The effect of periprosthetic bone loss on the failure risk of tibial total knee arthroplasty

Abstract

The effect of long‐term periprosthetic bone loss on the process of aseptic loosening of tibial total knee arthroplasty (TKA) is subject to debate. Contradicting studies can be found in literature, reporting either bone resorption or bone formation before failure of the tibial tray. The aim of the current study was to investigate the effects of bone resorption on failure of tibial TKA, by simulating clinical postoperative bone density changes in finite element analysis (FEA) models and FEA models were created of two tibiae representing cases with good and poor initial bone quality which were subjected to a walking configuration and subsequently to a traumatic stumbling load. Bone failure was simulated using a crushable foam model incorporating progressive yielding. Repetitive loading under a level walking load did not result in failure of the periprosthetic bone in neither the good nor poor bone quality tibia at the baseline bone densities. When applying a stumble load, a collapse of the tibial reconstruction was noticed in the poor bone quality model. Incorporating postoperative bone loss led to a significant increase of the failure risk, particularly for the poor bone quality model in which subsidence of the tibial component was substantial. Our results suggest bone loss can lead to an increased risk of a collapse of the tibial component, particularly in case of poor bone quality at the time of surgery. The study also examined the probability of medial or lateral subsidence of the implant and aimed to improve clinical implications. The FEA model simulated plastic deformation of the bone and implant subsidence, with further validation required via mechanical experiments.

Team Approach: Bone Health Optimization in Orthopaedic Surgery

“…Albright et al described an association between previous fragility fracture and increased susceptibility to infection after total knee arthroplasty (TKA) 26 , as bones with low density or compromised integrity possess reduced resistance to bacteria, rendering them more vulnerable to infection. Soltanihafshejani et al results showed poor bone health contributes to an increased risk of implant failure 26,27 . Implants rely on strong, healthy bone to provide optimal stability and support.…”

“…Risk factors include older age and female sex, hence the recommendation to start screening women at a younger age than men, low BMI [50][51][52][53][54] with low BMI defined as ,21 55 , a history of previous fracture, and a family history of osteoporosis 46,47 . A list of medications and medical conditions leading to increased risk of poor bone health, along with the adverse orthopaedic surgical outcomes associated with poor bone health, are outlined in Table II 2,9,[26][27][28][29][30][31][50][51][52][53][56][57][58][59][60][61][62][63][64][65][66][67] .…”

“…The risk of poor bone health is a major concern for orthopaedic surgery. Patients with osteoporosis or other bone-related conditions are at higher risk of postoperative fractures and adverse surgical outcomes 2,9,[26][27][28][29][30][31][32] . For example, Lindenberg-Larsen et al found that patients with osteoporosis were at increased risk of periprosthetic femoral fracture when undergoing THA 9 .…”

“…• Periprosthetic infection after TKA 26 • Implant failure after TKA 26,27 • Nonunion or failure of fixation after femoral neck fracture 31 • Nonunion of fractured distal radius 30 • Instrument failure and secondary subsidence after surgical treatment of spinal deformities 28 • Significantly greater rate of revision surgery, compression fracture, and/or instrument failure after spinal lumbar fusion 2…”