Doctor, What Does my Knee Arthroplasty Weigh?

Gibon, Emmanuel; Mouton, Antoine; Passeron, D.; Strat, Vincent Le; Graff, Wilfrid; Marmor, Simon

doi:10.1016/j.arth.2014.07.012

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…As a copolymer compound, in contrast to metals, the biomaterial PEEK has a range of properties superior to those of metals, including reduced allergenicity, lighter weight ( 27 ), greater fatigue and chemical resistance ( 28 ). The average amount of bone removed in a total knee arthroplasty is about 155 g, while the weight of a metal knee prosthesis with bone cement is about 430 g, so the weight gain of the knee joint after implantation of a metal joint is very significant ( 29 ). According to the data provided by the manufacturer, the weight of our prosthesis with bone cement is ~120 g. Attempts to use polymers for joint prostheses began in the 1980's, with Moore et al first pioneering attempts to use polyacetal (Delrin) for femoral prostheses ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial

Cai

Zhao

et al. 2022

Front. Surg.

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BackgroundTotal knee arthroplasty (TKA) is now frequently performed and is highly successful. However, patient satisfaction after TKA is often difficult to achieve. Because of the presence of metallic prosthetic knee joints, there is a lack of imaging tools that can accurately assess the patient's postoperative prosthetic position, soft tissue impingement, and periprosthetic bone density after TKA. We conducted a clinical trial of the world's first totally modular polyetheretherketone (PEEK) TKA and determined the bone density values in the stress concentration area around the prosthesis based on postoperative computed tomography data to reconstruct a three-dimensional model of the PEEK prosthetic knee joint after implantation. Based on the model, the overhang of the prosthesis was measured at various locations on the prosthesis.MethodsAll patients who underwent PEEK-based TKA were postoperatively assessed with radiography and computed tomography (CT). Hounsfield units (HUs) for the different components of the quantitative CT assessment were measured separately.ResultsTen patients (nine female and one male) aged 59–74 (mean 66.9, median 67) years were included. The HU values were as follows: PEEK prosthesis mean 182.95, standard deviation (SD) 4.90, coefficient of variation (CV) 2.68; polyethylene mean −89.41, SD 4.14, CV −4.63; lateral femoral osteochondral mean 192.19, SD 55.05, CV 28.64; lateral tibial osteochondral mean 122.94, SD 62.14, CV 42.86; medial femoral osteophyte mean 180.76, SD 43.48, CV 24.05; and medial tibial osteophyte mean 282.59, SD 69.28, CV 24.52. Analysis of the data at 1, 3, and 6 months showed that the mean PE (p = 0.598) and PEEK (p = 0.916) measurements did not change with the time of measurement. There was a decrease in bone mineral density in the lateral tibia at 3 months (p = 0.044). Otherwise, there was no significant change in bone density in other regions (p = 0.124–0.803). There was no overhang in all femoral prostheses, whereas there were two cases of overhang in tibial prostheses. Overhang measurements do not differ significantly across time points. The overhang measurements were not significantly different at all time points (p = 0.186–0.967).ConclusionPEEK knee joint prosthesis has excellent CT compatibility. The change in periprosthetic bone volume during the follow-up period can be determined using the HU value after CT scan, while the prosthesis position can be assessed. This assessment may potentially guide future improvements in knee prosthesis alignment techniques and artificial knee prosthesis designs.

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Section: Discussionmentioning

confidence: 99%

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial

Cai

Zhao

et al. 2022

Front. Surg.

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“…For now, the study targeting at Europeans showed that the weight gained on the knee ranged from 266.7 g to 380 g of patients after TKA, and for some patients, the weight of implants was six times higher than that of removed tissues during the procedure [10,11]. The large increase of knee joint weight after the procedure brought great challenges to the postoperative rehabilitation of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The development and manufacturing of medical implants that replace failed knee joint is of great importance for an aging population. Previous studies have shown that the influence of the implant design on functional outcomes found no significant difference, while, few reports focused on knee prosthesis weight [5][6][7]. It has been reported that changes in the weight of the knee joint are related to the prognosis [7].…”

Section: Introductionmentioning

confidence: 99%

Excised host tissues weight: New Indicators of Total Knee Arthroplasty Worthy of Attention

Zhu¹,

Ruan²,

Bai³

et al. 2020

Preprint

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Background: Knee osteoarthritis (KOA) is a crippling disease and affects many people around the world. Total knee arthroplasty (TKA) is an effective way to treat this disease. The objectaives of this study to compare the weight of the total knee arthroplasty implants and the weight of the natural knee in different groups and also to analyze facts which may affect the weight of surgical host excision. Methods: In total, 105 consecutive TKAs were enrolled in this prospective cohort study with three different brands of knee prostheses. Patients meeting the criterion were divided into the normal bone mass group, the osteopenia group or the osteoporosis group according to the results of preoperative bone density examination. The removal of bone and soft tissues that were collected during TKA operations of each group were weighed and compared with the total weight of the knee prosthesis (including implanted bone cement). Multivariate logistic stepwise regression analysis was conducted to identify indicators affecting host removal weight.Results: The average host removal weight was (132.56±36.88)g for normal bone mass group, (112.86±23.65)g for osteopenia group and (103.74±20.66)g for osteoporosis group. There were statically differences among the three groups. There was a significant difference between the normal bone mass group and the osteopenia group (P=0.003), while no difference between the osteopenia group and the osteoporosis group (P=0.154). No differences were found in the TKA components weight, bone cement weight and knee joint weight gained after TKA among all groups. Stepwise multiple regression analysis using the weight of excised host tissues as a dependent variable and BMD level, gender, age and other available indicators as independent variables revealed that BMD level(B=9.057, p=0.008), gender(B=21.692, p<0.001), Kellgren-Lawrence grade(B=13.790, p=0.003) are significant factors affecting excised host tissues weight. Conclusion: There is a positive correlation between the weight of the host removals of TKA and the patient's bone density. BMD level, gender and K-L stage of KOA were the main factors affecting the weight of the host removal.

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“…Holes along endoprosthesis crest are for muscle reattaching, such as rectus femoris which is important for hip function. Again, the main body should be divided into solid and porous structures in order to reduce endoprosthesis weight, guarantee endoprosthesis strength, and enhance bone ingrowth [28]. Previous studies have reported that porous structure with pore size of 300 to 800 μm and porosity of 70% can enhance bone ingrowth [29–33].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques

Wang

et al. 2019

J Orthop Surg Res

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BackgroundThis study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed custom-made endoprosthesis for hemipelvic tumorous bone defect.MethodsAccording to the pelvic tumor resection classification by Enneking and Dunham, the hemipelvis is divided into three zones including the ilium (P1), acetabulum (P2), and pubis and ischium (P3). Thirteen patients were included in this study. Of these, P1 and P2 were involved in three cases, while P1, P2, and P3 were involved in 10. Based on radiography data, 3D pelvic model was rebuilt, and virtual surgery was simulated. Different fixation methods were applied according to residual bone volume. Parameters of the first sacral (S1) vestibule, second sacral (S2) vestibule, the narrowest zone of superior pubic medullary cavity (NPSPMC), and the resected surface of superior pubic medullary cavity (RSSPMC) were selectively measured in various fixation methods. Model overlapping, feature simplifying, and size controlling were three basic steps during design procedure. Volume proportion of porous structure was determined according to estimated weight of resected specimen. Acetabular location, anteversion, and inclination were modulated. Screw diameter, direction, and combination were considered. The osteotomy guides and plastic models were used during surgery.ResultsOf 13 cases, after P1 resection, endoprostheses were fixed to sacra (8; 61.5%), ilia (3; 23.1%), and both (2; 15.4%). After P3 resection, endoprostheses were fixed to residual acetabulum (3; 23.1%), and residual pubis by stem (8; 61.5%) or “cap-like” structure (2; 15.4%). Mean area of the S1 vestibule, S2 vestibule, RSSPMC, and PSPMC were 327.9 (222.2 to 400), 131.7 (102.6 to 163.6), 200.5 (103.8 to 333.2), and 79.8 mm2 (40.4 to 126.2), respectively. Porous structure with 600 μm pore size and 70% porosity accounted for 68.8% (53.0 to 86.0) of the whole endoprosthesis on average. Mean acetabular anteversion and inclination were designed as 23.2° (20 to 25) and 42.4° (40 to 45). Median numbers of screws designed in the S1 vestibule was 5 (IQR, 4 to 6), in the S2 vestibule was 1 (IQR, 1 to 2), in the ilium was 5 (IQR, 2 to 6), and in the pubis was 1 (IQR, 1 to 1), while screws designed in the ischium was all 2. Median number of screws inserted in the S1 vestibule was 4 (IQR, 3 to 4), in the S2 vestibule was 1 (IQR, 1 to 1), in the ilium was 3 (IQR, 1 to 5), in the pubis was 1 (IQR, 0 to 1), and in the ischium was 1 (IQR, 1 to 1).ConclusionsThis study firstly presents detailed design and related surgical techniques of 3D-printed custom-made hemipelvic endoprosthesis reconstruction. Osseointegration is critical for long-term outcome and requires three design elements including interface connection, porous structure, and initial stability achieved by precise matching and proper fixation methods.

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Doctor, What Does my Knee Arthroplasty Weigh?

Cited by 13 publications

References 14 publications

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial

Excised host tissues weight: New Indicators of Total Knee Arthroplasty Worthy of Attention

Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques

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