Micromotion in cemented rotating platform total knee arthroplasty: cemented tibial stem versus hybrid fixation

Lüring, C.; Perlick, L.; Trepte, Constantin; Linhardt, O.; Perlick, Carsten; Plitz, W.; Grifka, Joachim

doi:10.1007/s00402-005-0082-5

Cited by 40 publications

(36 citation statements)

References 13 publications

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“…If the cement mantle was 3 mm thick or the stem was cemented, the micromotion decreased significantly. Also cadaver studies by Jazrawi et al [10] and Luring et al [12] revealed significantly increased micromotion when only cementing the tibial baseplate. Contrary to these in vitro studies, Peters et al did not find less micromotions when cementing the stem in cadaver knees [13].…”

Section: Discussionmentioning

confidence: 95%

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Comparison of cementing techniques of the tibial component in total knee replacement

Saari

Wood

et al. 2008

International Orthopaedics (SICOT)

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A few studies have shown that cementing the stem enhances fixation of the tibial baseplate in total knee replacement (TKR). Even the horizontal technique has been shown to provide good fixation. We used radiostereometry to study migration of the tibial component in 30 knees operated with Profix TKR. The knees were randomised for either complete (both under the baseplate and around the stem) or horizontal (only under the baseplate) cementing of the tibial component. At two years the tibial baseplate rotated externally a median of 0.18°in the uncemented stem group and internally a median of 0.23°in the cemented stem group. The tibial baseplate subsided 0.14 mm in the cemented stem group, and no translation was seen in the uncemented stem group. The differences in migration were small and probably without clinical significance. The findings do not favour either of the cementing techniques in TKR.Résumé Peu d'études ont démontré que la fixation cimentée de la queue améliorait la fixation du plateau tibial dans les prothèses totales du genou. Par ailleurs, les fixations horizontales ont également montré une bonne fixation. Nous avons utilisé la radiostéréométrie pour étudier la migration du composant tibial dans 30 genoux de type Profix. Les genoux ont été randomisés cimentation sous le plateau et autour de la queue ou cimentation horizontale uniquement sous le plateau. À 2 ans le plateau tibial présente une rotation externe de 0,18°d ans les PTG avec une queue non cimentée et une rotation interne moyenne de 0,23°dans le groupe des queues cimentées. La base du plateau tibial s'enfonce de 0,14mm dans le groupe des queues cimentées et il n'y a pas de translation dans le groupe des queues non cimentées. En conclusion, la différence au niveau de la migration est minime et sans signification clinique. Cette étude ne permet pas de choisir dans les prothèses totales du genou l'une des deux techniques de cimentation.

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Section: Discussionmentioning

confidence: 95%

“…However, Hyldahl et al showed in a radiostereometry (RSA) study that fixation was better at the two-year followup if the tibial stem was cemented [7,8]. In vitro studies have shown less micromotion when complete cementing is used [2,10,12], but Peters et al did not confirm this finding in a cadaver study [13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of cementing techniques of the tibial component in total knee replacement

Saari

Wood

et al. 2008

International Orthopaedics (SICOT)

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“…Highly localised peri-prosthetic plasticity has also been observed experimentally during vertebral fusion device subsidence [16]. Correct prediction of this stress distribution at the bone implant-interface will have implications for device design and in particular for peri-prosthetic bone remodelling and initial implant stability of the tibial component, which have been investigated in previous biomechanical studies [7,[17][18][19][20][21]. To our knowledge, the current study is the first to implement the CFI plasticity formulation for the trabecular material in the investigation of press-fit stem implantation in total arthroplasty.…”

Section: Discussionmentioning

confidence: 98%

An investigation of the inelastic behaviour of trabecular bone during the press-fit implantation of a tibial component in total knee arthroplasty

Kelly

Cawley

Shannon

et al. 2013

Medical Engineering & Physics

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“…There have been a few reports of tray micromotion and subsidence under cyclic loading in human cadaver tibiae. Factors that have been shown to significantly affect tray subsidence include the type of loading, the density of cancellous bone, the presence of a cement interface, the length of the tibial stem, and the *Address correspondence to this author at the 11025 North Torrey Pines Road, Suite 200, La Jolla, CA 92037, USA; Tel: 858-332-0166; Fax: 858-332-0669; Email: ddlima@scripps.edu presence of screw fixation [9][10][11][12][13]. However, the effect of tibial tray alignment has not been fully studied.…”

Section: Introductionmentioning

confidence: 99%

“…Surrogate bone models have been used to simulate the mechanical behavior of human bone [10]. A cementless tray when tested under cyclic loading (1000 N axial compression and 250 N horizontal shear) subsided 400 to 800 µm in a polyurethane surrogate bone with orthotropic material properties [14].…”

Section: Introductionmentioning

confidence: 99%

Effect of Tibial Tray Malalignment on Micromotion and Subsidence: A Preliminary Report

Patil

Steklov²,

Colwell³

et al. 2013

TOBONEJ

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Malalignment of the tibial tray in total knee arthroplasty has been linked to several complications including tibial tray subsidence, leading to revision surgery. However, quantitative biomechanical evidence to directly support the mechanism of failure is not available. We developed a model to study tibial tray micromotion and subsidence in vitro under multiaxial physiological loading conditions for up to 100,000 cycles. In Phase I, we tested four cadaver knees and two surrogate bone models to determine whether the surrogate models could reproduce the fatigue damage induced by cyclic loading. In Phase II, we tested six cadaver knees in a pairwise manner under conditions representing either neutral or varus malalignment.The surrogate bone models did not reproduce the progressive damage that was seen in human cadaver specimens. The altered loading conditions used to represent varus tray alignment increased the cyclic strain at the start of the fatigue loading and increased the cyclic strain at the end of the fatigue loading as well as the subsidence of the tray. The increase in final cyclic strain was greater in the varus condition indicating reduction in stiffness due to bone damage. This in vitro testing represents the clinical reports of early tray migration that lead to eventual aseptic loosening. This study provides biomechanical evidence supporting the hypothesis that a varus tray alignment could increase the risk of failure.

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Micromotion in cemented rotating platform total knee arthroplasty: cemented tibial stem versus hybrid fixation

Abstract: In conclusion, the stem of mobile bearing tibial components should be cemented to provide increased micromotion and earlier loosening.

Cited by 40 publications

References 13 publications

Comparison of cementing techniques of the tibial component in total knee replacement

Comparison of cementing techniques of the tibial component in total knee replacement

An investigation of the inelastic behaviour of trabecular bone during the press-fit implantation of a tibial component in total knee arthroplasty

Effect of Tibial Tray Malalignment on Micromotion and Subsidence: A Preliminary Report

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