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Osteolysis after total knee arthroplasty without cement
P C Peters1, G A Engh, K A Dwyer
1Anderson Orthopaedic Research Institute, Arlington, Virginia 22206.
The Journal of Bone and Joint Surgery. American Volume
|July 11, 1992
Summary
Osteolysis, or bone loss, is a complication of cementless total knee replacement. This study found osteolysis in 16% of implants, often requiring revision surgery due to wear debris and component failure.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Pathology
Background:
- Osteolysis is a significant concern in total knee arthroplasty (TKA).
- Cementless fixation is a common method for TKA, but its long-term effects require investigation.
Purpose of the Study:
- To determine the prevalence and characteristics of osteolysis following cementless total knee arthroplasty.
- To investigate the factors contributing to osteolysis in these implants.
Main Methods:
- Retrospective analysis of 174 consecutive cementless TKAs.
- Radiographic and intraoperative assessment of osteolysis.
- Histological evaluation of tissue from revision surgeries.
- Analysis of wear debris and component failure modes.
Main Results:
- Osteolysis was identified in 16% of implants (26 patients) at an average of 35 months post-operation.
- 56% of affected prostheses required revision surgery.
- Histology revealed polyethylene and metal wear debris, with sizes up to 3 micrometers.
- Contributing factors included polyethylene insert failure, polyethylene tibial eminence abrasion, patellar component failure, and screw-baseplate corrosion.
Conclusions:
- Osteolysis is a demonstrable complication associated with cementless total knee replacement.
- Wear debris from various implant components and material corrosion are key contributors to osteolysis.
- Understanding these mechanisms is crucial for improving the longevity of cementless TKAs.