Periprosthetic tibial bone mineral density changes after total knee arthroplasty

Jaroma, Antti; Soininvaara, Tarja; Kröger, Heikki

doi:10.3109/17453674.2016.1173982

Cited by 45 publications

(45 citation statements)

References 24 publications

(34 reference statements)

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“…Trabecular bone distal to metal-backed tibial trays has been shown to be more stress shielded than all-polyethylene implants using computational modeling (Thompson, Yohuno et al 2015). Changes in peri-prosthetic tibial bone density may not always lead to complications, with good clinical outcomes achievable (Jaroma, Soininvaara et al 2016). The importance of the cement-bone interface in achieving stable initial fixation cannot however be understated.…”

Section: Introductionmentioning

confidence: 99%

A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service

Srinivasan¹,

Miller

Mann

et al. 2017

Journal of Biomechanics

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Post-operative changes in trabecular bone morphology at the cement-bone interface can vary depending on time in service. This study aims to investigate how micromotion and bone strains change at the tibial bone-cement interface before and after cementation. This work discusses whether the morphology of the post-mortem interface can be explained by studying changes in these mechanical quantities. Three post-mortem cement-bone interface specimens showing varying levels of bone resorption (minimal, extensive and intermediate) were selected for this study Using image segmentation techniques, masks of the post-mortem bone were dilated to fill up the mould spaces in the cement to obtain the immediately post-operative situation. Finite element (FE) models of the post-mortem and post-operative situation were created from these segmentation masks. Subsequent removal of the cement layer resulted in the pre-operative situation. FE micromotion and bone strains were analyzed for the interdigitated trabecular bone. For all specimens micromotion increased from the post-operative to the post-mortem models (distally, in specimen 1: 0.1 to 0.5 μm; specimen 2: 0.2 to 0.8 μm; specimen 3: 0.27 to 1.62 μm). Similarly bone strains were shown to increase from post-operative to post-mortem (distally, in specimen 1: −185 to −389 με; specimen 2: −170 to −824 με; specimen 3: −216 to −1024 με). Post-mortem interdigitated bone was found to be strain shielded in comparison with supporting bone indicating that failure of bone would occur distal to the interface. These results indicate that stress shielding of interdigitated trabeculae is a plausible explanation for resorption patterns observed in post-mortem specimens.

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Section: Introductionmentioning

confidence: 99%

A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service

Srinivasan¹,

Miller

Mann

et al. 2017

Journal of Biomechanics

View full text Add to dashboard Cite

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“…After TKA, the bone density around the prosthesis decreased, and the medial side decreased more than the lateral side. In fact, the decrease in BMD following TKA had been widely reported and was generally believed to be the result of a biomechanical response to stress shielding of the tibial component [8,[22][23][24][25][26]. Surgery altered the intra-articular environment and osteotomy exposed cancellous bone.…”

Section: Discussionmentioning

confidence: 99%

“…The signi cant in uence of activity level on rBMD after 1 and 3 years could be attributed to adaptive bone remodeling and changes in load, as Jaroma, A et al reported that tibial metaphyseal periprosthetic bone was remodeled after TKA due to mechanical axis correction [8]. However, the postoperative activity level had no signi cant effect on BMD after 5 years.…”

Section: Discussionmentioning

confidence: 99%

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Effect of activity level after a posterior-stabilized TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone: a five-year follow-up study

Liu

et al. 2020

Preprint

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Background: The aim of this study was to evaluate the effect of activity level after a posterior-stabilized TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone. Methods: A retrospective review identified 121 patients (121 knees，19 men/102 women) that underwent PS TKA with 5-year follow-up. Patients activity level was evaluated by University of California Los Angeles (UCLA) activity score, and the relative BMD in periprosthetic tibial bone was measured by ImageJ software on anteroposterior X-ray images. Clinical assessments included Western Ontario and McMaster Universities (WOMAC), Knee Society, VAS score and UCLA activity score. Nonlinear regression analysis was used to assess the impact of activity levels on periprosthesis bone density.Results: Activity level significantly affected rBMD in the proximal tibia, with the smallest reduction in rBMD observed with moderate activity. The difference in rBMD% between the lateral and medial metaphysis was significant. The regions with a significant difference in rBMD% between the lateral and medial metaphysis were closest to the base plate of the prosthesis. The lateral and medial regions closest to the stem of the prosthesis showed no significant difference in rBMD%.Conclusions: We found that activity level had a significant effect on radiographic measurements of BMD at 1 and 3 years but not at 5 years and moderate activity was associated with a minimal reduction in proximal tibial BMD.

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“…Postoperative changes in the periprosthetic bone density in the tibia are closely related to the outcomes of TKA. Several studies [4][5][6][7] have reported a reduction in BMD in the proximal tibia after TKA, which can cause the subsidence of some components, especially of the tibial plateau, and increase the risk of prosthetic loosening and further revision.…”

Section: Introductionmentioning

confidence: 99%

Effect of activity level after TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone: a five-year follow-up study

Liu

et al. 2020

Preprint

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Background To suggest the best activity level to guide clinical rehabilitation by evaluating the effect of activity level on BMD in the proximal tibia 5 years after TKA. Methods In 121 patients, the UCLA activity rating was evaluated, and the relative BMD in periprosthetic tibial bone was measured by ImageJ software on anteroposterior X-ray images. ANOVA, chi-squared test, paired t test and nonlinear regression were used for data analysis. Results Activity level significantly affected rBMD in the proximal tibia, with the smallest reduction in rBMD observed with moderate activity. The difference in rBMD% between the lateral and medial metaphysis was significant. The regions with a significant difference in rBMD% between the lateral and medial metaphysis were closest to the base plate of the prosthesis. The lateral and medial regions closest to the stem of the prosthesis showed no significant difference in rBMD%. Conclusions Moderate-intensity functional exercise is recommended within 3 years after TKA.

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Periprosthetic tibial bone mineral density changes after total knee arthroplasty

Cited by 45 publications

References 24 publications

A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service

A modelling approach demonstrating micromechanical changes in the tibial cemented interface due to in vivo service

Effect of activity level after a posterior-stabilized TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone: a five-year follow-up study

Effect of activity level after TKA on the relative bone mineral density measured on standard radiographs in periprosthetic tibial bone: a five-year follow-up study

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