Medial Tibial Periprosthetic Bone Resorption and Its Effect on Clinical Outcomes After Total Knee Arthroplasty: Cobalt-Chromium vs Titanium Implants

Yoon, Chang-Hwan; Chang, Moon Jong; Chang, Chong Bum; Song, Min Kyu; Shin, Jae Hoon; Kang, Soon Beom

doi:10.1016/j.arth.2018.04.025

Cited by 31 publications

(31 citation statements)

References 27 publications

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“…The most important finding of the present study is that medial tibial bone resorption after TKA using a thick CoCr baseplate was not uncommon and showed various locations, types, and severities. These findings could not be systemati-cally interpreted with the previous definition of tibial bone resorption, 3,8,9,19 which reported the incidence of only type UT according to a novel classification. We used the previous classification system for type UT, 3 but types UC, C, and M had to be added.…”

Section: Discussioncontrasting

confidence: 79%

Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate

et al. 2020

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Recent literature has implicated a thick cobalt chromium baseplate as a potential source of stress shielding and medial tibial bone resorption after total knee arthroplasty (TKA) in a Western population. The purpose was to calculate the incidence of various types and severity of medial tibial bone resorption utilizing a novel classification system after TKA with a thick cobalt chromium baseplate in Asian patients. Five hundred TKAs using Attune prostheses with mean follow-up of 3.4 years were evaluated, using the prospective radiographic data. The mean age was 71.3 years. The preoperative mechanical axis was varus, 11.2 degrees. The type and severity of medial tibial bone resorption were categorized as type U (resorption under the tibial baseplate up to 50% [U1] or beyond 50% [U2] of medial tibial tray width), C (resorption around the penetrated cement under the baseplate), and M (resorption on the medial tibial cortex without extension to the baseplate). Bone resorption of medial proximal tibia was observed in 96 knees (19.2%). Types U1 and U2 were seen in 46 and 28 knees, respectively. Type C was observed in 12 knees and type M in 10 knees. The type U resorption group had significantly more preoperative varus deformity (varus 12.9 vs. 10.9 degrees, p = 0.017). Medial tibial bone resorption after TKAs using a thick cobalt chromium baseplate is not uncommon and has various locations, types, and severities. The medial tibial bone resorption might be related to various causes, including stress shielding, thermal necrosis from cement in the bony hole, and bony devascularization. The type-U resorption has to be closely observed in patients with preoperative severe varus deformity. This is a Level IV study.

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Section: Discussioncontrasting

confidence: 79%

Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate

et al. 2020

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“…In terms of causes of periprosthetic bone resorption of the tibia, it is related to the stress shielding phenomenon [3,[6][7][8][9]. The factors associated with bone resorption caused by stress shielding could be classified into two factors: the patient factor such as preoperative varus deformity and body mass index (BMI), and the implant factor such as material composition, thickness of the baseplate, and design of the implant [7,8,10]. However, no consensus exits in clinical study, and thus, the implant factors associated with the resorption need to be further evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…The stiffer component materials were reported to induce more stress shielding [7,11,12]. However, even with the same material, bone resorption was reported to be different depending on the different designs [7,10]. One clinical study reported that the incidence and average amount of medial tibia bone resorption were greater with the thicker tibial baseplate than those with thinner one with same material at a minimum of 2 years after TKA (44% vs 10% and 1.07 mm vs 0.16 mm respectively) [7].…”

Section: Introductionmentioning

confidence: 99%

A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption

et al. 2021

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Introduction Implant material is a more important factor for periprosthetic tibial bone resorption than implant design after total knee arthroplasty (TKA). The virtual perturbation study was planned to perform using single case of proximal tibia model. We determined whether the implant materials’ stiffness affects the degree of periprosthetic tibial bone resorption, and whether the effect of material change with the same implant design differed according to the proximal tibial plateau areas. Materials and methods This three-dimensional finite element analysis included two cobalt-chromium (CoCr) and two titanium (Ti) tibial implants with different designs. They were implanted into the proximal tibial model reconstructed using extracted images from computed tomography. The degree of bone resorption or formation was measured using the strain energy density after applying axial load. The same analysis was performed after exchanging the materials while maintaining the design of each implant. Results The degree of periprosthetic tibial bone resorption was not determined by the type of implant materials alone. When the implant materials were changed from Ti to CoCr, the bone resorption in the medial compartment increased and vice versa. The effect of material composition’s change on anterior and posterior areas varied accordingly. Conclusions Although the degree of bone resorption was associated with implant materials, it differed depending on the design of each implant. The effect on the degree of bone resorption according to the materials after TKA should be evaluated while concomitantly considering design.

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“…Although these procedures are all promising, the long‐term function and implant stability are suboptimal as none of them take advantage of the mechanoresponse of bone and result in bone resorption, implant loosening, and failure. [ 14,15 ] There may be an opportunity for these treatments to harness bone's natural mechanoresponse by invoking a localized increase in strain in the range of 1% to 8% to maintain or improve the quality of the bone in which they are placed. [ 1 ] Implants with apparent modulus designed to control bone mechanobiology would benefit from improved prediction and refined knowledge of the spatial variation of multi‐axial bone properties within the proximal tibia.…”

Section: Introductionmentioning

confidence: 99%

Mapping the Multi‐Directional Mechanical Properties of Bone in the Proximal Tibia

Munford

Jeffers

2020

Adv Funct Materials

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The remodeling behavior of bone is influenced by its mechanical environment. By mapping bone's mechanical properties in detail, orthopedic implants with respect to its mechanical properties could stimulate and harness remodeling to improve patient outcomes. In this study, multiaxial apparent modulus and strength of cadaveric proximal tibial bone are mapped and predicted from computed tomography (CT) derived apparent density. Group differences are identified from testing order, subchondral depth, condyle, and sub-meniscal bone with covariates; age and gender. Axial modulus is 50% greater than the transverse modulus. Medial axial modulus is 30% greater than the lateral side. On the lateral side, axial modulus decreases by 50% from proximal to 25 mm distal. On the medial side, axial modulus remains relatively constant. Differences are quantified for density and multiaxial modulus across all subchondral depths, and different power law relationships are provided for each location. Density explains 75% of variation when grouped by subchondral depth and condyle. Yield strength is well-predicted across all test directions, with density predicting 81% of axial strength variation and no differences over subchondral depth. Quantified mapping of bone multiaxial modulus based on condyle and subchondral depth is shown for the first time in a clinically viable protocol using conventional CT.

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Medial Tibial Periprosthetic Bone Resorption and Its Effect on Clinical Outcomes After Total Knee Arthroplasty: Cobalt-Chromium vs Titanium Implants

Cited by 31 publications

References 27 publications

Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate

Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate

A three-dimensional finite element analysis on the effects of implant materials and designs on periprosthetic tibial bone resorption

Mapping the Multi‐Directional Mechanical Properties of Bone in the Proximal Tibia

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