Early migration of tibial components is associated with late revision

Pijls, Bart G; Valstar, Edward R.; Nouta, Klaas-Auke; Plevier, Josepha W.M.; Fiocco, Marta; Middeldorp, Saskia; Nelissen, Rob G H H

doi:10.3109/17453674.2012.747052

Cited by 164 publications

(132 citation statements)

References 105 publications

(119 reference statements)

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“…Tibial trays with larger initial inducible displacement have greater migration (Toksvig-Larsen et al, 1998; Uvehammer and Karrholm, 2001; Wilson et al, 2010) and excessive early migration has been correlated with an increased risk of tray loosening (Pijls et al, 2012). Loss of cement–bone interlock that occurs during in vivo service, and the relationship with increased cement–bone micro-motion, as found in the present study, could be responsible for the inducible displacements measured with RSA.…”

Section: Discussionmentioning

confidence: 99%

Increased initial cement–bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service

Miller

TerBush

Goodheart

et al. 2014

Journal of Biomechanics

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Aseptic loosening of cemented tibial components in total knee arthroplasty (TKA) has been related to inadequate cement penetration into the trabecular bone bed during implantation. Recent postmortem retrieval work has also shown there is loss of interlock between cement and bone by resorption of trabeculae at the interface. The goal of this study was to determine if TKAs with more initial interlock between cement and bone would maintain more interlock with in vivo service (in the face of resorbing trabeculae) and have less micro-motion at the cement–bone interface. The initial (created at surgery) and current (after in vivo service) cement–bone interlock morphologies of sagittal implant sections from postmortem retrieved tibial tray constructs were measured. The implant sections were then functionally loaded in compression and the micro-motion across the cement–bone interface was quantified. Implant sections with less initial interdigitation between cement and bone and more time in service had less current cement–bone interdigitation (r2 = 0.86, p = 0.0002). Implant sections with greater initial interdigitation also had less micro-motion after in vivo service (r2 = 0.36, p = 0.0062). This work provides direct evidence that greater initial interlock between cement and bone in tibial components of TKA results in more stable constructs with less micro-motion with in vivo service.

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Section: Discussionmentioning

confidence: 99%

Increased initial cement–bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service

Miller

TerBush

Goodheart

et al. 2014

Journal of Biomechanics

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“…Both biological and mechanical factors have been recognized to contribute toward peri-prosthetic osteolysis and eventual loosening and failure of TKRs (Gallo et al, 2013). Mechanical aspects such as early migration of tibial trays have previously been related to aseptic loosening (Pijls et al, 2012). Tibial component malalignment has also been shown to contribute toward revision rate due to increased wear (Srivastava et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Strain shielding in trabecular bone at the tibial cement-bone interface

Srinivasan¹,

Miller

Mann

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Aseptic loosening of the tibial component remains the leading cause for revision surgery in total knee arthroplasty (TKA). Understanding the mechanisms leading to loss of fixation can offer insight into preventative measures to ensure a longer survival rate. In cemented TKA, loosening occurs at the cement-trabecular interface probably due to a stress-shielding effect of the stiffer implant material in comparison with bone. Using finite element models of lab-prepared tibial cement-trabeculae interface specimens (n=4) based on micro-CT images, this study aims to investigate the micromechanics of the interlock between cement and trabecular bone. Finite element micromotion between cement and trabeculae and bone strain were compared in the interdigitated trabeculae as well as strain in the bone distal to the interface. Lab-prepared specimens and their FE models were assumed to represent the immediate post-operative situation. The cement layer was removed in the FE models while retaining the loading conditions, which resulted in FE models that represented the pre-operative situation. Results showed that micromotion and bone strain decrease when interdigitation depth increases. Bone-cement micromotion and bone strain at the distal interdigitated region showed a dependence on bone volume fraction. Comparing the immediate post-operative and pre-operative situations, trabeculae embedded deep within the cement generally showed the highest level of strain-shielding. Strain shielding of interdigitated bone, in terms of reduction in compressive strains, was found to be between 35 and 61 % for the four specimens. Strain adaptive remodeling could thus be a plausible mechanism responsible for loss of interdigitated bone.

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“…Large inducible micro-motions and migration at the bone-implant interface have been related to increased risk of clinical loosening of tibial components (11; 12). However, to date, most laboratory studies have focused on quantifying the initial stability of components which represent the immediate postoperative situation, and few have explored the state of fixation after a period of in-vivo service (13; 14).…”

Section: Introductionmentioning

confidence: 99%

Peri-implant bone strains and micro-motion following in vivo service: A postmortem retrieval study of 22 tibial components from total knee replacements

et al. 2013

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Biological adaptation following placement of total knee replacements (TKR) is known to affect peri-implant bone mineral density (BMD) and implant fixation. The goals of this project were to quantify the proximal tibial bone strain and implant-bone micro-motion for functioning postmortem retrieved TKRs and to assess the strain/micro-motion relationships with chronological (donor age and time in service) and patient (body weight and BMD) factors. Twenty-two tibial constructs were functionally loaded to one body weight (60% medial/40% lateral) and the proximal tibial bone strains and tray/bone micro-motion were measured using a digital image correlation system. Donors with more time in service had higher bone strains (p=0.044), but there was not a significant (p=0.333) contribution from donor age. Donors with lower peri-implant BMD (p=0.0039) and higher body mass (p=0.0286) had higher bone strains. Long term implants (> 11 years) had proximal bone strains (900 με) that were almost twice as high as short term (< 5 years) implants (570 με). Micro-motion was greater for younger donors (p=0.0161) and longer time in service (p=0.0008). Increased bone strain with long term in-vivo service could contribute to loosening of TKRs by failure of the tibial peri-implant bone.

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Early migration of tibial components is associated with late revision

Cited by 164 publications

References 105 publications

Increased initial cement–bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service

Increased initial cement–bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service

Strain shielding in trabecular bone at the tibial cement-bone interface

Peri-implant bone strains and micro-motion following in vivo service: A postmortem retrieval study of 22 tibial components from total knee replacements

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