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Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Bone mineral density (BMD) in the proximal tibia decreases after TKA and is believed to be a factor in implant migration and loosening. Unicompartmental knee arthroplasty (UKA) is a less invasive procedure preserving knee compartments unaffected by degeneration. Finite element studies have suggested UKA may preserve BMD and that implants of differing stiffnesses might differentially affect BMD but these notions have not been clinically confirmed.

Questions/purposes

We therefore asked whether (1) proximal tibial BMD decreases after UKA, and (2) a cemented metal tibial component with a mobile polyethylene (PE) bearing would have greater BMD loss than a cemented PE tibial component.

Methods

We prospectively followed 48 patients who underwent 50 UKAs using one of two implants: one with a cemented metal tibial baseplate and a mobile PE insert (n = 26) and one with a cemented all-PE tibial component (n = 24). In followup we assessed pain and function (Oxford Knee Score, SF-12, The Knee Society Score©) and radiographs. BMD changes were assessed using quantitative CT osteodensitometry performed postoperatively and at 1 and 2 years after the index procedure.

Results

Mean cancellous BMD decreased 1.9% on the medial side and 1.1% on the lateral side. Mean cortical BMD was static, decreasing 0.4% on the medial side and increasing 0.5% on the lateral side. The greatest observed difference between implants for any region was 3.7%. There were no differences in pain or functional outcome scores.

Conclusions

BMD was preserved 2 years after UKA with no major differences seen between implant types.

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Acknowledgments

We thank Rocco P. Pitto MD, PhD, FRACS at the University of Auckland for assistance with the quantitative CT osteodensitometry analysis and Richard Feltham MBChB, FRANZCR, at Taranaki Base Hospital for assistance with CT scanning protocols and reports for the National Radiation Laboratory.

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Authors and Affiliations

  1. Department of Orthopaedics, Middlemore Hospital, Auckland, Manukau, 1640, New Zealand

    Bradley I. Richmond MBChB

  2. Department of Orthopaedics, Taranaki Base Hospital, New Plymouth, New Zealand

    Bradley I. Richmond MBChB, Simon V. Hadlow MBChB & Tim G. Lynskey MBChB

  3. Department of Engineering Science, University of Auckland, Auckland, New Zealand

    Cameron G. Walker PhD

  4. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand

    Jacob T. Munro MBChB

Authors
  1. Bradley I. Richmond MBChB
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  2. Simon V. Hadlow MBChB
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  3. Tim G. Lynskey MBChB
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  4. Cameron G. Walker PhD
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  5. Jacob T. Munro MBChB
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Corresponding author

Correspondence to Bradley I. Richmond MBChB.

Additional information

The institution of one or more of the authors (SVH, TGL) has received, during the study period, funding from the Taranaki Medical Foundation.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at the Taranaki Base Hospital, New Plymouth, New Zealand.

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Richmond, B.I., Hadlow, S.V., Lynskey, T.G. et al. Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty. Clin Orthop Relat Res 471, 1661–1669 (2013). https://doi.org/10.1007/s11999-013-2784-2

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  • DOI: https://doi.org/10.1007/s11999-013-2784-2

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