The dog as a preclinical model to evaluate interface morphology and micro-motion in cemented total knee replacement

Summary

Objectives: This study investigated cemented fixation of the tibial component from a canine total knee replacement preclinical model. The objective was to determine the local morphology at the material interfaces (implant, cement, bone) and the local relative micro-motion due to functional loading following in vivo service.

Methods: Five skeletally mature research dogs underwent unilateral total knee replacement using a cemented implant system with a polyethylene (PE) monobloc tibial component. Use of the implanted limb was assessed by pressure-sensitive walkway analysis. At 60 weeks post-surgery, the animals were euthanatized and the tibia sectioned en bloc in the sagittal plane to create medial and lateral specimens. High resolution imaging was used to quantify the morphology under the tray and along the keel. Specimens were loaded to 50% body weight and micro-motions at the PE-cement and cement-bone interfaces were quantified.

Results: There was significantly (p = 0.002) more cement-bone apposition and interdigitation along the central keel compared to the regions under the tray. Cavitary defects were associated with the perimeters of the implant (60 ± 25%). Interdigitation fraction was negatively correlated with cavitary defect fraction, cement crack fraction, and total micro-motion.

Clinical significance: Achieving good inter-digitation of cement into subchondral bone beneath the tibial tray is associated with improved interface morphology and reduced micro-motion; features that could result in a reduced incidence of aseptic loosening. Multiple drill holes distributed over the cut tibial surface and adequate pressurization of the cement into the subchondral bone should improve fixation and reduce interface micro-motion and cavitary defects.

Keywords

Canine - knee joint replacement - implant fixation - aseptic loosening - micro-motion - cavitary defects

• References

• 1 Furnes O, Espehaug B, Lie SA. et al. Failure mechanisms after unicompartmental and tricompart-mental primary knee replacement with cement. J Bone Joint Surg Am 2007; 89: 519-525.
• 2 Kurtz SM, Ong KL, Schmier J. et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 144-151.
• 3 Ryd L. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation. Acta Orthop Scand Suppl 1986; 220: 1-80.
• 4 Ryd L, Lindstrand A, Rosenquist R. et al. Tibial component fixation in knee arthroplasty. Clin Orthop Relat Res 1986; 141-149.
• 5 Li MG, Nilsson KG. Changes in bone mineral density at the proximal tibia after total knee arthroplasty: a 2–year follow-up of 28 knees using dual energy X-ray absorptiometry. J Orthop Res 2000; 18: 40-47.
• 6 Allen MJ, Leone KA, Lamonte K. et al. Cemented total knee replacement in 24 dogs: surgical technique, clinical results, and complications. Vet Surg 2009; 38: 555-567.
• 7 Miller MA, Hobbs A, Izant TH. et al. editors. Functional micromechanics of en bloc retrieved tibial components. Proceedings from the Annual Meeting of the Orthopaedic Research Society 2010. March New Orleans; LA, USA: 6-9.
• 8 Sumner DR, Turner TM, Urban RM. Animal models relevant to cementless joint replacement. J Musculoskelet Neuronal Interact 2001; 1: 333-345.
• 9 Skurla CP, Pluhar GE, Frankel DJ. et al. Assessing the dog as a model for human total hip replacement. Analysis of 38 canine cemented femoral components retrieved post-mortem. J Bone Joint Surg Br 2005; 87: 120-127.
• 10 Turner TM, Urban RM, Sumner DR. et al. Bone in-growth into the tibial component of a canine total condylar knee replacement prosthesis. J Orthop Res 1989; 7: 893-901.
• 11 Skurla CP, James SP. Assessing the dog as a model for human total hip replacement: analysis of 38 postmortem-retrieved canine cemented acetabular components. J Biomed Mater Res B Appl Biomater 2005; 73: 260-270.
• 12 Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty 2010; 25 (Suppl. 06) 2-4.
• 13 Hood RW, Wright TM, Burstein AH. Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses. J Biomed Mater Res 1983; 17: 829-842.
• 14 Mann KA, Miller MA, Cleary RJ. et al. Experimental micromechanics of the cement-bone interface. J Orthop Res 2008; 26: 872-879.
• 15 Sumner DR, Berzins A, Turner TM. et al. Initial in vitro stability of the tibial component in a canine model of cementless total knee replacement. J Biomech 1994; 27: 929-939.
• 16 Skripitz R, Aspenberg P. Pressure-induced peri-prosthetic osteolysis: a rat model. J Orthop Res 2000; 18: 481-484.
• 17 Massin P, Viguier E, Flautre B. et al. Migration of polyethylene debris along well-fixed cemented implants. J Biomed Mater Res B Appl Biomater 2004; 68: 140-148.
• 18 Baxter RM, Ianuzzi A, Freeman TA. et al. Distinct immunohistomorphologic changes in periprosthetic hip tissues from historical and highly cross-linked UHMWPE implant retrievals. J Biomed Mater Res A 2010; 95: 68-78.
• 19 Clarius M, Hauck C, Seeger JB. et al. Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty: pulsed lavage versus syringe lavage. Int Orthop 2009; 33: 1585-1590.
• 20 Ritter MA, Herbst SA, Keating EM. et al. Radio-lucency at the bone-cement interface in total knee replacement. The effects of bone-surface preparation and cement technique. J Bone Joint Surg Am 1994; 76: 60-65.
• 21 Lutz MJ, Pincus PF, Whitehouse SL. et al. The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty. J Arthroplasty 2009; 24: 461-467.
• 22 Smith S, Naima VS, Freeman MA. The natural history of tibial radiolucent lines in a proximally cemented stemmed total knee arthroplasty. J Arthroplasty 1999; 14: 3-8.
• 23 Richards L, Brown C, Stone MH. et al. Identification of nanometre-sized ultra-high molecular weight polyethylene wear particles in samples retrieved in vivo. J Bone Joint Surg Br 2008; 90: 1106-1113.
• 24 Berzins A, Sumner DR, Turner TM. et al. Effects of fixation technique on displacement incompatibilities at the bone-implant interface in cementless total knee replacement in a canine model. J Appl Biomater 1994; 5: 349-352.
• 25 Kraemer WJ, Harrington IJ, Hearn TC. Micro-motion secondary to axial, torsional, and shear loads in two models of cementless tibial components. J Arthroplasty 1995; 10: 227-235.
• 26 Peters CL, Craig MA, Mohr RA. et al. Tibial component fixation with cement: full- versus surface-cementation techniques. Clin Orthop Relat Res 2003; 158-168.
• 27 Conditt MA, Ismaily SK, Alexander JW. et al. Backside wear of modular ultra-high molecular weight polyethylene tibial inserts. J Bone Joint Surg Am 2004; 86 A 1031-1037.
• 28 Sumner DR, Turner TM, Dawson D. et al. Effect of pegs and screws on bone ingrowth in cementless total knee arthroplasty. Clin Orthop Relat Res 1994; 150-155.