Reasons for failure in primary total knee arthroplasty - An analysis of prospectively collected registry data

Mathis, Dominic T.; Löhrer, L.; Amsler, Felix; Hirschmann, Michael T.

doi:10.1016/j.jor.2020.12.008

Cited by 23 publications

(27 citation statements)

References 46 publications

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“…It is also noticeable that surgeon 1 stated several reasons for revisions in most patients, while surgeon 2 gave only one reason at a time. Thus, the surgeon and his clinical setting represents a possible bias that may explain differences in the respective indications for TKA revision [ 23 ]. However, it is pure speculation whether the reason for revision depends on the surgeon of the primary TKA, the surgical technique, the patient or the prosthesis itself.…”

Section: Discussionmentioning

confidence: 99%

Comparative retrieval analysis of antioxidant polyethylene: bonding of vitamin-E does not reduce in-vivo surface damage

Mathis

Schmidli

Hirschmann

et al. 2021

BMC Musculoskelet Disord

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Background With the Persona® knee system a new polyethylene formulation incorporating vitamin-E which aims to reduce oxidation and maintain wear resistance was introduced. Although in-vitro studies have demonstrated positive effects of the vitamin-E antioxidants on UHMWPE, no retrieval study has looked at polyethylene damage of this system yet. It was the aim to investigate the in-vivo performance of this new design, by comparing it with its predecessor in retrieval analysis. Methods 15 NexGen® and 8 Persona® fixed-bearing implants from the same manufacturer (Zimmer Biomet) were retrieved from two knee revision centres. For retrieval analysis, a macroscopic analysis of polyethylene using a peer-reviewed damage grading method was used (Hood-score). The roughness of all articulating metal components was measured using a contact profilometer. The reason(s) for TKA revision were recorded. Statistical analyses (t-test) were performed to investigate differences between the two designs. Results The mean Hood score for Persona® inserts was 109.3 and for NexGen® 115.1 without significant differences between the two designs. Results from the profilometer revealed that Persona® and NexGen® femoral implants showed an identical mean surface roughness of 0.14 μm. The Persona® tibial tray showed a significantly smoother surface (0.06 μm) compared to the NexGen® (0.2 μm; p < 0.001). Both Hood score and surface roughness were influenced by the reasons for revision (p < 0.01). Conclusions The bonding of the antioxidant vitamin-E to the PE chain used in the novel Persona® knee system does not reduce in-vivo surface damage compared to highly crosslinked PE without supplemented vitamin-E used in its predecessor knee system NexGen®. However, the Persona® titanium alloy tibial tray showed a significantly smoother surface in comparison to the NexGen® titanium alloy tibial tray. This study provides first retrieval findings of a novel TKA design and may help to understand how the new Persona® anatomic knee system performs in vivo.

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Section: Discussionmentioning

confidence: 99%

Comparative retrieval analysis of antioxidant polyethylene: bonding of vitamin-E does not reduce in-vivo surface damage

Mathis

Schmidli

Hirschmann

et al. 2021

BMC Musculoskelet Disord

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“…In most registries, aseptic loosening and infection followed by instability lead the list of TKA failures. An explanation for this distribution of frequencies might be the standardized, diagnostic work-up of our patients including routinely performed conventional and stress radiographs as well as 3D-SPECT/CT scans [ 26 ]. The latter was used to determine the specific component position in three radiological planes in all patients included.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, all possible causes for pain are systematically evaluated and in- or excluded in the course of the diagnostic process. It is, therefore, not surprising, that in most patients (91.6%), more than one pathology was found and TKA component-, instability- and patella-related problems are heading the list [ 26 ]. These findings correspond to the results of Hofmann et al who found also high proportions of component- (54%) or alignment-related (41%) failure modes when malalignment were routinely examined [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Mathis

Tschudi

Amsler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The diagnostic process in patients after painful total knee arthroplasty (TKA) is challenging. The more clinical and radiological information about a patient with pain after TKA is included in the assessment, the more reliable and sustainable the advice regarding TKA revision can be. The primary aim was to investigate the position of TKA components and evaluate bone tracer uptake (BTU) using pre-revision SPECT/CT and correlate these findings with previously published pain patterns in painful patients after TKA. Methods A prospectively collected cohort of 83 painful primary TKA patients was retrospectively evaluated. All patients followed a standardized diagnostic algorithm including 99m-Tc-HDP-SPECT/CT, which led to a diagnosis indicating revision surgery. Pain character, location, dynamics and radiation were systematically assessed as well as TKA component position in 3D-CT. BTU was anatomically localized and quantified using a validated localization scheme. Component positioning and BTU were correlated with pain characteristics using non-parametric Spearman correlations (p < 0.05). Results Based on Spearman’s rho, significant correlations were found between pain and patients characteristics and SPECT/CT findings resulting in nine specific patterns. The most outstanding ones include: Pattern 1: More flexion in the femoral component correlated with tender/splitting pain and patella-related pathologies. Pattern 3: More varus in the femoral component correlated with dull/heavy and tingling/stinging pain during descending stairs, unloading and long sitting in patients with high BMI and unresurfaced patella. Pattern 6: More posterior slope in the tibial component correlated with constant pain. Conclusion The results of this study help to place component positioning in the overall context of the "painful knee arthroplasty" including specific pain patterns. The findings further differentiate the clinical picture of a painful TKA. Knowing these patterns enables a prediction of the cause of the pain to be made as early as possible in the diagnostic process before the state of pain becomes chronic. Level of evidence Level III

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“…In the United States, about 20% of revision TKA procedures are performed due to mechanical loosening 2 . The main reason for this loosening is a malalignment of the prosthesis, resulting in a change in the kinematics of the tibiofemoral and patellofemoral joint 3,4 . Gasparini et al 5 have already pointed out the problem of patellar alignment measuring the forces involved in knee flexion.…”

Section: Introductionmentioning

confidence: 99%

Lift-off reduction and patella tracking in Total Knee Arthroplasty (TKA) using a 3D printed patient-specific knee model

Mercader

Ostner

Küppers

et al. 2021

Preprint

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The patellofemoral joint is greatly influenced by the geometry and position of the femur during knee flexion. After knee replacement surgery, the joint geometry is changed by the surface replacement and its kinematics by the orientation of the cutting planes planned by the surgeon. The technique presented in this study verifies the compatibility of the cutting method during total knee arthroplasty (TKA) with the geometry of the joint and the kinematics of knee flexion. To confirm the benefit of this method, three patient-specific knee models were printed in 3D. All models were made from the patient’s CT data and the patient’s measurement of flexion motion obtained with an infrared stereo camera. The models are operated according to three different techniques: Kinematic Alignment (KA), Measured Resection (MR) with 3 degrees of external rotation and MR with 9 degrees of external rotation. The resulting postoperative knees from the different alignment techniques are compared to the patient’s preoperative knee. The results show that the movement of the patella is modified after surgery on the model. The different alignments also lead to a variation in the behavior of the tibiofemoral joint. Based on these three examples, MR with an external orientation of the prosthesis results in a patellar movement closer to the preoperative movement. The KA method also reproduces the patella movement almost identically, but a lift-off appears at the tibiofemoral joint. The error observed for each cutting method between the pre-and postoperative patella position varies by a maximum of 5 degrees of rotation and 5 mm of translation, showing that the configuration has an overall small impact on the patellar movement. This study of three cases shows the importance of the preparation of the operation and the adjustment of the prosthesis for each specific patient using the 3D printed model.

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Reasons for failure in primary total knee arthroplasty - An analysis of prospectively collected registry data

Cited by 23 publications

References 46 publications

Comparative retrieval analysis of antioxidant polyethylene: bonding of vitamin-E does not reduce in-vivo surface damage

Comparative retrieval analysis of antioxidant polyethylene: bonding of vitamin-E does not reduce in-vivo surface damage

Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

Lift-off reduction and patella tracking in Total Knee Arthroplasty (TKA) using a 3D printed patient-specific knee model

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