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Screw Track Osteolysis in the Cementless Total Knee Replacement Design
Marcus Klutzny1, Gurpal Singh2, Rita Hameister3
1Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
The Journal of Arthroplasty
|February 20, 2019
Summary
Screw track osteolysis is a risk in cementless total knee arthroplasty (TKA) with screw fixation. Titanium wear may contribute to this tibial osteolysis, though screw angles
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Pathology
Background:
- Limited reports exist on osteolysis linked to tibial screw fixation in cementless total knee arthroplasty (TKA).
- The underlying pathophysiology of screw track osteolysis in cementless TKA remains unclear.
Purpose of the Study:
- To describe the pathology of screw track osteolysis around the tibia in cementless TKA.
- To investigate potential contributing factors to this phenomenon.
Main Methods:
- Analysis of 100 revised cementless TKAs with tibial screw fixation.
- Radiological assessment of osteolysis and screw angles.
- Histopathological and biochemical analysis of tissue and wear debris.
- Electrochemical evaluation of screw-tray interactions.
Main Results:
- Screw track osteolysis was prevalent medially, correlating with smaller screw angles.
- Osteolysis showed high titanium concentrations, but not polyethylene particles.
- Tissue analysis revealed necrosis, osteolytic cysts, and inflammatory cells.
Conclusions:
- Cementless TKA with screw fixation carries a risk of screw track osteolysis.
- Titanium wear is a potential contributor to screw track osteolysis in this TKA design.
- The role of screw angles in osteolysis requires further investigation.
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