A compliant interface for total knee arthroplasty

Miegel, R. E.; Walker, Peter S.; Inadomi, John M.; Maxine, M.

doi:10.1002/jor.1100040412

Cited by 13 publications

(2 citation statements)

References 21 publications

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“…There are some studies in the literature which have specifically compared cruciate-retaining and cruciatesubstituting designs, 14,20,26,28 Nevertheless, the present study is sought to investigate if there was a difference in the clinical outcome as measured by the commonly-used scoring systems. 10 (International Knee Society Score, 31 Western Ontario McMasters Osteoarthritis (WOMAC) 32 index and the SF-36 health survey 33 survivorship, radiological outcome and a kinematic performance between cruciate retaining and cruciate-substituting arthroplasties with the same surface geometry.…”

Section: Introductionmentioning

confidence: 99%

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases

Saini¹,

Gautam²,

Mehta³

2020

IJOS

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The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) has been widely discussed in the orthopaedic literature. Theoretical and functional arguments and survivorship have all been used to support both its retention and its substitution. Moreover, with the advent of robotics and ever evoluting kinematic surgical procedures, the results for the cruciate-retaining arthroplasties are found to be more variable than for the cruciate substituting arthroplasties. The present study is sought to investigate if there was a difference in the clinical outcome as measured by the commonly-used scoring systems which includes (International Knee Society Score, Western Ontario McMasters Osteoarthritis (WOMAC) index and the SF-36 health survey along with the radiological scores and outcomes of the two procedures in TKA. Methodology and Results: We performed a prospective, randomized trial of 30 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior-cruciate-ligament substituting total knee arthroplasty. Statistical analysis was performed using the Student's t-test and ANOVA test for multiple trials. At follow-up at 3 months, no statistically significant differences were found in the clinical outcome measurements for either design. The results of the WOMAC 35 score which were subdivided into pain, stiffness and function showed high scores for cruciate substituting groups for pain as compared to the cruciate retaining groups whereas, other parameters were same in both the groups. For other systems including SF-36 and knee society score the results did not seem to vary to a great extent statistically. Conclusion: To conclude the present study found almost similar results for Cruciate ligament retaining and substituting procedures in long term follow up at 3 months, with slightly better outcomes for Cruciate ligament retaining groups at the earliest phases pre operatively and post operatively.

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Section: Introductionmentioning

confidence: 99%

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases

Saini¹,

Gautam²,

Mehta³

2020

IJOS

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“…9,10 Inlay plastic components were introduced to improve fixation and preserve peripheral bone, 11 although metal-backing is still expected to distribute the load more uniformly. 12 The interplay between these various factors in component fixation is still unclear. The hypothesis of our study was that even though plastic inlay tibial components require less bone resection and preserve stronger bone, the stresses and strains on the bone at the interface will be more favorable with metal-backed components and additionally, that all-plastic onlays will only be a small improvement over inlays.…”

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confidence: 99%

Comparison of Interface Stresses and Strains for Onlay and Inlay Unicompartmental Tibial Components

et al. 2011

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There are several types of designs used for unicompartmental tibial components. The all-plastic inlay component is recessed and it preserves bone around the outer edge of the tibia. For an onlay component, the entire condyle is resected, and the plastic bearing is usually metal-backed, although all-plastic components are also available. The purpose of this study was to investigate the hypothesis that while 6-mm inlay components require less bone removal, the peak stresses and strains at the surface of the bone will be much greater when compared with 8-mm metal-backed onlay components, and that all-plastic onlays will be only a slight advantage over inlays. Tibial models were generated using computed tomography (CT) scans, while typical inlay and onlay components were modeled. Finite element analyses of bones and components were completed by assigning material properties based on the CT scans and applying loads. Results indicated that plastic inlays generated 6 times more peak stress at the tibial surface when compared with metal-backed onlays. Moreover, models using inlay components produced strain values exceeding onlay components by a factor of 13.5 due to areas of softer bone at the interface. Off-center loading toward the anterior or posterior of the components produced similar results. The stresses and strains for the 8-mm all-plastic onlay were reduced compared with the inlay but still much higher than for the metal-backed onlay. These findings indicated that metal-backed onlays may be a better option when considering load distribution on the tibial surface.

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An investigation of a compliant interface for press‐fit joint replacement

Walker

Rodger

Miegel

et al. 1990

Journal Orthopaedic Research

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Earlier in vitro studies showed that a compliant layer between a metal surface and trabecular bone improved the load distribution. In this study, the behavior of a compliant layer of Dacron velour was investigated in vivo using a patella resurfacing in a sheep as a model. Bilateral cases were used to compare the velour interface with a direct metal-to-bone interface. For the metal patellas, a fibrous layer developed adjacent to the metal while the underlying bone formed a new subchondral-like layer. With the velour interface, fibrous tissue invaded the velour, followed later by bone, which sometimes reached the metal surface. For follow-ups of 8 months or more, the load across the interface was transferred over localised patches, for both the press-fit and velour interfaces. There was no significant difference in the areas of contact. There was evidence that this was due to the irregularity of the bony surface beneath the fibrous layer, or to bone nodules actually growing up to the metal. It was concluded that in this in vivo model, the velour layer did not retain a more uniform load distribution compared with the press-fit joint, due to the nature of the bone and fibrous tissue that formed at the interfaces.

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A compliant interface for total knee arthroplasty

Cited by 13 publications

References 21 publications

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases

Original Research Article Comparision of outcomes of posterior cruciate ligament substituting vs retaining in total knee arthroplasty-a prospective, randomised, open labelled study of 30 cases

Comparison of Interface Stresses and Strains for Onlay and Inlay Unicompartmental Tibial Components

An investigation of a compliant interface for press‐fit joint replacement

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