Experimental pre-clinical assessment of the primary stability of two cementless femoral knee components

Berahmani, Sanaz; Hendriks, Marloes; Wolfson, David; Wright, Abraham; Janssen, Dennis

doi:10.1016/j.jmbbm.2017.07.043

Cited by 13 publications

(23 citation statements)

References 32 publications

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“…Although the femoral components in our study continued to migrate up to one year postoperatively, the Attune components migrated less. This could be due to better initial resistance to micromotion, as shown by Berahmani et al 30 Table III. The mean migration of the femoral component at two years postoperatively and the rate of migration in the second postoperative year of the Attune (n = 30) and Low Contact Stress (n = 28) total knee arthroplasties.…”

Section: Discussionmentioning

confidence: 76%

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A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty

Koster

Rassir

Kaptein

et al. 2023

The Bone & Joint Journal

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Aims The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. Methods A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. Results The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. Conclusion The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected. Cite this article: Bone Joint J 2023;105-B(2):148–157.

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Section: Discussionmentioning

confidence: 76%

“…In 2017, Berahmani et al 30 performed a preclinical cadaveric study assessing the migration of the femoral component of cementless Attune and LCS TKAs using digital image correlation. They reported that the micromotions under different loading trials were significantly less for the Attune TKA, indicating better initial fixation.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty

Koster

Rassir

Kaptein

et al. 2023

The Bone & Joint Journal

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“… Seehaus et al [ 15 ] 2009 Experimental study To evaluate the experimental accuracy and precision of the MBRSA method for four different, but typical prosthesis geometries that are commonly implanted Radiostereophotogrammetric analysis 1 femur, 1 tibia, and 2 hip (argo-TEP and Antea) Translation and rotation MBRSA in-plane: better than -0.034 to 0.107 mm translation, and -0.038 to 0.162 deg out-of-plane: better than − 0.217 to 0.069 mm translation, and − 1.316 to 0.071 deg MBRSA method can be used with many common implant geometries, and the method could lead to a wider application of the RSA for investing clinical implant fixation that has been possible to date. Järvenpää et al [ 19 ] 2014 Prospective study To assess long-term periprosthetic BMD changes after TKR in obese and nonobese patients DEXA 69 TKR in 61 patients Bone mineral density Average bone loss at 7 years: 17.6% in anterior, 30.7% in central, 17.6% in posterior, 22.2% in total metaphyseal ROIs, 10.3% in diaphyseal ROI Bone loss is likely caused by the stress shielding and immobilization in the first postoperative phase Berahmani et al [ 20 ] 2017 Experimental and pre-clinical analysis To evaluate the primary stability of the Attune cementless femoral components, and compared it against a conventional implant under simplified gait and deep knee bend loads DIC 6 pairs of femur BMD Micromotion Attune: 126 mg/cm2 BMDLCS: 136 mg/cm2 BMDGaitAttune 32 µmLCS 71 µmDKBAttune: 55 µmLCS: 83 µm Micromotions of Attune were significantly lower than LCS under both loading conditions BMD was only a significant factor affecting the micromotions under simplified gait loading Schroder et al [ 21 ] 2001 Prospective study To report long-term results with TKR in an unselected series of patients with osteoarthrosis and rheumatoid arthritis Radiograph Questionnaire 114 patients (cementless) Alignment Clinical score Survival rate Alignment 10-...…”

Section: Resultsmentioning

confidence: 99%

“…Three studies show a dominating tendency toward decrease in tibia and femur bone mineral density (BMD) after the implantation of TKR [7][8][9][10][11][12][13][14][15][16][17][18][19]. However, BMD was shown to be an effective tool only in some specific loading conditions, as stated in a preclinical cadaveric study [20].…”

Section: Causes and Evaluation Methods Of Migrationmentioning

confidence: 99%

“…Three RSA studies have shown that loosening can be concretely assessed in the early postoperative period [12][13][14][15][16][17][18][19][20][21][22]. Henricson et al [11] reported a displacement of the femoral component MTPM of 0.10 mm per year for cemented implant and 0.09 mm per year for the cementless implant, throughout a 10-year follow-up evaluation.…”

Section: Quantification Of Migration and Patients' Outcomesmentioning

confidence: 99%

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Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review

et al. 2020

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Loosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its influence on patients’ clinical outcomes. The aim of this narrative review was (1) to provide information about of the influence of migration in femoral component of TKR prostheses, (2) to assess how migration may affect patient clinical outcomes and (3) to present alternative solution to the standard cobalt-chrome prostheses. A database search was performed on PubMed Central® according to the PRISMA guidelines for studies about Cobalt-Chrome femoral component migration in people that underwent primary TKR published until May 2020. Overall, 18 articles matched the selection criteria and were included in the study. Few studies investigated the femoral component through the migration, and no clear migration causes emerged. The Roentgen Stereophotogrammetric Analysis has been mostly used to assess the migration for prognostic predictions. An annual migration of 0.10 mm seems compatible with good long-term performance and good clinical and functional outcomes. An alternative solution to cobalt-chrome prostheses is represented by femoral component in PEEK material, although no clinical evaluations have been carried out on humans yet. Further studies are needed to investigate the migration of the femoral component in relation to clinical outcomes and material used.

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Optimal intersurface stability for unicompartmental femoral component design with two pegs placed on the distal resection surface: 5 mm peg length increment and 10° peg inclination

Sun,

Li,

Zhao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe present study aimed to identify the optimal design of the unicompartmental femoral component through parameter analysis and stability evaluation.MethodsA finite element (FE) analysis was applied to analyse and adjust the parameter combinations of the anterior tilt angle of the posterior condyle resection surface, the position of the peg, the length of the peg and the inclination angle of the peg, resulting in 10 different FE models. Setting three knee flexion angles of 8.4° (maximum load state during walking), 40° (maximum load state during stair climbing) and 90° (maximum load state during squatting exercise), quantitatively analysing the micromotion values of the bone–prosthesis interface and defining a weighted scoring formula to evaluate the stability of different FE models. The validity of the FE analysis was verified using the Digital Image Correlation (DIC) device.ResultsThe errors between the FE analysis and the DIC test at three flexion angles were 5.6%, 1.7% and 11.1%. The 10 different femoral component design models were measured separately. The FE analysis demonstrated that the design with a 0° anterior tilt angle of the posterior condyle resection surface, both pegs placed on the distal resection surface, lengthened 5 mm pegs and a 10° peg inclination angle provided the best stability.ConclusionThe current study proposed a method for evaluating the stability of the femoral component design. The optimal intersurface stability design of the unicompartmental femoral component was achieved with two pegs placed on the distal resection surface, a 5‐mm peg length increment and a 10° peg inclination. These results might provide a reference for the selection of unicompartmental femoral components in clinical practice and therefore improve the survival rate of future unicompartmental knee arthroplasty.Level of EvidenceLevel III.

show abstract

Experimental pre-clinical assessment of the primary stability of two cementless femoral knee components

Cited by 13 publications

References 32 publications

A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty

A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty

Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review

Optimal intersurface stability for unicompartmental femoral component design with two pegs placed on the distal resection surface: 5 mm peg length increment and 10° peg inclination

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