: 10.1016/j.jse.2015.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The longevity of total shoulder replacement is primarily limited by the performance of the ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid component in vivo. Variations in glenoid design (conformity, thickness), biomechanics (joint kinematics), and UHMWPE material selection (sterilization, cross-linking) distinguish total shoulder replacements from hip and knee arthroplasty devices. These variables can lead to severe mechanical failures, including gross fracture. METHODS Sixteen retrieved glenoids with severe fracture were analyzed. The explant cohort included 3 material groups (gamma-sterilized Hylamer; gamma-sterilized UHMWPE; and gas plasma-sterilized, remelted, highly cross-linked UHMWPE [HXL]) and a range of conformities (0- to 10-mm radial mismatch). Analysis included fractography (optical and scanning electron microscopy) and Fourier transform infrared spectroscopy for oxidative analysis. RESULTS Fracture primarily occurred along the exterior rim for all 16 explants. Fourier transform infrared analysis and fractography revealed significant oxidative embrittlement for all gamma-sterilized glenoids. Fatigue striations and internal flaws were evident on the fracture surface of the HXL glenoid, with little oxidation detected. CONCLUSIONS Fracture initiated at the external rim of all devices. Elevated oxidation levels and visible material distortion for representative gamma-sterilized conventional and Hylamer devices suggest oxidative embrittlement as a driving force for crack inception and subsequent fracture. Brittle fracture of theHXL glenoid resulted from a combination of elevated contact stress due to a nonconforming surface, an internal flaw, and reduced resistance to fatigue crack growth. This demonstrates that glenoid fracture associated with oxidation has not been eliminated with the advent of modern materials (HXL) in the shoulder domain. LEVEL OF EVIDENCE Basic Science Study; Implant Retrieval Study.
Collapse
Affiliation(s)
- Farzana Ansari
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA.
| | - Taylor Lee
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Louis Malito
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Audrey Martin
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Stephen B Gunther
- Department of Orthopaedic Surgery, Martha Jefferson Hospital, Charlottesville, CA, USA
| | - Samuel Harmsen
- San Francisco Shoulder, Elbow & Hand Clinic, San Francisco, CA, USA
| | - Tom R Norris
- San Francisco Shoulder, Elbow & Hand Clinic, San Francisco, CA, USA
| | - Mike Ries
- Tahoe Fracture and Orthopaedic Clinic, Carson City, NV, USA
| | | | - Lisa Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| |
Collapse
|
|
26
|
Wernle JD, Mimnaugh KD, Rufner AS, Popoola OO, Argenson JN, Kelly M. Grafted Vitamin-E UHMWPE may increase the durability of posterior stabilized and constrained condylar total knee replacements. J Biomed Mater Res B Appl Biomater 2016; 105:1789-1798. [PMID: 27192378 DOI: 10.1002/jbm.b.33710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/27/2015] [Accepted: 05/01/2016] [Indexed: 11/08/2022]
Abstract
The suitability of grafted vitamin-E highly crosslinked polyethylene (VE-HXPE) for use in posterior stabilized (PS) and constrained condylar knee (CCK) applications has not been explored. We hypothesized that VE-HXPE performs better than conventional and crosslinked polyethylene under clinically relevant conditions. PS tibial post fracture resistance under adverse shear loading conditions, CCK tibial post resistance to torsional fatigue, delamination resistance under high stress, and wear resistance were evaluated. Grafted VE-HXPE exhibits (1) 10% and 57% improved PS post fatigue strength compared to conventional PE (CPE) and remelted HXPE; (2) 45% improved CCK post fatigue strength compared to CPE; (3) Greater than 36× the delamination resistance of CPE; and (4) 96% and 73% wear reduction compared to CPE and HXPE. VE-HXPE performed well under clinically relevant in vitro conditions. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1789-1798, 2017.
Collapse
Affiliation(s)
| | | | | | | | - Jean-Noel Argenson
- Center for Arthritis Surgery, Hospital Sainte-Marguerite, Aix-Marseille University, Marseille, France
| | - Michael Kelly
- Hackensack University Medical Center, Hackensack, New Jersey
| |
Collapse
|
|
27
|
MRI of Polyethylene Tibial Inserts in Total Knee Arthroplasty: Normal and Abnormal Appearances. AJR Am J Roentgenol 2016; 206:1264-71. [PMID: 26999729 DOI: 10.2214/ajr.15.15107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the normal and abnormal MRI appearances of polyethylene tibial inserts. Subjects who underwent MRI before revision total knee arthroplasty were identified. The polyethylene tibial insert's shape was categorized on MRI, and the presence of abnormalities was noted. CONCLUSION The shape of the polyethylene tibial insert varied with the design. Polyethylene tibial insert abnormalities seen on MRI included displacement and fracture. MRI distinguishes various designs of polyethylene tibial inserts and can show associated abnormalities.
Collapse
|
|
28
|
Functional Outcomes of a New Mobile-Bearing Ultra-Congruent TKA System: Comparison With the Posterior Stabilized System. J Arthroplasty 2015; 30:2137-42. [PMID: 26187388 DOI: 10.1016/j.arth.2015.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 02/01/2023] Open
Abstract
We determined whether a new mobile-bearing ultra-congruent (UC) TKA system provides better functional outcomes than an established posterior-stabilized (PS) prosthesis. The functional outcomes (motion arc, AKS scores, WOMAC Index, and SForm-36 scores evaluated at 1 and 2 years postoperatively), satisfaction and incidences of adverse events were compared between the knees implanted with mobile-bearing UC prosthesis (n=103) and the mobile-bearing PS prosthesis (n=99). At 2 years, mobile-bearing UC TKAs showed similar functional outcomes and satisfaction, but smaller motion arc compared to mobile-bearing PS TKAs (126° vs. 131°). There were no differences in the incidence of adverse events. Mobile-bearing UC prosthesis can be considered a safe and viable alternative to the PS design, with an expectation of smaller postoperative maximum flexion.
Collapse
|
|
29
|
Kim YH, Park JW, Kim JS, Lee JH. Highly Crosslinked-remelted versus Less-crosslinked Polyethylene in Posterior Cruciate-retaining TKAs in the Same Patients. Clin Orthop Relat Res 2015; 473:3588-94. [PMID: 26115866 PMCID: PMC4586214 DOI: 10.1007/s11999-015-4425-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/19/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concern regarding osteolysis attributable to polyethylene wear after TKA, particularly in younger patients, has prompted the introduction of highly crosslinked-remelted polyethylene (HXLPE) for TKAs. However, few in vivo comparative results of TKAs using HXLPE and less-crosslinked polyethylene inserts in the same patients are available, regarding fracture or failure of the locking mechanism of tibial polyethylene inserts or of osteolysis in patients younger than 60 years. QUESTIONS/PURPOSES We wanted to determine whether (1) survivorship free from aseptic loosening in knees with HXLPE inserts was different from survivorship in knees with less-crosslinked polyethylene inserts, (2) the prevalence of fracture or failure of the locking mechanism of the tibial polyethylene insert was greater in knees with HXLPE than in those with less-crosslinked polyethylene, and (3) the proportion of patients who had osteolysis develop was greater with HXLPE than with less-crosslinked polyethylene inserts. METHODS One hundred seventy-one patients with a mean age of 58 ± 8 years (range, 35-59 years) received posterior cruciate-retaining prostheses with a less-crosslinked polyethylene tibial insert in one knee and a HXLPE tibial insert in the contralateral knee. From January 2007 to January 2010, we performed 366 same-day bilateral simultaneous sequential posterior cruciate-retaining TKAs in 183 patients, of whom 171 (93%) participated in this study. All patients during this study period underwent posterior cruciate-retaining TKAs regardless of deformity of the knees and we did not perform posterior-stabilized TKAs during the same period. Patients who had bilateral end-stage osteoarthritis and were younger than 60 years were selected for inclusion. Six patients (4%) were lost to followup before 5 years. Twenty-six patients were males and 145 were females. The mean duration of followup was 6 years (range, 5-8 years). At each followup, patients were assessed for loosening of the components, fracture or failure of the locking mechanism of the polyethylene inserts, or osteolysis. RESULTS The survival rate of the knee prosthesis at a mean of 5.8 years after surgery was 100% (95% CI, 0.95-1.00) in both groups for the endpoint aseptic loosening and 99.4% (95% CI, 0.95-1.00) in both groups for the endpoint revision. No knee in either group had fracture or failure of the locking mechanism of the tibial polyethylene insert, and none had osteolysis. CONCLUSIONS With the numbers available, we found no clinically important differences between HXLPE and less-crosslinked polyethylene inserts in posterior cruciate-retaining TKAs. Given that HXLPE is newer, as-yet unproven, and more expensive than the proven technology (less-crosslinked polyethylene), we suggest not adopting HXLPE for clinical use until it shows superiority. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, MokDong Hospital, Ewha Womans University School of Medicine, 911-1, MokDong, YangChun-Ku, Seoul, 158-710, Republic of Korea.
| | - Jang-Won Park
- The Joint Replacement Center, MokDong Hospital, Ewha Womans University School of Medicine, 911-1, MokDong, YangChun-Ku, Seoul, 158-710, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, MokDong Hospital, Ewha Womans University School of Medicine, 911-1, MokDong, YangChun-Ku, Seoul, 158-710, Republic of Korea
| | - June-Hyung Lee
- The Joint Replacement Center, MokDong Hospital, Ewha Womans University School of Medicine, 911-1, MokDong, YangChun-Ku, Seoul, 158-710, Republic of Korea
| |
Collapse
|
|
30
|
Nakamura S, Sharma A, Nakamura K, Ikeda N, Kawai J, Zingde SM, Komistek RD. In vivo kinematic effects of ball and socket third condyle as a post-cam mechanism in tri-condylar knee implants. Knee 2015; 22:237-42. [PMID: 25835265 DOI: 10.1016/j.knee.2015.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tri-condylar implants containing a ball and socket third condyle as a post-cam mechanism were developed to accommodate a lifestyle requiring frequent deep flexion activities. The purpose of the current study was to examine the kinematic effects of the ball and socket third condyle during a deep knee bend activity, and to confirm the contact status of the ball and socket joint. METHODS Seventeen knees implanted with tri-condylar implants were analyzed using a 3D to 2D registration approach. A distance of less than 1mm denoted ball and socket contact. Medial and lateral contact positions and axial rotation were compared before and after contact. Moreover, the contact position at the third condyle and the center of the ball joint were analyzed. RESULTS After the third condyle contact, posterior translation of the medial and lateral contact positions increased considerably. Meanwhile, the angular rotation remained still. The center of the third condyle did not move after contact, and the contact position at the third condyle remained low. CONCLUSIONS The third condyle induced intensive posterior translation of both condyles, and did not prevent axial rotation, which was proved to work properly as a posterior stabilizing post-cam mechanism.
Collapse
Affiliation(s)
- Shinichiro Nakamura
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
| | - Adrija Sharma
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
| | - Kenji Nakamura
- Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan
| | - Noboru Ikeda
- Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan
| | - Jun Kawai
- Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan
| | - Sumesh M Zingde
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
|
31
|
Renner L, Faschingbauer M, Boettner F. Is there a rationale to use highly cross-linked polyethylene in posterior-stabilized total knee arthroplasty? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:63. [PMID: 25992362 DOI: 10.3978/j.issn.2305-5839.2015.01.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa Renner
- Hospital for Special Surgery, New York, NY 10021, USA
| | | | | |
Collapse
|
|
32
|
Pianigiani S, Scheys L, Labey L, Pascale W, Innocenti B. Biomechanical analysis of the post-cam mechanism in a TKA: comparison between conventional and semi-constrained insert designs. Int Biomech 2015. [DOI: 10.1080/23335432.2015.1014849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|
|
33
|
Kumar N, Yadav C, Raj R, Yadav S. Fracture of the polyethylene tibial post in a posterior stabilized knee prosthesis: A case report and review of literature. J Orthop 2015; 12:160-3. [PMID: 26236121 DOI: 10.1016/j.jor.2015.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022] Open
Abstract
We report a case of fracture of tibial polyethylene post fracture from base in a 56 year old lady 10 years from posterior stabilized total knee arthroplasty following trivial trauma. There have been signs of wear at the base especially anteriorly. After revision of tibial polyethylene component patient developed complete relief of symptom.
Collapse
Affiliation(s)
- Nishikant Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrashekhar Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Raj
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
34
|
Fracture of the polyethylene tibial post in a Scorpio SuperFlex posterior-stabilized knee arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
|
35
|
Can post-cam function be replaced by addition of a third condyle in PS TKA? J Arthroplasty 2014; 29:1871-6. [PMID: 24890996 DOI: 10.1016/j.arth.2014.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of the study was to analyze the effectiveness of an additional ball and socket articulation in implanted knees and whether it can replicate post-cam function. Fifteen knees implanted with a cruciate substituting (CS) polyethylene without a post and ten knees implanted with a posterior stabilized (PS) polyethylene with a post were analyzed using 3D model fitting approach. Two types of designs showed similar posterior translation and similar axial rotation. Most of the contact points at the ball and socket joint stayed within the socket height for the PS group. This study indicates that the ball and socket joint is able to function as a replacement of the post-cam mechanism, which might serve as a new way to achieve posterior stability.
Collapse
|
|
36
|
A prospective, randomized comparison of posterior stabilized versus cruciate-substituting total knee arthroplasty: a preliminary report with minimum 2-year results. J Arthroplasty 2014; 29:179-81. [PMID: 25047457 DOI: 10.1016/j.arth.2014.03.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 02/19/2014] [Accepted: 03/14/2014] [Indexed: 02/01/2023] Open
Abstract
We compared 56 patients who received a PS post/cam tibial insert and 55 patients who received a more congruent anterior-lipped tibial insert. We hypothesized that clinical outcomes would be equivalent and that tourniquet time and intraoperative blood loss would differ. The mean follow-up is 45 months (30-57 months). Clinical and radiographic outcomes were equivalent for both groups, except that male PS patients received significantly more transfusions than male CS patients (P<.039) and tourniquet time was significantly longer for all patients in the PS group (P<.015). At the minimum 2-year follow-up in this ongoing study, the results demonstrate equivalent functional and radiographic outcomes of the 2 devices, and significant differences in the perioperative findings of transfusion rates and tourniquet times.
Collapse
|
|
37
|
|
|
38
|
Li N, Tan Y, Deng Y, Chen L. Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2014; 22:556-64. [PMID: 23117166 DOI: 10.1007/s00167-012-2275-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 10/22/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the outcomes between posterior cruciate-retaining and posterior stabilized total knee arthroplasty (TKA) in order to evaluate which approach is superior. METHODS Randomized controlled trials (RCTs) comparing posterior cruciate-retaining with posterior stabilized TKA were reviewed which were published up to August 2011. Methodological quality of each included RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale. The relevant data were analysed using Review Manager 5.1. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. RESULTS Eight RCTs involving 888 patients with 963 knee joints met predetermined inclusion criteria. The postoperative range of motion (ROM) and flexion angle were 11.07° and 2.88° higher for patients with a posterior stabilized TKA than those with a posterior cruciate-retaining TKA, respectively [weighted mean difference (WMD), -11.07; 95% confidence interval (CI), -18.06 to -4.08; p < 0.01 and WMD, -2.88; 95% CI, -5.63 to -0.12; p = 0.04]. No statistical differences were observed between the two designs for knee society pain score, extension angle, 2- and 5-year knee society score, 2- and 5-year knee society function score and complications after primary TKA. CONCLUSION Posterior cruciate-retaining and posterior stabilized TKA have similar clinical outcomes with regard to knee function, postoperative knee pain and the other complications. Prosthesis survivorship for both posterior cruciate-retaining and posterior stabilized TKA is satisfactory, and there are no differences between them at short- and middle-term follow-up. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Ning Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | | | | |
Collapse
|
|
39
|
Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure. Case Rep Orthop 2014; 2014:896348. [PMID: 24587928 PMCID: PMC3920922 DOI: 10.1155/2014/896348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022] Open
Abstract
This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.
Collapse
|
|
40
|
Yoon JR, Jeong HI, Oh KJ, Yang JH. Bilateral condyle fracture of tibial insert in mobile bearing total knee arthroplasty. Knee 2014; 21:318-21. [PMID: 23340095 DOI: 10.1016/j.knee.2012.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 12/04/2012] [Accepted: 12/26/2012] [Indexed: 02/02/2023]
Abstract
We report a case of polyethylene insert breakage in a 45-year-old man after 3.5 years of cruciate retaining type mobile bearing total knee arthroplasty (TKA). Interstingly, both condyles of the polyethylene insert have fractured. The visual assessment done by stereoscopic microscope in the investigation report suggested that the fracture propagation was a result of cyclic loading and that the fracture was from the articular surface as a result of tibio-femoral and anteroposterior shear loading. The initial flexion-extension gap mismatch and/or specific Asian habits like kneeling or deep knee bending could have been the possible factors for over-stress for the insert causing this complication. After replacement of the broken insert and modification for daily activity preventing deep knee flexion, the patient obtained complete relief of previous symptoms. It remains unclear whether insert breakage was secondary to polyethylene insufficient design or to the polyethylene material fracture propagation.
Collapse
Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | | | - Kwang-Jun Oh
- Department of Orthopedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hyuk Yang
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
|
41
|
Ansari F, Chang J, Huddleston J, Van Citters D, Ries M, Pruitt L. Fractography and oxidative analysis of gamma inert sterilized posterior-stabilized tibial insert post fractures: report of two cases. Knee 2013; 20:609-13. [PMID: 24220187 DOI: 10.1016/j.knee.2013.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/30/2013] [Accepted: 04/04/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) has shown success in reducing wear in hip arthroplasty but there remains skepticism about its use in Total Knee Replacement (TKR) inserts that are known to experience fatigue loading and higher local cyclic contact stresses. METHODS Two Legacy Posterior-Stabilized (LPS) Zimmer NexGen tibial implants sterilized by gamma irradiation in an inert environment with posts that fractured in vivo were analyzed. Failure mechanisms were determined using optical and scanning electron microscopy along with oxidative analysis via Fourier Transform Infra-Red (FTIR) spectroscopy. RESULTS Micrographs of one retrieval revealed fatigue crack initiation on opposite sides of the post and quasi-brittle micromechanisms of crack propagation. FTIR of this retrieval revealed no oxidation. The fracture surface image of the second retrieval indicated a brittle fracture process and FTIR revealed oxidation in the explant. CONCLUSIONS These two cases suggest that crosslinking of UHMWPE as a manufacturing process or sterilization method in conjunction with designs that incorporate high stress concentrations, such as the tibial post, may reduce material strength. Moreover, free radicals generated from ionizing radiation can render the polymer susceptible to oxidative embrittlement. CLINICAL RELEVANCE Our findings suggest that tibial post fractures may be the results of in vivo oxidation and low level crosslinking. These and previous reports of fractured crosslinked UHMWPE devices implores caution when used with high stress concentrations, particularly when considering the potential for in vivo oxidation in TKR.
Collapse
Affiliation(s)
- Farzana Ansari
- University of California, Berkeley, Berkeley, California, 2521 Hearst Avenue, Etcheverry Hall Rm#2121, Berkeley, CA 94709, United States.
| | | | | | | | | | | |
Collapse
|
|
42
|
Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC. Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2013; 21:2850-9. [PMID: 23111827 DOI: 10.1007/s00167-012-2265-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study is to investigate whether the preservation of the posterior cruciate ligament (PCL) can be helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing total knee arthroplasty (TKA). METHODS Ninety osteoarthritic knees were randomly allocated to either the PCL-preserving group or the PCL-sacrificing group. Passive kinematics was recorded with a navigation system immediately after implantation. Three parameters (anterior/posterior translation, varus/valgus rotation, and internal/external rotation) were analysed from 0° to 120° flexion. RESULTS The PCL-preserving group (42 knees) had more varus rotation over 90° flexion (p < 0.05) and more anterior translation of the femur in all ranges of flexion (p < 0.05) than those in the PCL-sacrificing group (44 knees). There was no difference in the internal/external rotation (p > 0.05). The range of motion, functional scores, and radiographic results did not significantly differ between the two groups at the final follow-up. Three knees in the PCL-preserving group were revised: two presented with instability caused by traumatic attenuation of the PCL and one with subluxation of the insert due to a tight PCL. CONCLUSION The preservation of the PCL was not helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing TKA.
Collapse
Affiliation(s)
- Yoon Whan Roh
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 110-744, Korea,
| | | | | | | | | | | | | | | |
Collapse
|
|
43
|
Niki Y, Takeda Y, Udagawa K, Enomoto H, Toyama Y, Suda Y. Is greater than 145{degrees} of deep knee flexion under weight-bearing conditions safe after total knee arthroplasty?: a fluoroscopic analysis of Japanese-style deep knee flexion. Bone Joint J 2013; 95-B:782-7. [PMID: 23723272 DOI: 10.1302/0301-620x.95b6.30757] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the characteristics of patients who achieved Japanese-style deep flexion (seiza-sitting) after total knee replacement (TKR) and measured three-dimensional positioning and the contact positions of the femoral and tibial components. Seiza-sitting was achieved after surgery by 23 patients (29 knees) of a series of 463 TKRs in 341 patients. Pre-operatively most of these patients were capable of seiza-sitting, had a lower body mass index and a favourable attitude towards the Japanese lifestyle (27 of 29 knees). According to two-/three-dimensional image registration analysis in the seiza-sitting position, flexion, varus and internal rotation angles of the tibial component relative to the femoral component had means of 148° (SD 8.0), 1.9° (SD 3.2) and 13.4° (SD 5.9), respectively. Femoral surface contact positions tended to be close to the posterior edge of the tibial polyethylene insert, particularly in the lateral compartment, but only 8.3% (two of 24) of knees showed femoral subluxation over the posterior edge. The mean contact positions of the femoral cam on the tibial post were located 7.8 mm (sd 1.5) proximal to the lowest point of the polyethylene surface and 5.5 mm (SD 0.9) medial to the centre of the post, indicating that the post-cam contact position translated medially during seiza-sitting, but not proximally. Collectively, the seiza-sitting position seems safe against component dislocation, but the risks of posterior edge loading and breakage of the tibial polyethylene post remain.
Collapse
Affiliation(s)
- Y Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | | | | | | | | | | |
Collapse
|
|
44
|
Paterson NR, Teeter MG, MacDonald SJ, McCalden RW, Naudie DDR. The 2012 Mark Coventry award: a retrieval analysis of high flexion versus posterior-stabilized tibial inserts. Clin Orthop Relat Res 2013; 471:56-63. [PMID: 22661024 PMCID: PMC3528893 DOI: 10.1007/s11999-012-2387-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear. QUESTIONS/PURPOSES We therefore examined whether the design changes between HF and posterior-stabilized (PS) tibial inserts would affect overall damage or damage on their articular surface, backside, and tibial post and whether flexion angle achieved related to damage. METHODS We matched 20 retrieved HF inserts to 20 retrieved PS inserts from the same implant system on the basis of duration of implantation, body mass index, and age. Inserts were divided into 16 zones and a microscopic analysis of surface damage was carried out. Five inserts were scanned using micro-CT to further quantify instances of severe post notching. We determined overall damage with a scoring system. RESULTS We found greater backside and post damage in the HF group but no difference in the articular surface or overall damage scores. Backside and post damage scores correlated to flexion angle in the HF group. There was no flexion/damage correlation in the PS group. Notch depths around the post in both groups ranged from 0.6 to 1.9 mm. CONCLUSIONS HF inserts are more susceptible to post damage, possibly as a result of higher contact stresses from greater flexion. The increased backside damage was unexpected because the two groups have the same tibial component, locking mechanism, and sterilization method. CLINICAL RELEVANCE The introduction of a highly crosslinked HF insert will require close scrutiny as a result of the potential for post damage demonstrated in this series.
Collapse
Affiliation(s)
- Nicholas R. Paterson
- />Division of Orthopaedic Surgery, London Health Sciences Centre—University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Matthew G. Teeter
- />Imaging Research Laboratories, Robarts Research Institute, London, ON Canada
- />Department of Medical Biophysics, The University of Western Ontario, London, ON Canada
| | - Steven J. MacDonald
- />Division of Orthopaedic Surgery, London Health Sciences Centre—University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Richard W. McCalden
- />Division of Orthopaedic Surgery, London Health Sciences Centre—University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Douglas D. R. Naudie
- />Division of Orthopaedic Surgery, London Health Sciences Centre—University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| |
Collapse
|
|
45
|
Kwak JY, Jeong JH, Lee SH, Jung HJ, Jung YB. Comparison of the clinical outcomes after total knee arthroplasty with the LCS rotating platform mobile bearing knee system and the PFC Sigma RP-F mobile bearing knee system. Clin Orthop Surg 2012. [PMID: 23205234 PMCID: PMC3504689 DOI: 10.4055/cios.2012.4.4.256] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background We compared clinical outcomes after total knee arthroplasty with the Low Contact Stress (LCS) rotating platform mobile bearing knee system and the Press Fit Condylar Sigma rotating platform high flexion (PFC Sigma RP-F) mobile bearing knee system. Methods Fifty cases of total knee arthroplasty were performed with the PFC Sigma RP-F mobile bearing knee system and sixty-one cases were performed with the LCS mobile bearing total knee arthroplasty. The average duration of follow-up was 2.9 years. Results The mean Hospital for Special Surgery (HSS) knee score was 62.1 (range, 52 to 75) in the LCS group and 61.9 (range, 50 to 74) in the Sigma RP-F group preoperatively, and 90.1 (range, 84 to 100) in the LCS group and 89.8 (range, 83 to 100) in the Sigma RP-F group at the final follow-up. The mean preoperative flexion contracture was 6.7° (range, 0° to 10°) in the LCS group and 9.3° (range, 0° to 15°) in the Sigma RP-F group preoperatively. The mean range of motion was 124.6° (range, 105° to 150°) in the LCS group and 126.1° (range, 104° to 145°) in the Sigma RP-F group at the final follow-up. Conclusions After a minimum duration of follow-up of two years, we found no significant differences between the two groups with regard to the range of knee motion or the clinical or radiographic results.
Collapse
Affiliation(s)
- Ju-Yeong Kwak
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
|
46
|
Jones MA, Yousef A, Dhaliwal J, Kulkarni SS. Failures of the Dual Articular knee prosthesis due to fracture of the polyethylene post. Knee 2011; 18:428-31. [PMID: 21093271 DOI: 10.1016/j.knee.2010.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 07/28/2010] [Accepted: 08/09/2010] [Indexed: 02/02/2023]
Abstract
The Dual Articular (DA) total knee replacement was designed for revision and complex primary knee arthroplasty. A number of these knees failed due to fracture of the polyethylene post. We aimed to identify the proportion of DA prostheses that failed in this manner in our hospital. The hospital database was interrogated to identify all patients undergoing revision total knee replacement under the care of one surgeon from 1995 to 2007. Case notes were then reviewed to collect information about the history surrounding the knee surgery, and determine the patient's weight at the time of surgery. Telephone follow-up was carried out to obtain complete contemporary data. Forty-eight prostheses were implanted into 39 patients (21 male, 18 female). Thirty-two of the prostheses were DA and of these, 7 underwent arthroscopy or arthrotomy to reveal a fracture of the polyethylene post (22%). T-tests showed no statistical difference in age (p=0.73) or weight (p=0.79) between the group of DA patients with fractured posts and those without. Six of the 7 fractures were in male patients (Chi-squared; p=0.01). Patients complained of pain, clicking and instability at a mean of 7 years post-surgery. Sixteen DA2000 prostheses were implanted, but none of these had failed due to a fractured polyethylene post. A high proportion of DA prostheses failed due to post fracture. We recommend that patients with DA prostheses be kept under review to detect failures early. Pain, clicking and instability should be investigated with arthroscopy and the tibial insert exchanged as appropriate.
Collapse
Affiliation(s)
- M A Jones
- Department of Trauma and Orthopaedics, King's Mill Hospital, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, NG17 4JL, United Kingdom.
| | | | | | | |
Collapse
|
|
47
|
Medel FJ, Kurtz SM, Sharkey PF, Austin MS, Klein GR, Cohen AR, Patel H, Goldberg VM, Kraay MJ, Rimnac CM. Post damage in contemporary posterior-stabilized tibial inserts: influence of implant design and clinical relevance. J Arthroplasty 2011; 26:606-14. [PMID: 21575793 DOI: 10.1016/j.arth.2010.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 05/17/2010] [Indexed: 02/01/2023] Open
Abstract
The mechanisms of damage at the polyethylene post in 3 contemporary tibial insert designs were evaluated and compared with a historical standard (Insall-Burstein II; Zimmer, Warsaw, Ind). One hundred five gamma sterilized posterior-stabilized tibial inserts were revised after an average of 4.7 years (0.05-13.6 years). Retrievals were classified according to their designs: Insall-Burstein II (n = 28); PFC (Johnson & Johnson, Raynham, Mass; n = 30); NexGen (Zimmer; n = 32); and Scorpio (Stryker Orthopaedics, Mahwah, NJ; n = 15). Reasons for revision and patient details were available. Surface damage scoring and photogrammetry were performed on all the retrieved tibial inserts. Oxidation analysis was carried out for traceable historical, gamma air-sterilized and conventional, gamma inert-sterilized tibial inserts (n = 61) with the use of infrared spectroscopy. The posts for all 3 contemporary designs exhibited damage similar to the historical controls. Articular, post, and backside damage scores significantly increased with implantation time. Post damage was insensitive to design and patient factors but was exacerbated by oxidation. An association between damage at the post and articular surface was also confirmed. Logistic models suggested an interaction between post damage, backside surface damage, and implant loosening.
Collapse
Affiliation(s)
-
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, 3401 Market Street. Suite 300, Philadelphia, PA 19104, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Lachiewicz PF. How to treat a tibial post fracture in total knee arthroplasty? A systematic review. Clin Orthop Relat Res 2011; 469:1709-15. [PMID: 20963534 PMCID: PMC3094630 DOI: 10.1007/s11999-010-1609-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/21/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior-stabilized TKAs, which use a polyethylene tibial post to articulate against a metal femoral cam, are used regularly. Reported complications are related to the patellofemoral articulation or the tibial post-cam mechanism. Fracture of the tibial post is an uncommon but disabling complication after posterior-stabilized TKA that requires operative treatment. QUESTIONS/PURPOSES The literature was reviewed to determine the frequency of tibial post fracture and address three questions: (1) Is there a specific prosthetic design or patient demographics in knees with a fracture of the tibial post? (2) What are the common presenting complaints and methods of diagnosis? (3) What methods of treatment have been used? METHODS A PubMed search of English language articles from February 1982 to April 2010 was performed and 20 articles, all Level IV studies, were identified. RESULTS One specific design of posterior-stabilized tibial post with a central screw hole had a 12.4% incidence of fracture. Tibial post fracture has been reported with other designs, but with an incidence of 1% or less. The most common presenting symptoms include effusion, instability, or patella clunk syndrome. The most common method of diagnosis was clinical examination followed by arthroscopic examination. Treatment with revision to a new tibial polyethylene liner generally has been successful at short-term followup. CONCLUSIONS Tibial post fracture is a relatively uncommon complication after posterior-stabilized TKA that usually is treated successfully with liner exchange. The low quality of available literature makes it difficult to recommend a specific treatment protocol.
Collapse
Affiliation(s)
- Paul F. Lachiewicz
- Department of Surgery, Durham VA Medical Center, Durham, NC USA ,Department of Orthopaedic Surgery, Duke University, Durham, NC USA ,Chapel Hill Orthopedics Surgery and Sports Medicine, 101 Conner Drive, Suite 200, Chapel Hill, NC 27514 USA
| |
Collapse
|
|
49
|
Stoller AP, Johnson TS, Popoola OO, Humphrey SM, Blanchard CR. Highly crosslinked polyethylene in posterior-stabilized total knee arthroplasty: in vitro performance evaluation of wear, delamination, and tibial post durability. J Arthroplasty 2011; 26:483-91. [PMID: 20413249 DOI: 10.1016/j.arth.2010.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 02/21/2010] [Indexed: 02/01/2023] Open
Abstract
Recent advances in total knee arthroplasty (TKA) include the development of highly crosslinked polyethylene (HXPE). To assess the suitability of using HXPE in posterior-stabilized TKA, knee simulator wear testing and a novel tibial post durability test were performed on a modern posterior-stabilized implant design with both conventional polyethylene (CPE) and HXPE materials. The laboratory testing reproduced clinically relevant wear and tibial post damage mechanisms. For the designs tested, wear volume was reduced by 67% to 75% for aged HXPE compared with aged CPE. Components of HXPE also demonstrated superior tibial post durability compared with the CPE design, despite the use of unaged material to represent best-case CPE tibial post strength. With appropriate design considerations, HXPE can be successfully incorporated into a posterior-stabilized TKA.
Collapse
|
|
50
|
Huot JC, Van Citters DW, Currier JH, Currier BH, Mayor MB, Collier JP. Evaluating the suitability of highly cross-linked and remelted materials for use in posterior stabilized knees. J Biomed Mater Res B Appl Biomater 2010; 95:298-307. [DOI: 10.1002/jbm.b.31714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|