High incidence of radiolucent lines at the implant–cement interface of a new total knee replacement

Abstract

BackgroundRecently introduced total knee arthroplasty (TKA) implants have been linked with the early development of periprosthetic radiolucency (PPRL). The aim of this study was to carry out a retrospective clinical and radiographical analysis of a consecutive series of a new TKA, and to assess the incidence and distribution of PPRL.MethodsA retrospective review of all new TKA implants performed by a single surgeon at a single hospital between March 2013 and October 2017 was performed. The minimum follow‐up period was 3 months, with ongoing patient review at 6, 12 and 36 months. Sequential post‐operative radiographs were performed to determine the presence of PPRL.ResultsA total of 122 TKAs were identified in 112 patients over the 4.5‐year study period. The average follow‐up time was 21 months (range 3–51 months). PPRL was noted in 29 TKAs (23.8%). When comparing the PPRL group to those without PPRL, there was a difference in body mass index, with body mass index associated with an increased likelihood of PPRL (P = 0.003). There was no difference in constraint of implant (P = 0.818), cement type (P = 0.340), patella resurfacing (P = 0.286), age (P = 0.984) gender (P = 0.376) or initial mechanical axis deviation (P = 0.054) between groups. PPRL were most commonly seen in tibial anterior‐posterior (AP) zone 1 and zone 2 (96.6%), followed by femoral lateral zone 5 (58.6%), tibia lateral zone 1 (55.2%) and tibial lateral zone 2 (53.2%). No patients have required revision surgery.ConclusionA high incidence of early PPRL is seen in patients undergoing primary TKA using a new implant system, mainly involving the tibial component. Ongoing clinical and radiological assessment for patients seems warranted based on these findings.

Tibial tray debonding from the cement mantle is associated with deformation of the backside of polyethylene tibial inserts

“…Their findings agreed with those of others, 7,31 although the rate of radiolucent lines (23.8%) was higher than that reported by Ranawat et al, 31 who found a 7.3% rate of radiolucencies at two years in a series of 54 TKAs. The findings of Kaptein et al 8 also agreed with those of Hoskins et al 30 They undertook a randomized controlled trial comparing the migration of the tibial component of 38 Attune cemented CR TKAs with 36 PFC-sigma TKAs. 8 At two years postoperatively, radiolucencies were seen between the Attune medial baseplate and the cement in 14 TKAs (42%) compared with three in Sigma PFC TKAs (9%).…”

“…29 The results which have been published, however, have not shown obvious improvements compared with the PFC design it was intended to replace. Hoskins et al 30 reviewed 122 Attune TKAs, at a mean follow-up of 21 months. Periprosthetic radiolucent lines were noted in 29 (23.8%).…”

Development of an innovative in vivo model of PJI treated with DAIR

“…While no implant loosening was observed, the absence of bone cement means that the bone cut may have been incompletely covered by the implant. However, as radiolucent lines are common following joint replacement ( 57 ), we believe this does not impact the relevancy of our model. Moreover, this could prove advantageous to show the impact of injectable treatments of biofilms by allowing the formation of biofilm inaccessible to mechanical debridement.…”

Is TKA femoral implant stability improved by pressure applied cement? a comparison of 2 cementing techniques

“…We cannot determine any clear association between our results and the occurrence of radiolucent lines noted radiographically. Hoskins et al reported the majority of radiolucent lines distally (34.5%) and anteriorly (6.9%) while Staats et al described them as being predominantly posteriorly located (12%) [ 19 , 20 ]. The authors therefore do not see any noticeable association with the results of the current study.…”

“…Although loosening of the femoral components accounts for only 4.6% of revisions [ 4 ], the continuously increasing number of implantations and revisions, in addition to earlier reports of significantly higher loosening rates of modern high-flex prostheses has justified detailed investigations of methods for optimizing prosthesis fixation [ 15 – 18 ]. Also, recent publications have reported a higher incidence of radiolucent lines accompanying a new prosthesis design when compared to its predecessor, although the clinical and biomechanical significance of this is currently unclear [ 19 , 20 ].…”