Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement

Saari, Tuuli; Uvehammer, Johan; Carlsson, L.V.; Regnér, Lars; Kärrholm, Johan

doi:10.1002/jor.20358

Cited by 35 publications

(22 citation statements)

References 23 publications

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“…Although the BMD decline in our patients has not resulted in clinical failure, longer-term remodeling is less clear. Some authors have reported stabilization of BMD by 2 years [7,8], with Saari et al [17] finding stable BMD loss out to 5 years. Others have reported ongoing loss at 3 years [4,11,12].…”

Section: Discussionmentioning

confidence: 98%

“…They reported mean tibial BMD loss of as much as 10% at 2 years but found no difference between groups. Saari et al [17] examined tibial BMD change in stemmed components with either posterior-stabilized or cruciate-retaining polyethylene inserts. Loading on the proximal tibia was theorized to differ between designs as a result of increased constraint in the posterior-stabilized knee.…”

Section: Discussionmentioning

confidence: 99%

“…Dual-energy xray absorptiometry (DEXA) studies suggest proximal tibial BMD declines after TKA [1,5,9,12,17,[19][20][21]. However, it is not clear whether there are differences in BMD changes between cortical and cancellous bone.…”

Section: Introductionmentioning

confidence: 99%

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Loss of Tibial Bone Density in Patients with Rotating- or Fixed-platform TKA

Munro

Pandit

Walker

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Little is known about tibial bone remodeling with TKA and its clinical relevance. We performed a randomized clinical trial to compare tibial bone density changes in cemented components with different bearing designs. Bone density changes were assessed using quantitative computed tomography (qCT)-assisted osteodensitometry. Twenty-eight rotating-platform and 26 fixed-platform cemented TKAs were included. The nonoperated contralateral side was used as a control. CT scans were performed postoperatively and 1 year and 2 years after the index operation. Cancellous bone density loss (up to 12.6% at 2 years) was observed in all proximal tibial regions in both cohorts. In contrast, we found lower cortical bone density loss (up to 3.6% at 2 years). We found no differences in bone loss between fixed-and rotating-platform implants. The decrease of cancellous bone density after TKA suggests stress transfer to the cortical bone.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Loss of Tibial Bone Density in Patients with Rotating- or Fixed-platform TKA

Munro

Pandit

Walker

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The bone remodeling was simulated for a period of sixty months as the previous clinical evidence suggested that bone suffers 'memory loss' and the adaptive process stops after this period (Petersen et al, 1995;Saari et al, 2007).…”

Section: Bone Remodeling Simulationmentioning

confidence: 99%

Numerical analysis of an osseointegrated prosthesis fixation with reduced bone failure risk and periprosthetic bone loss

Tomaszewski

Diest

Bulstra

et al. 2012

Journal of Biomechanics

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Currently available implants for direct attachment of prosthesis to the skeletal system after transfemoral amputation (OPRA system, Integrum AB, Sweden and ISP Endo/Exo prosthesis, ESKA Implants AG, Germany) show many advantages over the conventional socket fixation. However, restraining biomechanical issues such as considerable bone loss around the stem and peri-prosthetic bone fractures are present. To overcome these limiting issues a new concept of the direct intramedullary fixation was developed. We hypothesize that the new design will reduce the peri-prosthetic bone failure risk and adverse bone remodeling by restoring the natural load transfer in the femur. Generic CT-based finite element models of an intact femur and amputated bones implanted with 3 analyzed implants were created and loaded with a normal walking and a forward fall load. The strain adaptive bone remodeling theory was used to predict long-term bone changes around the implants and the periprosthetic bone failure risk was evaluated by the von Mises stress criterion. The results show that the new design provides close to physiological distribution of stresses in the bone and lower bone failure risk for the normal walking as compared to the OPRA and the ISP implants. The bone remodeling simulations did not reveal any overall bone loss around the new design, as opposed to the OPRA and the ISP implants, which induce considerable bone loss in the distal end of the femur. This positive outcome shows that the presented concept has a potential to considerably improve safety of the rehabilitation with the direct fixation implants.

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“…Subsequent to the early studies mentioned above, clinical evidence has suggested that bone suffers 'memory loss' and the adaptive process stops after sixty months (Petersen et al, 1995;Saari et al, 2007). Therefore, the bone remodelling following joint replacement was simulated for a period equivalent to sixty months.…”

Section: Strain-adaptive Bone Remodelling Simulationmentioning

confidence: 98%