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Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements?
Aseptic tibial loosening is a frequent cause of long-term failure following primary cemented total knee replacement. Failure of the tibial implant can occur at the implant-cement interface or at the cement-bone interface. Currently, it is unknown at which interface failure occurs in cases of aseptic...
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Published in: | The Journal of arthroplasty 2021-07, Vol.36 (7), p.2497-2501 |
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creator | Martin, J. Ryan Otero, Jesse E. Mason, J. Bohannon Fehring, Thomas K. |
description | Aseptic tibial loosening is a frequent cause of long-term failure following primary cemented total knee replacement. Failure of the tibial implant can occur at the implant-cement interface or at the cement-bone interface. Currently, it is unknown at which interface failure occurs in cases of aseptic tibial loosening. The following study was designed to determine which interface represents the “weak link” for tibial implant fixation.
We performed a retrospective analysis of 149 patients who were revised secondary to aseptic tibial loosening at our institution from 2005 to 2017. Operative reports and radiographs were reviewed on each patient to determine the location and pattern of fixation failure.
Implant failure was more prevalent at the implant-cement than cement-bone interface, 140/149 (94.0%) vs 9/149 (6.0%). Additionally, we noted 2 distinct patterns of failure in patients that loosened at the implant-cement interface. Ninety of 140 (64.3%) patients developed varus collapse pattern of failure. Forty-nine of 140 (35.0%) patients developed failure between the implant-cement interface without angulation. All 149 patients had heterotopic bone formation anterior to the tibial baseplate, which was consistent regardless of which interface failed.
The most frequent interface failure identified in our study was at the implant-cement interface, 140/149 (94.0%). This finding has substantial clinical ramifications. Because failure was predominantly at the implant-cement interface there may be design opportunities for increasing implant fixation to cement. Implants with improved undersurface tibial tray features may be necessary to mitigate the risk of failure at this interface, especially in overly active patients or those with elevated body mass indices. |
doi_str_mv | 10.1016/j.arth.2021.02.029 |
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We performed a retrospective analysis of 149 patients who were revised secondary to aseptic tibial loosening at our institution from 2005 to 2017. Operative reports and radiographs were reviewed on each patient to determine the location and pattern of fixation failure.
Implant failure was more prevalent at the implant-cement than cement-bone interface, 140/149 (94.0%) vs 9/149 (6.0%). Additionally, we noted 2 distinct patterns of failure in patients that loosened at the implant-cement interface. Ninety of 140 (64.3%) patients developed varus collapse pattern of failure. Forty-nine of 140 (35.0%) patients developed failure between the implant-cement interface without angulation. All 149 patients had heterotopic bone formation anterior to the tibial baseplate, which was consistent regardless of which interface failed.
The most frequent interface failure identified in our study was at the implant-cement interface, 140/149 (94.0%). This finding has substantial clinical ramifications. Because failure was predominantly at the implant-cement interface there may be design opportunities for increasing implant fixation to cement. Implants with improved undersurface tibial tray features may be necessary to mitigate the risk of failure at this interface, especially in overly active patients or those with elevated body mass indices.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2021.02.029</identifier><identifier>PMID: 33676813</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>aseptic failure ; aseptic loosening ; aseptic tibial loosening ; revision total knee ; total knee arthroplasty</subject><ispartof>The Journal of arthroplasty, 2021-07, Vol.36 (7), p.2497-2501</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-323264f92d71b08c1bc132bdf049fdb587f280d4c0fe8836b19bd0f9e50b82393</citedby><cites>FETCH-LOGICAL-c356t-323264f92d71b08c1bc132bdf049fdb587f280d4c0fe8836b19bd0f9e50b82393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33676813$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martin, J. Ryan</creatorcontrib><creatorcontrib>Otero, Jesse E.</creatorcontrib><creatorcontrib>Mason, J. Bohannon</creatorcontrib><creatorcontrib>Fehring, Thomas K.</creatorcontrib><title>Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements?</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Aseptic tibial loosening is a frequent cause of long-term failure following primary cemented total knee replacement. Failure of the tibial implant can occur at the implant-cement interface or at the cement-bone interface. Currently, it is unknown at which interface failure occurs in cases of aseptic tibial loosening. The following study was designed to determine which interface represents the “weak link” for tibial implant fixation.
We performed a retrospective analysis of 149 patients who were revised secondary to aseptic tibial loosening at our institution from 2005 to 2017. Operative reports and radiographs were reviewed on each patient to determine the location and pattern of fixation failure.
Implant failure was more prevalent at the implant-cement than cement-bone interface, 140/149 (94.0%) vs 9/149 (6.0%). Additionally, we noted 2 distinct patterns of failure in patients that loosened at the implant-cement interface. Ninety of 140 (64.3%) patients developed varus collapse pattern of failure. Forty-nine of 140 (35.0%) patients developed failure between the implant-cement interface without angulation. All 149 patients had heterotopic bone formation anterior to the tibial baseplate, which was consistent regardless of which interface failed.
The most frequent interface failure identified in our study was at the implant-cement interface, 140/149 (94.0%). This finding has substantial clinical ramifications. Because failure was predominantly at the implant-cement interface there may be design opportunities for increasing implant fixation to cement. Implants with improved undersurface tibial tray features may be necessary to mitigate the risk of failure at this interface, especially in overly active patients or those with elevated body mass indices.</description><subject>aseptic failure</subject><subject>aseptic loosening</subject><subject>aseptic tibial loosening</subject><subject>revision total knee</subject><subject>total knee arthroplasty</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kMFqGzEQhkVJaRy3L9BD0TGXdUbS7lqCQgmmTkMMhZAS6EXsSiMsZ3flSOvQ3PIg6cvlSbKOnRwDPwzD_PPD_xHylcGEAStPVpMq9ssJB84mwAepD2TECsEzmUN5QEYgpciKHMQhOUppBcBYUeSfyKEQ5bSUTIzI3-slRqTnifZLpE8Pj9dY3dCF726eHv7T4Ojc_6t6HzrqOzoLXY_tOsQq3tMZtjisll6FvmroRYdIL3HdVOblkH58Jh9d1ST8sp9j8mf-82r2K1v8PjufnS4yI4qyzwQXvMyd4nbKapCG1YYJXlsHuXK2LuTUcQk2N-Bw6FPWTNUWnMICasmFEmNyvMtdx3C7wdTr1ieDTVN1GDZJ81xJpaYqF4OV76wmhpQiOr2Ovh3aaAZ6y1Sv9Jap3jLVwAdt87_t8zd1i_bt5RXiYPi-M-DQ8s5j1Ml47AxaH9H02gb_Xv4zc7SI-g</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Martin, J. Ryan</creator><creator>Otero, Jesse E.</creator><creator>Mason, J. Bohannon</creator><creator>Fehring, Thomas K.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210701</creationdate><title>Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements?</title><author>Martin, J. Ryan ; Otero, Jesse E. ; Mason, J. Bohannon ; Fehring, Thomas K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-323264f92d71b08c1bc132bdf049fdb587f280d4c0fe8836b19bd0f9e50b82393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>aseptic failure</topic><topic>aseptic loosening</topic><topic>aseptic tibial loosening</topic><topic>revision total knee</topic><topic>total knee arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martin, J. Ryan</creatorcontrib><creatorcontrib>Otero, Jesse E.</creatorcontrib><creatorcontrib>Mason, J. Bohannon</creatorcontrib><creatorcontrib>Fehring, Thomas K.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martin, J. Ryan</au><au>Otero, Jesse E.</au><au>Mason, J. Bohannon</au><au>Fehring, Thomas K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements?</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>36</volume><issue>7</issue><spage>2497</spage><epage>2501</epage><pages>2497-2501</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Aseptic tibial loosening is a frequent cause of long-term failure following primary cemented total knee replacement. Failure of the tibial implant can occur at the implant-cement interface or at the cement-bone interface. Currently, it is unknown at which interface failure occurs in cases of aseptic tibial loosening. The following study was designed to determine which interface represents the “weak link” for tibial implant fixation.
We performed a retrospective analysis of 149 patients who were revised secondary to aseptic tibial loosening at our institution from 2005 to 2017. Operative reports and radiographs were reviewed on each patient to determine the location and pattern of fixation failure.
Implant failure was more prevalent at the implant-cement than cement-bone interface, 140/149 (94.0%) vs 9/149 (6.0%). Additionally, we noted 2 distinct patterns of failure in patients that loosened at the implant-cement interface. Ninety of 140 (64.3%) patients developed varus collapse pattern of failure. Forty-nine of 140 (35.0%) patients developed failure between the implant-cement interface without angulation. All 149 patients had heterotopic bone formation anterior to the tibial baseplate, which was consistent regardless of which interface failed.
The most frequent interface failure identified in our study was at the implant-cement interface, 140/149 (94.0%). This finding has substantial clinical ramifications. Because failure was predominantly at the implant-cement interface there may be design opportunities for increasing implant fixation to cement. Implants with improved undersurface tibial tray features may be necessary to mitigate the risk of failure at this interface, especially in overly active patients or those with elevated body mass indices.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33676813</pmid><doi>10.1016/j.arth.2021.02.029</doi><tpages>5</tpages></addata></record> |
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subjects | aseptic failure aseptic loosening aseptic tibial loosening revision total knee total knee arthroplasty |
title | Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements? |
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