No relationship between postoperative changes in bone density at the proximal tibia and the migration of the tibial component 2 years after total knee arthroplasty

Li, Ming G.; Nilsson, Kjell

doi:10.1054/arth.2001.24376

Cited by 27 publications

(34 citation statements)

References 24 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%

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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%

“…Quality of proximal tibial bone mineral density (BMD) is a factor that may determine migration of implants after TKA [6,8,13,25]. Dual-energy xray absorptiometry (DEXA) studies suggest proximal tibial BMD declines after TKA [1,5,9,12,17,[19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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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“…Most bone loss was seen during the first postoperative year in all regions of interest as found in earlier studies. 1,2, 6 Li and Nilsson 1,2 reported that the mean BMD in all ROIs at the proximal tibia temporarily decreased by 13% during the initial 3 months after TKR. A general metabolic reaction of the skeleton to the operative trauma combined with the effect of the postoperative immobilization was speculated to cause this reduction.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Stress shielding is considered the major cause for this bone loss. Several studies have shown that the most pronounced reduction occurs during the first year after implantation.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown that the most pronounced reduction occurs during the first year after implantation. 1,2,6 According to a finite element study by Van Lenthe et al, 7 the bone resorption will continue in the distal femur for more than 2 years after TKR. Changes of BMD could influence component fixation depending on the quality of the interface.…”

Section: Introductionmentioning

confidence: 99%

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

Saari

Uvehammer

Carlsson

et al. 2007

Journal Orthopaedic Research

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After total knee replacement (TKR) the bone mineral density (BMD) decreases in the proximal tibia. Our aim was to evaluate if changes in constraint of the cemented AMK TKR (DePuy, Johnson & Johnson, Leeds, UK) had any effect on postoperative bone remodeling in the proximal tibia. We used dual-energy X-ray absorptiometry in 43-53 knees to record changes in BMD in three regions of interest around the tibial component up to 5 years after operation with the AMK (DePuy) TKR. The knees had been randomly allocated to receive a flat or a concave tibial insert with retention of the posterior cruciate ligament when preoperative deformity was less severe, and either a concave or a posterior-stabilized (PS) insert with resection of the posterior cruciate ligament when deformity was more pronounced. All designs were associated with loss of BMD in the proximal tibia. The mean bone loss varied from 5 to 23% depending on the region of interest. There were no statistically significant differences between the groups, and the alteration of tibial insert constraint did not influence the bone remodeling. However, low precision values may have impaired the detection of differences. ß

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Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study

Anijs¹,

Eemers²,

Minoda

et al. 2021

J Biomed Mater Res

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Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain-adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values.Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain-adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject-specific comparisons using followup CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.

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No relationship between postoperative changes in bone density at the proximal tibia and the migration of the tibial component 2 years after total knee arthroplasty

Cited by 27 publications

References 24 publications

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

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

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

Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study

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