Download PDF
J Knee Surg 2022; 35(04): 434-442
DOI: 10.1055/s-0040-1715085
Original Article

Various Types of Medial Tibial Bone Resorption after Total Knee Arthroplasty Using a Thick Cobalt Chromium Tibial Baseplate

Sang Jun Song
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Hyun Woo Lee
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Se Gu Kang
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Dae Kyung Bae
2   Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea (the Republic of)
,
Cheol Hee Park 
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Recent literature has implicated a thick cobalt chromium baseplate as a potential source of stress shielding and medial tibial bone resorption after total knee arthroplasty (TKA) in a Western population. The purpose was to calculate the incidence of various types and severity of medial tibial bone resorption utilizing a novel classification system after TKA with a thick cobalt chromium baseplate in Asian patients. Five hundred TKAs using Attune prostheses with mean follow-up of 3.4 years were evaluated, using the prospective radiographic data. The mean age was 71.3 years. The preoperative mechanical axis was varus, 11.2 degrees. The type and severity of medial tibial bone resorption were categorized as type U (resorption under the tibial baseplate up to 50% [U1] or beyond 50% [U2] of medial tibial tray width), C (resorption around the penetrated cement under the baseplate), and M (resorption on the medial tibial cortex without extension to the baseplate). Bone resorption of medial proximal tibia was observed in 96 knees (19.2%). Types U1 and U2 were seen in 46 and 28 knees, respectively. Type C was observed in 12 knees and type M in 10 knees. The type U resorption group had significantly more preoperative varus deformity (varus 12.9 vs. 10.9 degrees, p = 0.017). Medial tibial bone resorption after TKAs using a thick cobalt chromium baseplate is not uncommon and has various locations, types, and severities. The medial tibial bone resorption might be related to various causes, including stress shielding, thermal necrosis from cement in the bony hole, and bony devascularization. The type-U resorption has to be closely observed in patients with preoperative severe varus deformity. This is a Level IV study.

Keywords

knee - arthroplasty - cobalt chromium - resorption - classification


Publication History

Received: 11 February 2020

Accepted: 25 June 2020

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Qadir I, Shah B, Waqas M, Ahmad U, Javed S, Aziz A. Component alignment in simultaneous bilateral versus unilateral total knee arthroplasty. Knee Surg Relat Res 2019; 31 (01) 31-36
    CrossrefPubMedGoogle Scholar
  • 2 Kim D-H, Bae K-C, Kim D-W, Choi B-C. Risk factors of uncontrolled periprosthetic knee joint infection after two-stage reimplantation. Knee Surg Relat Res 2020; 32 (01) 22
    CrossrefPubMedGoogle Scholar
  • 3 Deen JT, Clay TB, Iams DA, Horodyski M, Parvataneni HK. Proximal tibial resorption in a modern total knee prosthesis. Arthroplast Today 2017; 4 (02) 244-248
    CrossrefPubMedGoogle Scholar
  • 4 Cerquiglini A, Henckel J, Hothi H. et al. Analysis of the Attune tibial tray backside: a comparative retrieval study. Bone Joint Res 2019; 8 (03) 136-145
    CrossrefPubMedGoogle Scholar
  • 5 Berry DJ, Currier JH, Mayor MB, Collier JP. Knee wear measured in retrievals: a polished tray reduces insert wear. Clin Orthop Relat Res 2012; 470 (07) 1860-1868
    CrossrefPubMedGoogle Scholar
  • 6 Martin JR, Jennings JM, Watters TS, Levy DL, McNabb DC, Dennis DA. Femoral implant design modification decreases the incidence of patellar crepitus in total knee arthroplasty. J Arthroplasty 2017; 32 (04) 1310-1313
    CrossrefPubMedGoogle Scholar
  • 7 Innocenti B, Truyens E, Labey L, Wong P, Victor J, Bellemans J. Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study. J Orthop Surg Res 2009; 4: 26
    CrossrefPubMedGoogle Scholar
  • 8 Martin JR, Watts CD, Levy DL, Kim RH. Medial tibial stress shielding: a limitation of cobalt chromium tibial baseplates. J Arthroplasty 2017; 32 (02) 558-562
    CrossrefPubMedGoogle Scholar
  • 9 Yoon C, Chang MJ, Chang CB, Song MK, Shin JH, Kang SB. Medial tibial periprosthetic bone resorption and its effect on clinical outcomes after total knee arthroplasty: cobalt-chromium vs titanium implants. J Arthroplasty 2018; 33 (09) 2835-2842
    CrossrefPubMedGoogle Scholar
  • 10 Kim YH, Matsuda S, Kim TK. Clinical faceoff: do we need special strategies for Asian patients with TKA?. Clin Orthop Relat Res 2016; 474 (05) 1102-1107
    CrossrefPubMedGoogle Scholar
  • 11 Kim DK, Seo MC, Song SJ, Kim KI. Are Korean patients different from other ethnic groups in total knee arthroplasty?. Knee Surg Relat Res 2015; 27 (04) 199-206
    CrossrefPubMedGoogle Scholar
  • 12 Petersson IF, Boegård T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain. Ann Rheum Dis 1997; 56 (08) 493-496
    CrossrefPubMedGoogle Scholar
  • 13 Giesinger JM, Hamilton DF, Jost B, Behrend H, Giesinger K. WOMAC, EQ-5D and Knee Society score thresholds for treatment success after total knee arthroplasty. J Arthroplasty 2015; 30 (12) 2154-2158
    CrossrefPubMedGoogle Scholar
  • 14 Kim SH, Park YB, Song MK, Lim JW, Lee HJ. Reliability and validity of the femorotibial mechanical axis angle in primary total knee arthroplasty: navigation versus weight bearing or supine whole leg radiographs. Knee Surg Relat Res 2018; 30 (04) 326-333
    CrossrefPubMedGoogle Scholar
  • 15 Lee HW, Song SJ, Bae DK, Park CH. The influence of computer-assisted surgery experience on the accuracy and precision of the postoperative mechanical axis during computer-assisted lateral closing-wedge high tibial osteotomy. Knee Surg Relat Res 2019; 31: 15
    CrossrefPubMedGoogle Scholar
  • 16 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
    PubMedGoogle Scholar
  • 17 Park MH, Bin SI, Kim JM, Lee BS, Lee CR, Kwon YH. Using a tibial short extension stem reduces tibial component loosening after primary total knee arthroplasty in severely varus knees: long-term survival analysis with propensity score matching. J Arthroplasty 2018; 33 (08) 2512-2517
    CrossrefPubMedGoogle Scholar
  • 18 Cabuk H, Imren Y, Tekin AC, Dedeoglu SS, Gurbuz H. High varus angle and lower posterior tibial slope associated with PCL injury in cruciate retaining total knee arthroplasty: an MRI study. J Knee Surg 2018; 31 (03) 277-283
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Martin JR, Watts CD, Levy DL, Miner TM, Springer BD, Kim RH. Tibial tray thickness significantly increases medial tibial bone resorption in cobalt-chromium total knee arthroplasty implants. J Arthroplasty 2017; 32 (01) 79-82
    CrossrefPubMedGoogle Scholar
  • 20 Au AG, James Raso V, Liggins AB, Amirfazli A. Contribution of loading conditions and material properties to stress shielding near the tibial component of total knee replacements. J Biomech 2007; 40 (06) 1410-1416
    CrossrefPubMedGoogle Scholar
  • 21 Goodheart JR, Miller MA, Oest ME, Mann KA. Trabecular resorption patterns of cement-bone interlock regions in total knee replacements. J Orthop Res 2017; 35 (12) 2773-2780
    CrossrefPubMedGoogle Scholar
  • 22 Cawley DT, Kelly N, McGarry JP, Shannon FJ. Cementing techniques for the tibial component in primary total knee replacement. Bone Joint J 2013; 95-B (03) 295-300
    CrossrefPubMedGoogle Scholar
  • 23 Miller MA, Goodheart JR, Izant TH, Rimnac CM, Cleary RJ, Mann KA. Loss of cement-bone interlock in retrieved tibial components from total knee arthroplasties. Clin Orthop Relat Res 2014; 472 (01) 304-313
    CrossrefPubMedGoogle Scholar
  • 24 Kurata K, Matsushita J, Furuno A, Fujino J, Takamatsu H. Assessment of thermal damage in total knee arthroplasty using an osteocyte injury model. J Orthop Res 2017; 35 (12) 2799-2807
    CrossrefPubMedGoogle Scholar
  • 25 Goudarz Mehdikhani K, Morales Moreno B, Reid JJ, de Paz Nieves A, Lee YY, González Della Valle A. An algorithmic, pie-crusting medial soft tissue release reduces the need for constrained inserts patients with severe varus deformity undergoing total knee arthroplasty. J Arthroplasty 2016; 31 (07) 1465-1469
    CrossrefPubMedGoogle Scholar
  • 26 Tang Q, Yu HC, Shang P. et al. Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty. J Orthop Surg Res 2017; 12 (01) 174
    CrossrefPubMedGoogle Scholar
  • 27 Munro JT, Pandit S, Walker CG, Clatworthy M, Pitto RP. Loss of tibial bone density in patients with rotating- or fixed-platform TKA. Clin Orthop Relat Res 2010; 468 (03) 775-781
    CrossrefPubMedGoogle Scholar
  • 28 Koh IJ, Kim TK, Chang CB, Cho HJ, In Y. Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin Orthop Relat Res 2013; 471 (05) 1441-1450
    CrossrefPubMedGoogle Scholar