Micromotion of Cementless Tibial Baseplates: Keels with Adjuvant Pegs Offer More Stability Than Pegs Alone

Bhimji, Safia; Meneghini, R. Michael

doi:10.1016/j.arth.2014.02.016

Cited by 47 publications

(12 citation statements)

References 31 publications

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“… 2013 ). Also the ribbed non-keeled stem of the LCS may provide less stability when compared with the keeled version (Bhimji and Meneghini 2014 ). Greater micromotion at the bone–implant interface has been reported for the uncemented non-keeled LCS Complete when compared with other tibial designs (Taylor et al.…”

Section: Discussionmentioning

confidence: 99%

Early aseptic loosening of a mobile-bearing total knee replacement

et al. 2017

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Background and purposeRegistry-based studies have reported an increased risk of aseptic tibial loosening for the cemented Low Contact Stress (LCS) total knee replacement compared with other cemented designs; however, the reasons for this have not been established. We made a retrieval analysis with the aim of identifying the failure mechanism.Patients and methodsWe collected implants, cement, tissue, blood, and radiographs from 32 failed LCS Complete cases. Damage to the tibial baseplate and insert was assessed. Exposure to wear products was quantified in 11 cases through analysis of periprosthetic tissue and blood. Implant alignment and bone cement thickness was compared with a control group of 43 non-revised cases.ResultsLoosening of the tibial baseplate was the reason for revision in 25 retrievals, occurring at the implant–cement interface in 16 cases. Polishing was observed on the lower surface of the baseplate and correlated to the level of cobalt, chromium, and zirconium in the blood. No evidence of abnormally high polyethylene wear was present. For each 1 mm increase in cement thickness the odds of failure due to aseptic loosening decreased by 61%. Greater varus alignment was associated with a shorter time to failure. The roughness, Ra, of a new LCS baseplate’s lower surface was 3.7 (SD 0.7) µm.InterpretationDebonding of the tibial component at the implant–cement interface was the predominant cause of tibial aseptic loosening. A thin cement layer may partly explain the poor performance. Furthermore, the comparatively low tibial surface roughness and the lack of a keeled stem may have played a role in the failures observed.

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Section: Discussionmentioning

confidence: 99%

Early aseptic loosening of a mobile-bearing total knee replacement

et al. 2017

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“…For reasons of specimen preservation, micromotion measurements within the cadaveric test specimens were limited to a small region of interest over a limited number of loading cycles. Manufactured foam models have been used in a handful of prior studies 21,37,43,47 as a means of testing primary stability of cementless tibial components, however, open-celled polyurethane foam has not been validated as a representative substitute for tibial cancellous bone. In this study, foam tibia models were used as a first step comparison in a standardized test bed, prior to cadaveric testing.…”

Section: Discussionmentioning

confidence: 99%

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

et al. 2019

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Highly porous ingrowth surfaces have been introduced into tibial tray fixation to improve long-term survivorship in cementless total knee arthroplasty. This study was designed to evaluate the effect of porous ingrowth surface on primary stability in the implanted cementless tibial component. Three tibial tray designs possessing sintered bead or roughened porous coating ingrowth surfaces were implanted into a foam tibia model with primary stability assessed via digital image correlation during stair descent and condylar liftoff loading. Follow-up testing was conducted by implanting matched-pair cadaveric tibias with otherwise identical trays with two iterations of ingrowth surface design. Trays were loaded and micromotion evaluated in a condylar liftoff model. The sintered bead tibial tray exhibited slightly lower micromotion than the roughened porous coating in stair descent loading. However, no significant difference in primary stability was observed in condylar liftoff loading in either foam or cadaveric specimens. Cementless tibial trays featuring two different iterations of porous ingrowth surfaces demonstrated both good stability in cadaveric specimens with less than 80 microns of micromotion and 1 mm of subsidence under cyclic loading. While improved ingrowth surfaces may lead to improved biological fixation and long-term osteointegration, this study was unable to identify a difference in primary stability associated with subsequent ingrown surface design iteration.

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“…Prior studies have utilised fixed and intrusive electromechanical transducers for single-axis measurement or computational methods for estimated micromotion analysis. 33 - 39 The introduction of digital image correlation technologies into biomechanical research has allowed for non-contact optical measurement of the relative displacement between implant and bone in three dimensions with high accuracy and resolution for increased measurement ease and expanded research applications. For example, in a recent study, Mann et al 40 used DIC to assess micromotion in tibial components in postmortem retrieval specimens and reported a measurement error of 1.1 µm using similar point-to-point techniques as the current study.…”

Section: Discussionmentioning

confidence: 99%

Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixedversusrotating platform designs

Small

Rogge

Malinzak

et al. 2016

Bone & Joint Research

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ObjectivesInitial stability of tibial trays is crucial for long-term success of total knee arthroplasty (TKA) in both primary and revision settings. Rotating platform (RP) designs reduce torque transfer at the tibiofemoral interface. We asked if this reduced torque transfer in RP designs resulted in subsequently reduced micromotion at the cemented fixation interface between the prosthesis component and the adjacent bone.MethodsComposite tibias were implanted with fixed and RP primary and revision tibial trays and biomechanically tested under up to 2.5 kN of axial compression and 10° of external femoral component rotation. Relative micromotion between the implanted tibial tray and the neighbouring bone was quantified using high-precision digital image correlation techniques.ResultsRotational malalignment between femoral and tibial components generated 40% less overall tibial tray micromotion in RP designs than in standard fixed bearing tibial trays. RP trays reduced micromotion by up to 172 µm in axial compression and 84 µm in rotational malalignment models.ConclusionsReduced torque transfer at the tibiofemoral interface in RP tibial trays reduces relative component micromotion and may aid long-term stability in cases of revision TKA or poor bone quality.Cite this article: Mr S. R. Small. Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixed versus rotating platform designs. Bone Joint Res 2016;5:122–129. DOI: 10.1302/2046-3758.54.2000481.

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Micromotion of Cementless Tibial Baseplates: Keels with Adjuvant Pegs Offer More Stability Than Pegs Alone

Cited by 47 publications

References 31 publications

Early aseptic loosening of a mobile-bearing total knee replacement

Early aseptic loosening of a mobile-bearing total knee replacement

Primary Stability in Cementless Rotating Platform Total Knee Arthroplasty

Micromotion at the tibial plateau in primary and revision total knee arthroplasty: fixedversusrotating platform designs

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