High rate of tibial debonding and failure in a popular knee replacement

Keohane, David; Sheridan, Gerard A.; Masterson, Eric

doi:10.1302/2633-1462.36.bjo-2022-0043.r1

Cited by 10 publications

(3 citation statements)

References 26 publications

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“…As stated above, it can be assumed that the majority of aseptic loosening cases are not related to mechanical issues such as malpositioning or cement debonding as those would likely manifest early. (16)(17)(18)(19)(20)(21) Thus, in the current study of mid-to long-term failures, early stage osteolysis caused by wear debris or other foreign bodies (e.g. cement debris, corrosion products, etc.)…”

Section: Discussionmentioning

confidence: 94%

“…Instability is commonly attributed to malpositioning, cement debonding, or other mechanical issues, which would likely manifest within the first 5 years after primary surgery. (16)(17)(18)(19)(20)(21) Therefore, it is plausible that instability in the mid-to long-term frequently may occur secondary to delamination. Delamination, which is the result of surface fatigue wear under combined rolling and sliding motion in the knee, has been a prominent problem in TKA with tibial inserts made from historic PE leading to early failures.…”

Section: Discussionmentioning

confidence: 99%

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Is Wear Still a Concern in TKA With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the Mid- to Long-Term?

Asher,

Wright,

Hall

et al. 2024

Preprint

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BackgroundModern literature has brought into question if wear of tibial inserts made from conventional or highly-crosslinked polyethylene (HXL PE) is still a factor limiting longevity of total knee arthroplasty (TKA) in the mid- to long-term. It is the objective of this study to determine: 1) most common causes of mid- to long-term TKA failure, 2) the prevalence of delamination, and 3) the medial/lateral linear wear rates of conventional and HXL PE tibial inserts retrieved in the mid- to long-term.MethodsA tibial insert retrieval cohort of 107 inserts (79 conventional, 28 HXL PE) with a minimum timein situof 6.5 years (mean 11.7±4) was studied. Failure causes were determined from chart-review, delamination presence was assessed microscopically, and medial/lateral linear wear was determined by minimal thickness changes measured with a dial-indicator.ResultsThe most common mid-to long-term etiologies for failure were instability (44.9%), PE wear 15%), aseptic loosening (14%) and infection (13.1%). Delamination occurred in 70% of inserts (72.1% conventional, 64.3% HXLPE). Gross material loss due to delamination appeared to be the underlying reason for at least 33.3% of cases exhibiting instability. Of the cases removed for infection, 75% exhibited no histopathological hallmarks of acute infection. The medial/lateral wear rates were 0.054/0.051 (conventional) and 0.014/0.011 (HXL) mm/year, respectively.ConclusionsPolyethylene wear still appears to be a major primary and secondary cause for TKA revision in the mid- to long-term. Wear may manifest as destabilizing delamination or as continuous release of fine wear particles potentially resulting in inflammatory responses and subsequent failure.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Is Wear Still a Concern in TKA With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the Mid- to Long-Term?

Asher,

Wright,

Hall

et al. 2024

Preprint

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“…Concerns over the early aseptic failure of modern TKAs is not an issue unique to the Attune ® prostheses. Keohane et al recently reported an exceptionally high rate of aseptic loosening in the NexGen ® implant design in their series which has subsequently been recalled by the manufacturer [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Does lucency equate to revision? A five‐year retrospective review of Attune and Triathlon total knee arthroplasty

O’Donovan

McAleese

Harty

2023

Knee surg. sports traumatol. arthrosc.

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Purpose The Attune® total knee arthroplasty system was introduced in 2013 to address lingering issues of patient dissatisfaction. However, recent literature reports concerns of early tibial tray debonding. The aim of this study was to compare the incidence of radiolucent lines, survivorship and patient reported outcome-measures between the Attune® system and the well-established Triathlon® system. Methods This retrospective database review was conducted at a single institution in Cork, Ireland. All primary Attune® (N = 445) and Triathlon® (N = 285) systems implanted between 2015 and 2016 were reviewed. Radiolucent lines were assessed for those with a minimum two-year radiological follow-up (Attune® = 338; Triathlon® = 231). X-rays were taken post op, at 6 months, 2 years and 5 years. Radiolucent lines were documented using the Modern Knee Society Radiographic System. Five-year survival was assessed using Kaplan–Meier analysis with the Log Rank method to determine statistical significance. The Oxford Knee Score and EQ-5D-5L, were collected pre-op, at 6 months, 2 years and 5 years post-operatively and compared using the Kruskal–Wallis Test. Results The Attune® had a higher proportion of radiolucent lines at the tibial tray [87.1% (54/62) vs 61.4% (27/44); p = 0.001] and at the implant–cement interface [62.9% (39/62) vs 43.2% (19/44); p = 0.02]. Conversely, the Triathlon® had a higher proportion AT the femur [38.6% (17/44) vs 12.9% (8/62); p = 0.001] and at the cement–bone interface [56.8% (25/44) vs 37.1% (23/62); p = 0.02]. The overall frequency of radiolucent lines was similar in both the Attune® and Triathlon® groups [17.8%, (60/338) vs 17.7%, (41/231); p = 0.49]. There was no difference in revision-free survival analysis at 5 years (Attune® 97.8% vs Triathlon® 95.8%; p = 0.129). The Attune® performed better at 5 years in the Oxford Knee Score [Attune® = 42.6 (SD 5.2) vs Triathlon® = 41 (SD 6.4); p = 0.001] and in the EQ-5D [Attune® = 0.773 (SD 0.187) vs Triathlon® = 0.729 (SD 0.218); p = 0.013]. There was no difference at 5 years in the EQ-VAS [Attune® = 80.4 (SD 13.7) vs Triathlon® = 78.5 (SD 15.3); p = 0.25]. Conclusion The Attune® system exhibited a higher incidence of radiolucent lines at the tibial tray. However, this did not lead to decreased survivorship at medium term follow-up compared to the Triathlon®. Furthermore, improvements in patient reported outcomes modestly favoured the Attune® system. Level of evidence III.

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Knee joint replacements

Joyce

2024

Joint Replacement in the Human Body

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High rate of tibial debonding and failure in a popular knee replacement

Cited by 10 publications

References 26 publications

Is Wear Still a Concern in TKA With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the Mid- to Long-Term?

Is Wear Still a Concern in TKA With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the Mid- to Long-Term?

Does lucency equate to revision? A five‐year retrospective review of Attune and Triathlon total knee arthroplasty

Knee joint replacements

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