Periprosthetic bone remodelling after total knee arthroplasty: early assessment by dual energy X-ray absorptiometry

Karbowski, A.; Schwitalle, M.; Eckardt, Anke; Heine, J.

doi:10.1007/s004020050419

Cited by 51 publications

(39 citation statements)

References 9 publications

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“…The same effect occurred in valgus knees. Studies with controls [5,6,9,20] have found no evidence of BMD change either in the contralateral knee or spine after TKA. This implies a local effect attributable to the implant and changes in mechanical alignment as opposed to a global BMD change.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

“…Dual-energy xray absorptiometry (DEXA) studies suggest proximal tibial BMD declines after TKA [1,5,9,12,17,[19][20][21]. However, it is not clear whether there are differences in BMD changes between cortical and cancellous bone.…”

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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“…Some authors [4,11] found significant bone density decrease in the periprosthetic tibial area during the followup. Tibial bone loss can be caused by load changes on the metaphyseal bone, and long-term studies show that after an initial stable period, the bone density of the proximal tibia consistently decreased at a rate of 5% per year [6].…”

Section: Discussionmentioning

confidence: 99%

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Hernández-Vaquero

García-Sandoval

Fernández-Carreira

et al. 2006

International Orthopaedics (SICO

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We prospectively measured the changes in bone mineral density (BMD) in the proximal tibia of 20 total knee arthroplasties, ten with cruciform stems and ten with cylindrical stems. The measurements were made one, four and seven years after surgery. We observed a uniform density decrease in three regions of interest from one to seven years of follow-up. Cylindrical stems showed an asymmetrical density decrease between the three regions of interest, with no change in the central region, a slight decrease in the lateral region, and large decrease in the medial region. Multivariate analysis with general linear model showed the stem type factor as statistically significant for medial region of interest (p=0.006). The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component. Résumé Nous avons de façon prospective mesuré les modifications de la densité minérale osseuse (BMD) au niveau de la partie proximale du tibia chez 20 patients ayant bénéficié d'une prothèse totale du genou, 10 avec une quille cruciforme et 10 avec une quille cylindrique. Les mesures ont été réalisées de 1.4 à 7 ans après l'intervention chirurgicale. Nous avons observé une diminution uniforme de la densité minérale osseuse dans trois zones, durant cette période de 1 à 7 ans de suivi. La quille cylindrique montre que la densité minérale osseuse diminue de façon asymé-trique dans ces 3 régions sans modification au niveau de la région centrale, avec une légère diminution de la région externe (latérale) et une diminution plus importante de la région interne (médiale). Une analyse de régression multi variable montre que le type de quille est l'élément le plus significatif au niveau de la région interne (p=0.006). La quille cylindrique étant un facteur statistiquement significatif et entraînant des modifications hétérogènes de la BMD, sous le plateau tibial. Ces modifications peuvent être un risque potentiel de migration du composant tibial.

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“…However, the quantitative evaluation of periprosthetic bone density is unreliable on plain radiographs. Changes in bone density must exceed 20-50% in order to be visually observable on standard radiographs (Mintzer et al 1990, Robertson et al 1994, Petersen et al 1995, Lewis et al 1998, Karbowski et al 1999, Spittlehouse et al 1999, Soininvaara et al 2000.…”

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confidence: 99%

Periprosthetic tibial bone mineral density changes after total knee arthroplastyOne-year follow-up study of 69 patients

Soininvaara

Miettinen

Jurvelin

et al. 2004

Acta Orthopaedica Scandinavica

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Background The critical structure supporting the prosthetic components in total knee arthroplasty (TKA) is tibial trabecular bone. The quality of tibial bone can be evaluated by bone mineral density (BMD) measurements.Patients and methods We prospectively measured changes in BMD in the proximal tibia after cemented TKA in osteoarthrotic knees. 69 patients were scanned by dual-energy X-ray absorptiometry (DXA) within a week after surgery, and after 3, 6 and 12 months.Results At baseline, the medial region of interest (ROI) BMD was higher in the varus knees than in the valgus aligned knees (p = 0.02). The medial metaphyseal ROI showed a decrease in BMD during the follow-up in preoperatively varus knee joints (p < 0.001). In preoperatively valgus knees, there was a slight increase in medial compartment BMD which was not significant (p = 0.2). Alignment correction in both groups showed bone remodeling giving similar medial and lateral BMD values, suggesting that the bone became equally strong in both compartments of the metaphysis. There was no association between increasing American Knee Society (AKS) scores and bone remodeling.Interpretation We suggest that this remodeling is caused by postoperative changes in tibial loading. Our results support the clinical importance of recreating proper valgus alignment of the knee joint in the TKA operation, thus possibly providing better conditions for longevity of the tibial component.

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Periprosthetic bone remodelling after total knee arthroplasty: early assessment by dual energy X-ray absorptiometry

Cited by 51 publications

References 9 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

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Periprosthetic tibial bone mineral density changes after total knee arthroplastyOne-year follow-up study of 69 patients

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