Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses

Ryd, Leif; Albrektsson, B. E. J.; Carlsson, Lars; Dansgård, Finn; Herberts, Peter; Lindstrand, Anders; Regnér, Lars; Toksvig‐Larsen, Sören

doi:10.1302/0301-620x.77b3.7744919

Cited by 500 publications

(524 citation statements)

References 32 publications

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“…We found that early micromotion measured with RSA increased the risk of clinical failure, consistent with previous studies [4,13,14,18,19,21,26]. However, the total mean stem subsidence for the Spectron EF Primary stem at 2 years did not exceed the threshold of 0.15 mm suggested by van der Voort et al [4,13,26] despite the fact that the 10-year stem survival rate was below 95%.…”

Section: Discussionsupporting

confidence: 90%

“…Multiple studies have established the ability of radiostereometry (RSA) to predict later failure of hip [4,13,14,18,26] and knee [19,21] prostheses. Measurement of early implant migration performed with the high-resolution RSA has therefore been recommended as an important part of a stepwise introduction of new implants [15].…”

Section: Introductionmentioning

confidence: 99%

“…Measurement of early implant migration performed with the high-resolution RSA has therefore been recommended as an important part of a stepwise introduction of new implants [15]. Some studies have evaluated the predictive value of early implant migration based on followup of the same cohort of patients [13,14,21], whereas others merged short-term RSA data with data on revision rates extracted from registry studies [4,18,19]. In a recent evaluation of this kind, van der Voort et al analyzed 24 RSA studies and 56 studies on survival of cemented and uncemented hip stems [26].…”

Section: Introductionmentioning

confidence: 99%

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Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes

Johanson

Antonsson

Shareghi

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Radiostereometry (RSA) measurements of early micromotion can predict later failure in hip and knee prostheses. In hip implants, RSA has been particularly helpful in the evaluation of composite-beam stem designs. The Spectron EF Primary stem (Smith & Nephew, London, UK) has shown inferior performance compared with its predecessors in both clinical studies and registry reports. Early RSA studies have shown somewhat greater subsidence for the Spectron EF Primary stem compared with the earlier Spectron EF, but still within boundaries considered to be safe.Questions/purposes Our primary research question was whether stem subsidence and rotation for this stem design measured with RSA at 2 years can predict later stem failure. A secondary question was whether high femoral stem offset and small stem sizes, both features specific to the Spectron EF Primary stem compared with its predecessors, are associated with stem failure rate. Methods Two hundred forty-seven hips (209 patients with median age 63 years [range, 29-80 years], 65% female, and 77% primary osteoarthritis) with a valid RSA examination at 2 years were selected from four different RSA studies (totaling 279 hips in 236 patients) in our department. The studies were primarily aimed at evaluating cup fixation, bone cement, and polyethylene types. All study patients received a cemented Spectron EF Primary stem. The selected hips had complete followup until stem failure, death, or the end of the followup period. Stem failure was defined as revision of a loose femoral stem or radiological failure with significant osteolysis in Gruen zones 2 to 6. Cox regression analyses were performed to evaluate if stem subsidence and rotation after 2 years, adjusted for age, sex, stem size, standard/high stem offset, and conventional/highly crosslinked polyethylene, could predict later clinical aseptic failure of the stem. We identified 32 stem failures (27 revisions, five radiological failures) at 14 years median followup (range, 3-18 years). Ten-year stem survival was 94% (95% confidence interval [CI], 90%-96%).Results Stem subsidence at 2 years (adjusted hazard ratio [HR], 6.0; 95% CI, 2.5-15; p \ 0.001) and retrotorsion of the stem (adjusted HR, 1.7; 95% CI, 1.1-2.5; p = 0.018) were associated with later stem failure. Further risk factors were male sex (subsidence analysis HR, 6.9; p [ 0.001), use of the two smallest stem sizes (HR size 1 , 8.0; p[0.001,

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes

Johanson

Antonsson

Shareghi

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This is the threedimensional motion of the prosthetic marker, which moves the most and indicates the magnitude of the motion. Our results indicated that the all-polyethylene component has a lower MTPM and therefore the risk of revision for aseptic loosening is less in comparison with the metal-backed component [43].…”

Section: Discussionmentioning

confidence: 64%

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

Nouta

Verra

Pijls

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones. Questions/purposes We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate.Methods We systematically reviewed the literature for clinical studies comparing all-polyethylene and metalbacked tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason. Results Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Metaregression showed strong evidence that the all-polyethylene design has improved with time compared with the metalbacked design. Conclusions The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…The early fixation of total joint replacements also depends on a fracture-type response in metaphyseal bone. Increased bone formation at early stages in the healing or incorporation process might provide a better long-term prognosis due to the correlation between improved early fixation and reduced risk of late loosening [1].…”

Section: Introductionmentioning

confidence: 99%

The effects of Dickkopf-1 antibody on metaphyseal bone and implant fixation under different loading conditions

Agholme

Isaksson

Kuhstoss

et al. 2011

Bone

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The secreted protein Dickkopf-1 (Dkk1) is an antagonist of canonical Wnt signaling, expressed during fracture healing. It is unknown if it is involved in the mechanical control of bone maintenance. We investigated the response to administration of a Dkk1 neutralizing antibody (Dkk1-ab) in metaphyseal bone under different loading conditions, with or without trauma. In this three part experiment, 120 rats had a screw or bone chamber inserted either unilaterally or bilaterally in the proximal tibia. Mechanical (pull-out) testing, µCT and histology were used for evaluation. The animals were injected with either 10 mg/kg Dkk1-ab or saline every 14 days for 14, 28, or 42 days. Antibody treatment increased bone formation around the screws and improved their fixation. After 28 days, the pull-out force was increased by over 100%. In cancellous bone, the bone volume fraction was increased by 50%. In some animals, one hind limb was paralyzed with Botullinum toxin A (Botox) to create a mechanically unloaded environment. This did not increase the response to antibody treatment with regard to screw fixation, but in cancellous bone, the bone volume fraction increased by 233 %. Thus, the response in unloaded, untraumatized bone was proportionally larger, suggesting that Dkk1 may be up-regulated in unloaded bone. There was also an increase in thickness of the metaphyseal cortex. In bone chambers, the antibody treatment increased the bone volume fraction. The results suggest that antibodies blocking Dkk1 might be used to stimulate bone formation especially during implant fixation, fracture repair, or bone disuse. It also seems that Dkk1 is up-regulated both after metaphyseal trauma and after unloading, and that Dkk1 is involved in mechano-transduction.

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Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses

Cited by 500 publications

References 32 publications

Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes

Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

The effects of Dickkopf-1 antibody on metaphyseal bone and implant fixation under different loading conditions

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