Removal of a Well-Fixed Trabecular Metal Monoblock Tibial Component

Klein, Gregg R.; Levine, Harlan B.; Hartzband, Mark A.

doi:10.1016/j.arth.2007.05.004

Cited by 25 publications

(14 citation statements)

References 2 publications

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“…The cementless porous tantalum component attains good and durable stability [67], with no progressive radiolucencies at the bone-implant interface observed on postoperative radiographs [20,23,30,63], and a smaller risk of early aseptic loosening than that of cemented components [14,67]. Fixation by osseointegration has been reported in the few reported revision cases of this implant [34,55,56]. We think that the absence of differences in radiologic data of our two groups, at a mid-term followup, agrees well with the small differences observed in the clinical outcomes, with an inconclusive clinical significance.…”

Section: Discussionmentioning

confidence: 90%

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Fernández-Fairén

Hernández-Vaquero

Murcia

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup. Questions/purposes We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant.Methods We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied. Results At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was À4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups. Conclusions Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.

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Section: Discussionmentioning

confidence: 90%

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Fernández-Fairén

Hernández-Vaquero

Murcia

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Despite a meticulous surgical technique and attention to minimizing metallic dispersion, postoperative radiographs showed abundant debris with potential for local inflammatory reaction and third-body wear [4].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Klein et al [4] reported the use of a broad 3-cm flat osteotome inserted at the tantalum-bone interface in four revision cases, which they suggested minimized metallic debris generation and preserved bone stock. They recommended beginning anterior to the tibial pegs.…”

Section: Discussionmentioning

confidence: 99%

“…Once the tibial pegs are encountered, firm impaction of the osteotome will separate the tibial pegs from the prosthesis. After this, the posterior tantalum-bone interface can be disrupted by careful osteotome impaction [4]. In addition, they mentioned these two fixation pegs can be left in the proximal tibia or removed, depending on clinical indication, surgeon preference, and the space required for the stem or keel of the revision tibial prosthesis [4].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Klein et al [4] recognized the potential for generation of tantalum debris during removal of well-fixed knee arthroplasty tantalum implants. It is concerning that the metallic debris potentially can seed the periarticular soft tissues and may be difficult to completely remove during surgery.…”

Section: Introductionmentioning

confidence: 99%

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Case Reports: Tantalum Debris Dispersion During Revision of a Tibial Component for TKA

Márquez

Sel

Leali

et al. 2008

Clin Orthop Relat Res

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Porous tantalum nonmodular tibial components for TKA were introduced in 1999. We revised three well-fixed tantalum tibial trays. For removal, we used osteotomes and revision oscillating saw blades. Removal of the components was laborious and resulted in generation of abundant tantalum debris that seeded the periarticular soft tissues despite meticulous protection with gauze. The retained metallic debris that is visible on postoperative radiographs has the potential for generation of third-body wear. We alert the orthopaedic community about this phenomenon and recommend minimizing the use of motorized revision instruments for removal of trabecular metal implants.

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Revisionsendoprothetik im Kniegelenksbereich

Merk

Spank²

2010

AE-Manual Der Endoprothetik

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Removal of a Well-Fixed Trabecular Metal Monoblock Tibial Component

Cited by 25 publications

References 2 publications

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Case Reports: Tantalum Debris Dispersion During Revision of a Tibial Component for TKA

Revisionsendoprothetik im Kniegelenksbereich

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