Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up
(2021) In Knee Surgery and Related Research 33(1).- Abstract
Background: Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years. Methods: This was a prospective longitudinal... (More)
Background: Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years. Methods: This was a prospective longitudinal cohort study of 29 patients (number of female/male patients 17/12, mean age 65.2 years), received a hybrid Persona® TKA (Zimmer Biomet, Warsaw, IN, USA) consisting of a cemented tibial, an all-polyethylene patella, and uncemented trabecular metal femoral components. Follow up: preoperative, 1 week, and 3, 6, 12 and 24 months after surgery, and double examinations for RSA and DXA were performed at 12 months. RSA results were presented as maximal total point of motion (MTPM) and segmental motion (translation and rotation), and DXA results were presented as changes in BMD in different regions of interest (ROI). Results: MTPM at 3, 6, 12, and 24 months was 0.65 mm, 0.84 mm, 0.92 mm, and 0.96 mm for the femoral component and 0.54 mm, 0.60 mm, 0.64 mm, and 0.68 mm, respectively, for the tibial component. The highest MTPM occurred within the first 3 months. Afterwards most of the curves flattened and stabilized. Between 12 and 24 months after surgery, 16% of femoral components had migrated by more than 0.10 mm and 15% of tibial components had migrated by more than 0.2 mm. Percentage change in BMD in each ROI for distal femur was as follows: ROI I 26.7%, ROI II 9.2% and ROI III 3.3%. BMD and at the proximal tibia: ROI I 8.2%, ROI II 8.6% and ROI III 7.0% after 2 years compared with 1 week postoperative results. There was no significant correlation between maximal percentwise change in BMD and MTPM after 2 years. Conclusion: Migration patterns and changes in BMD related to femoral components after TKA in our study correspond well with previous studies; we observed marginally greater migration with the tibial component.
(Less)
- author
- Yilmaz, Müjgan ; Holm, Christina Enciso ; Lind, Thomas ; Flivik, Gunnar LU ; Odgaard, Anders and Petersen, Michael Mørk
- organization
- publishing date
- 2021-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- DXA, MBRSA, Persona®, Total knee arthroplasty, Total knee replacement
- in
- Knee Surgery and Related Research
- volume
- 33
- issue
- 1
- article number
- 25
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85112757776
- pmid:34404487
- ISSN
- 2234-0726
- DOI
- 10.1186/s43019-021-00111-5
- language
- English
- LU publication?
- yes
- id
- 7c4f9ac9-7b14-4d67-869c-5e8dae2cdbdc
- date added to LUP
- 2021-09-03 11:40:43
- date last changed
- 2024-06-15 15:35:25
@article{7c4f9ac9-7b14-4d67-869c-5e8dae2cdbdc,
abstract = {{<p>Background: Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years. Methods: This was a prospective longitudinal cohort study of 29 patients (number of female/male patients 17/12, mean age 65.2 years), received a hybrid Persona® TKA (Zimmer Biomet, Warsaw, IN, USA) consisting of a cemented tibial, an all-polyethylene patella, and uncemented trabecular metal femoral components. Follow up: preoperative, 1 week, and 3, 6, 12 and 24 months after surgery, and double examinations for RSA and DXA were performed at 12 months. RSA results were presented as maximal total point of motion (MTPM) and segmental motion (translation and rotation), and DXA results were presented as changes in BMD in different regions of interest (ROI). Results: MTPM at 3, 6, 12, and 24 months was 0.65 mm, 0.84 mm, 0.92 mm, and 0.96 mm for the femoral component and 0.54 mm, 0.60 mm, 0.64 mm, and 0.68 mm, respectively, for the tibial component. The highest MTPM occurred within the first 3 months. Afterwards most of the curves flattened and stabilized. Between 12 and 24 months after surgery, 16% of femoral components had migrated by more than 0.10 mm and 15% of tibial components had migrated by more than 0.2 mm. Percentage change in BMD in each ROI for distal femur was as follows: ROI I 26.7%, ROI II 9.2% and ROI III 3.3%. BMD and at the proximal tibia: ROI I 8.2%, ROI II 8.6% and ROI III 7.0% after 2 years compared with 1 week postoperative results. There was no significant correlation between maximal percentwise change in BMD and MTPM after 2 years. Conclusion: Migration patterns and changes in BMD related to femoral components after TKA in our study correspond well with previous studies; we observed marginally greater migration with the tibial component.</p>}},
author = {{Yilmaz, Müjgan and Holm, Christina Enciso and Lind, Thomas and Flivik, Gunnar and Odgaard, Anders and Petersen, Michael Mørk}},
issn = {{2234-0726}},
keywords = {{DXA; MBRSA; Persona®; Total knee arthroplasty; Total knee replacement}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Knee Surgery and Related Research}},
title = {{Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up}},
url = {{http://dx.doi.org/10.1186/s43019-021-00111-5}},
doi = {{10.1186/s43019-021-00111-5}},
volume = {{33}},
year = {{2021}},
}