The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.
The
relationship of the hierarchical organization of the skeleton
with the local electronic and atomic structure of bone is investigated.
The Ca 2p photoemission from intact and various arthritis-damaged
areas was measured and examined to study site-dependent peculiarities
of calcium bonds in subchondral femoral bone. The medial and lateral
condyles of the femur resected during total knee arthroplasty were
used as samples. The Ca 2p3/2,1/2
–1 photoelectron
spectra demonstrate the distinct hierarchy-induced deviations of calcium
bonds on the proximal side of the samples. It is shown that the apatite
calcium bonds dominate in intact area, whereas non-apatite bonds dominate
in OA-damaged areas, especially near sclerotic area but not inside
it. The site dependence is associated with the interaction of broken
collagen molecules with hydroxyapatite nanocrystallites at the cartilage–bone
interface. The interplay of biomechanical and biochemical processes
is examined, and the restoration of calcium bonds in sclerotic bone
is discussed.
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