Mechanisms of Failure of the Femoral and Tibial Components in Total Knee Arthroplasty

Windsor, Russell E.; Scuderi, Giles R.; Moran, Michael C.; Insall, John N.

doi:10.1097/00003086-198911000-00005

Cited by 203 publications

(93 citation statements)

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“…We also observed a low incidence of early aseptic loosening (six of 698 [0.9%]) that is comparable to conventional implants [4,10,29,44,48]. The results of this study support several others reporting no or few loosening cases with the same HF prostheses [18,25,26,39,40,43,50] (Table 3).…”

Section: Discussionsupporting

confidence: 87%

“…The femoral loosening was observed in only three of 698 cases (0.4%) in the present study. Such low incidence of femoral component loosening was also reported with conventional TKA in 0.35% with an average time to failure of 2 years [48] and in 0.9% (15 of 1600 knees) during 4 to 10 years followup [27], and therefore femoral component loosening cannot be regarded as a specific mode of failure in HF prostheses.…”

Section: Discussionmentioning

confidence: 54%

“…Both studies suggested this substantial early aseptic loosening was associated with postoperative deep flexion ability. Early aseptic loosening of the femoral component reportedly occurs in 0% to 0.9% of patients at 2 to 10 years [4,10,27,29,44,48] in conventional TKA, and concerns have therefore been raised about the high incidence of early aseptic loosening in HF designs [7,17]. However, a number of clinical studies reporting 25 to 259 knees [3,8,20,[24][25][26] have suggested conflicting findings with only a few instances of prosthesis-related failures after HF TKA at mean followups of 12 to 51 months even in the same ethnic group [5,20,[24][25][26]41].…”

Section: Introductionmentioning

confidence: 99%

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High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.Questions/purposes We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients. Methods We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen 1 Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2-8.7 years). We performed a survival analysis on all patients for aseptic loosening. Results Three hundred sixty knees (52%) could achieve C 135°maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Complications after TKA such as malalignment, instability, subluxation, excessive wear, and loosening have been attributed to poor soft-tissue balance [32,48,59]. Refinements in surgical technique and instrumentation and surgical navigation systems have improved component alignment [7,19,50,51,54].…”

Section: Intraoperative Usementioning

confidence: 99%

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

D’Lima

Patil

Steklov

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid. Questions/purposes We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory. Methods Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A thirdgeneration system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware. Results By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (À12 to +4 mm), mediolateral translation (À1 to 1.5 mm), axial rotation (À3°to 12°), and adduction-abduction (À1°t o +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy. Conclusions Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

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“…Varus alignment of a total knee replacement has been associated with early tibial component loosening and the presence of radiolucent lines [4,5]. In the normal knee, the articular surface of the proximal tibia angle is an average of 3°o f varus to the mechanical axis.…”

Section: Introductionmentioning

confidence: 99%

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

et al. 2009

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Postoperative alignment is a predictor for longterm survival of total knee arthroplasty (TKA). The purpose of this study was to evaluate whether or not preoperative deformities predispose to intraoperative malposition of TKA components. A retrospective radiographic analysis of 53 primary TKA cases was performed. Preoperative AP hip to ankle and lateral knee radiographs were compared with postoperative views to evaluate component positioning. The following angles were measured: the hip-knee-ankle (HKA) angle expressing the mechanical axis of the leg, the mechanical lateral distal femur angle (mLDFA), the medial proximal tibia angle (MPTA), the posterior distal femur angle (PDFA), and the posterior proximal tibia angle (PPTA). Postoperative measurement of the HKA revealed 34.0% of the cases had a deviation of >±3°from neutral alignment. Sixteen knees (30.2%) were in varus and, with one exception, all presented with severe varus gonarthrosis prior to surgery with a mean tibiofemoral angle of 12.4°c ompared with 1.0°of valgus in the optimally aligned group. Patients (93.3%) with preoperative valgus malalignment showed optimal postoperative HKA. Odds ratios for malalignment of TKA for varus knees in comparison with valgus knees were 7

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Mechanisms of Failure of the Femoral and Tibial Components in Total Knee Arthroplasty

Cited by 203 publications

References 0 publications

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

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