Varus Collapse in Total Knee Arthroplasty: Does Fixation or Bone Fail First?

Cox, Zach C; Green, Cody C.; Otero, Jesse E.; Mason, J. Bohannon; Martin, John R.

doi:10.1016/j.arth.2021.09.012

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Rather, a lift-off moment was used to simulate a mechanism for aseptic loosening described in the literature [45][46][47]. It was sufficiently controllable to enable research for a partial loosening state, and it produced a failure at the implant-cement interface that resembled contemporary clinical reports of tibial debonding [7][8][9][10][11][12][13][14][15][16][17][18]. The work is also limited in that only a single cementation technique for a single brand of bone-cement was studied.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, most contemporary loosening failures are mechanical in origin, initiating from the cement mantle. A bias towards failure at the implant–cement interface (tibial debonding) has been regularly reported in recent arthroplasty literature [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Indeed, a 94% failure rate at the implant–cement interface was recorded in a recent retrospective study of 149 knees that were revised for aseptic loosening [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Hall,

Cegla,

van Arkel

2024

Sensors

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Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant–cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Hall,

Cegla,

van Arkel

2024

Sensors

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“…Cox et al. demonstrated that the most common mechanisms of TKA mechanical failure were failure of the cement–implant interface and tibial varus collapse, defined as a change in component position of > 10° [ 30 ]. They advocated for use of stemmed tibial implants in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Total knee arthroplasty in patients with severe obesity: outcomes of standard keeled tibial components versus stemmed universal base plates

Elcock

MacDonald

Clement

et al. 2023

Knee Surg & Relat Res

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Background Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m2] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m2: standard keeled (SK) or universal base plate (UBP), which incorporates a stem. Methods This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m2: mean age 62.2 ± 8.0 (44–87) years, mean BMI 44.3 ± 4.6 (40–65.7) kg/m2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Results Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan–Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4–100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre. Conclusions At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m2. Varus alignment of either tibial component or the limb was associated with revision and return to theatre.

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“…Current therapeutic treatments for bone tissues include bone transplantation (e.g., autogenous bone or allogeneic bone), (Behrend et al, 2016), bone substitution materials (e.g., titanium plate), (Diwu et al, 2020), stem cell transplantation (e.g., bone marrow stem cells, bMSCs), (Benavides et al, 2021), biological agents (e.g., growth factors), (Kitaura et al, 2022), gene therapy, (Gao et al, 2022), distraction osteogenesis, (Qi et al, 2009), and barrier membrane to guide bone regeneration. (Han et al, 2018) The purposes of applying bone filling materials in guided bone regeneration (GBR) procedures are: 1) supporting the barrier film to avoid collapse; (Cox et al, 2022) 2) scaffolding for new bone to grow in from the receptive area; (Roseti et al, 2017) 3) stimulating the growth of new bone from the receptive area; (Robling and Bonewald, 2020) 4) resisting to surface soft tissue pressure; (Hao et al, 2022) 5) protecting the new bone mass and avoiding its absorption. (Cosman, 2009) Therefore, four basic characteristics of bone defect repair materials must be considered: 1) biocompatibility, 2) mechanical tolerance, 3) biodegradability, and 4) induce reproduction.…”

Section: Introductionmentioning

confidence: 99%

The biological applications of exosomal-based materials in bone/cartilage tissue engineering

Chen

Cheng²,

Zhang³

et al. 2023

Front. Mater.

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Exosomes are secreted by various cells including stem cells, dendritic cells, and tumor cells, also known as the cell-derived extracellular vesicles. Exosomes, can carry informative cargos from host cells, thus have been employed as potential nanomaterials for their multifarious biological functions in biomedical fields, such as drug and genes delivery, tumor targeting, and disease treatment. Recently, the biological applications of exosomes in bone tissue engineering have gained increasing attention. Some important progress has been made while the tissue regeneration and functional recovery of boneremain as the key challenges to be addressed. In this article, we first made a summary of exosomes and their applications in the regeneration of bone and cartilage tissue. Then, modification approaches used for exosomes to equip them with excellent capacities are summarized. Finally, current concerns and future outlooks of exosomes in bone/cartilage tissue engineering and regeneration are discussed.

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Varus Collapse in Total Knee Arthroplasty: Does Fixation or Bone Fail First?

Cited by 7 publications

References 20 publications

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Total knee arthroplasty in patients with severe obesity: outcomes of standard keeled tibial components versus stemmed universal base plates

The biological applications of exosomal-based materials in bone/cartilage tissue engineering

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