Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty.
Bone density.
Cement penetration.
Cement–bone interface.
Fixation strength.
Knee arthroplasty
UKA
Journal
The Knee
ISSN: 1873-5800
Titre abrégé: Knee
Pays: Netherlands
ID NLM: 9430798
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
17
06
2019
revised:
08
10
2019
accepted:
21
01
2020
pubmed:
7
2
2020
medline:
5
11
2020
entrez:
7
2
2020
Statut:
ppublish
Résumé
Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae. Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis. Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136). Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
Sections du résumé
BACKGROUND
BACKGROUND
Unicompartmental knee arthroplasty (UKA) offers good long-term survivorship and superior kinematics and function compared with total knee arthroplasty (TKA). However, revision rates are higher with aseptic loosening representing a major cause. Biomechanical stability depends on cement penetration. The goal of this study was to analyze the influence of cement morphology and bone density on primary stability of tibial UKA under physiological loading conditions in human tibiae.
METHODS
METHODS
Thirty-six tibial trays were implanted in fresh-frozen human cadaver knees and tested for primary stability using dynamic compression-shear testing. Prior to implantation, bone density had been quantified for all 18 tibiae. Postoperatively, cement penetration has been assessed on frontal cuts based on eight predefined parameters. The influence of bone density and cement morphology on biomechanical stability was determined using correlation and linear regression analysis.
RESULTS
RESULTS
Mean failure load was 2691 ± 832.9 N, mean total cement thickness was 2.04 ± 0.37 mm, mean cement penetration was 1.54 ± 0.33 mm and mean trabecular bone mineral density (BMD) was 107.1 ± 29.3 mg/ml. There was no significant correlation between failure load and cement morphology (P > .05). Failure load was significantly positive correlated with trabecular BMD (r = 0.843; P < .0001) and cortical BMD (r = 0.432; P = .0136).
CONCLUSIONS
CONCLUSIONS
Simulating physiological loading conditions, the failure load of tibial UKA is linearly dependent on the trabecular BMD. The observed parameters of cementation morphology seem capable of preventing failure at the bone-cement interface before inherent bone stability is reached. Further research is required to assess the usefulness of a preoperative assessment of bone quality for patient selection in UKA.
Identifiants
pubmed: 32024609
pii: S0968-0160(20)30004-1
doi: 10.1016/j.knee.2020.01.005
pii:
doi:
Substances chimiques
Bone Cements
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
587-597Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest P.E.M. received research funding in correlation with Aesculap R&D project and is an advising surgeon of Aesculap R&D projects. M.F.P. and P.E.M. received payments for lectures and instructional courses in knee/shoulder arthroscopy. There are no other relationships/conditions/circumstances that present a potential conflict of interest. T.M.G. is an employee of Aesculap (manufacturer of orthopedic implants).