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On New Implants - The results of five prospective, randomized RSA trials with aspects on phased introduction and continuous migration

Molt, Mats LU (2014) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2014:137.
Abstract
A concern that arises with any change in design or operative technique is whether it affects the long-term implant stability or not. One way to address this is, by measuring early micromotion, to predict the future revision rate. This study was set to evaluate the early migration and the functional outcome of the Triathlon™ total knee arthroplasty system in different subsets of design. In addition, two methods of predicting the risk of future revision were investigated.

Each paper consisted of 60 patients, prospectively randomized into two groups. The three-dimensional tibia component migration was measured by radiostereometric analysis at three months and at one, two, and also at five years in Paper VI. Clinical outcome was... (More)
A concern that arises with any change in design or operative technique is whether it affects the long-term implant stability or not. One way to address this is, by measuring early micromotion, to predict the future revision rate. This study was set to evaluate the early migration and the functional outcome of the Triathlon™ total knee arthroplasty system in different subsets of design. In addition, two methods of predicting the risk of future revision were investigated.

Each paper consisted of 60 patients, prospectively randomized into two groups. The three-dimensional tibia component migration was measured by radiostereometric analysis at three months and at one, two, and also at five years in Paper VI. Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score, with an addition of EQ-5D in Paper II, at three months and one and two years.

Comparisons were made between the Triathlon™ vs its predecessor the Duracon® total knee prosthesis (Papers I and VI), with vs without perioperative tourniquet (Paper II), the posterior stabilized vs the cruciate retaining design (Paper III), the non-cemented press fit vs Peri-Apatite designs (Paper IV) and the standard tibia stem design vs the short stem (Paper V).

There was no difference in mean maximum total point motion (MTPM), when comparing groups over two (Papers I-III, V) or five years (Paper VI), except for the mean MTPM reported in Paper IV. There was no major difference in patient related outcome.

The predicted future risk of revision for all designs was a > 5 % risk of revision at ten years when analyzed at one year according to Pijls et al., and < 5 % when analyzed at two years according to Ryd et al. (Ryd, Albrektsson et al. 1995, Pijls, Valstar et al. 2012).

The five year result of continuous migration (Paper VI) concluded that the cemented Triathlon™ CR is as safe to use as its predecessor, the Duracon® (< 5 %).

Key words

New total knee arthroplasty, TKA, RSA, randomized, prospective, prediction, continuously migrating, safety, stability CR, PS, PF, PA, short stem, tourniquet. (Less)
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author
supervisor
opponent
  • professor Weidenhielm, Lars, KI
organization
publishing date
type
Thesis
publication status
published
subject
keywords
New total knee arthroplasty, TKA, RSA, randomized, prospective, prediction, continuously migrating, safety, stability CR, PS, PF, PA, short stem, tourniquet
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2014:137
pages
102 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Kulturhuset i Hässleholm
defense date
2014-12-11 13:30
ISSN
1652-8220
ISBN
978-91-7619-066-1
language
English
LU publication?
yes
id
5606734e-b95e-4dde-b3f4-8cc6dd63d349 (old id 4778617)
date added to LUP
2014-11-12 07:45:19
date last changed
2016-09-19 08:44:47
@phdthesis{5606734e-b95e-4dde-b3f4-8cc6dd63d349,
  abstract     = {A concern that arises with any change in design or operative technique is whether it affects the long-term implant stability or not. One way to address this is, by measuring early micromotion, to predict the future revision rate. This study was set to evaluate the early migration and the functional outcome of the Triathlon™ total knee arthroplasty system in different subsets of design. In addition, two methods of predicting the risk of future revision were investigated.<br/><br>
Each paper consisted of 60 patients, prospectively randomized into two groups. The three-dimensional tibia component migration was measured by radiostereometric analysis at three months and at one, two, and also at five years in Paper VI. Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score, with an addition of EQ-5D in Paper II, at three months and one and two years.<br/><br>
Comparisons were made between the Triathlon™ vs its predecessor the Duracon® total knee prosthesis (Papers I and VI), with vs without perioperative tourniquet (Paper II), the posterior stabilized vs the cruciate retaining design (Paper III), the non-cemented press fit vs Peri-Apatite designs (Paper IV) and the standard tibia stem design vs the short stem (Paper V).<br/><br>
There was no difference in mean maximum total point motion (MTPM), when comparing groups over two (Papers I-III, V) or five years (Paper VI), except for the mean MTPM reported in Paper IV. There was no major difference in patient related outcome.<br/><br>
The predicted future risk of revision for all designs was a &gt; 5 % risk of revision at ten years when analyzed at one year according to Pijls et al., and &lt; 5 % when analyzed at two years according to Ryd et al. (Ryd, Albrektsson et al. 1995, Pijls, Valstar et al. 2012).<br/><br>
The five year result of continuous migration (Paper VI) concluded that the cemented Triathlon™ CR is as safe to use as its predecessor, the Duracon® (&lt; 5 %).<br/><br>
Key words<br/><br>
New total knee arthroplasty, TKA, RSA, randomized, prospective, prediction, continuously migrating, safety, stability CR, PS, PF, PA, short stem, tourniquet.},
  author       = {Molt, Mats},
  isbn         = {978-91-7619-066-1},
  issn         = {1652-8220},
  keyword      = {New total knee arthroplasty,TKA,RSA,randomized,prospective,prediction,continuously migrating,safety,stability CR,PS,PF,PA,short stem,tourniquet},
  language     = {eng},
  pages        = {102},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {On New Implants - The results of five prospective, randomized RSA trials with aspects on phased introduction and continuous migration},
  volume       = {2014:137},
  year         = {2014},
}