Abstract
Purpose
Regenerex is a novel porous titanium construct with a three-dimensional porous structure and biomechanical characteristics close to that of normal trabecular bone. The aim of this study was to evaluate the adaptive bone remodeling of the proximal tibia after uncemented total knee arthroplasty (TKA) using a tibial tray with this novel coating compared to a well-proven standard porous coated (PPS) tibial tray.
Materials
Sixty patients scheduled for TKA were randomized to receive either a Regenerex (n = 31) or a PPS tibial component (n = 29). Changes in bone mineral density (BMD) of the proximal tibia were measured at three, six, 12 and 24 months by dual-energy X-ray absorptiometry (DEXA).
Results
In the lateral region (ROI 3), a significant increase in BMD was seen in both groups at three, six, and 12 months after surgery. The relative increase at 12 months was 8.1 % (P = 0.007) for the PPS group and 6.5 % (P = 0.002) for the Regenerex group. Positive values were retained at 24 months in both groups. At 24 months BMD in the distal region below the central stem (ROI 1) had decreased in the PPS group by 3.4 % (P = 0.005) and in the Regenerex group by 2.4 % (P = 0.17). In the medial region (ROI 2) BMD remained unchanged at all follow-up evaluations in both groups. There were no significant differences between the two groups (P = 0.45) in any ROI at any follow-up evaluation.
Conclusion
The significant increase in BMD of the lateral proximal tibia plateau with very limited changes medially and distally seen in both implants suggests that the novel porous titanium construct Regenerex and the PPS implant have a pronounced beneficial effect with regard to maintaining periprosthetic BMD in all regions of interest investigated.
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References
Bohr HH, Lund B (1987) Bone mineral density of the proximal tibia following uncemented arthroplasty. J Arthroplasty 2(4):309–312
Soininvaara TA, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM, Kröger HP (2004) Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients. Acta Orthop Scand 75(5):600–605
Levitz CL, Lotke PA, Karp JS (1995) Long-term changes in bone mineral density following total knee replacement. Clin Orthop Relat Res 321:68–72
Petersen MM, Nielsen PT, Lebech A, Toksvig-Larsen S, Lund B (1999) Preoperative bone mineral density of the proximal tibia and migration of the tibial component after uncemented total knee arthroplasty. J Arthroplasty 14(1):77–81
Petersen MM, Nielsen PT, Lauritzen JB, Lund B (1995) Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A 3-year follow-up of 25 knees. Acta Orthop Scand 66(6):513–516
Donaldson CL, Hulley SB, Vogel JM, Hattner RS, Bayers JH, McMillan DE (1970) Effect of prolonged bed rest on bone mineral. Metabolism 19(12):1071–1084
Krolner B, Toft B (1983) Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clin Sci (Lond) 64(5):537–540
Lanyon LE (1983) Functional strain as a determinant for bone remodeling. Calcif Tissue Int 36(Suppl 1):S56–S61
Järvinen M, Kannus P (1997) Injury of an extremity as a risk factor for the development of osteoporosis. J Bone Joint Surg Am 79(2):263–276
Li MG, Nilsson KG (2000) The effect of the preoperative bone quality on the fixation of the tibial component in total knee arthroplasty. J Arthroplasty 15(6):744–753
Bobyn JD, Pilliar RM, Cameron HU, Weatherly GC (1980) The optimum pore size for the fixation of porous-surfaced metal implants by the ingrowth of bone. Clin Orthop Relat Res 150:263–270
Cameron HU, Pilliar RM, MacNab I (1973) The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res 7(4):301–311
Dabrowski B, Swieszkowski W, Godlinski D, Kurzydlowski KJ (2010) Highly porous titanium scaffolds for orthopaedic applications. J Biomed Mater Res B Appl Biomater 95(1):53–61
Karageorgiou V, Kaplan D (2005) Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials 26(27):5474–5491
Søballe K, Hansen ES, B-Rasmussen H, Jørgensen PH, Bunger C (1992) Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions. J Orthop Res 10(2):285–299
Andersson SM, Nilsson BE (1979) Changes in bone mineral content following tibia shaft fractures. Clin Orthop Relat Res 144:226–229
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Petersen MM, Gehrchen PM, Ostgaard SE, Nielsen PK, Lund B (2005) Effect of hydroxyapatite-coated tibial components on changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty: a prospective randomized study using dual-energy X-ray absorptiometry. J Arthroplasty 20(4):516–520
Li MG, Nilsson KG (2000) Changes in bone mineral density at the proximal tibia after total knee arthroplasty: a 2-year follow-up of 28 knees using dual energy X-ray absorptiometry. J Orthop Res 18(1):40–47
Hvid I, Bentzen SM, Jørgensen J (1988) Remodeling of the tibial plateau after knee replacement. CT bone densitometry. Acta Orthop Scand 59(5):567–573
Saari T, Uvehammer J, Carlsson L, Regnér L, Kärrholm J (2007) Joint area constraint had no influence on bone loss in proximal tibia 5 years after total knee replacement. J Orthop Res 25(6):798–803
Regnér LR, Carlsson LV, Kärrholm JN, Hansson TH, Herberts PG, Swanpalmer J (1999) Bone mineral and migratory patterns in uncemented total knee arthroplasties: a randomized 5-year follow-up study of 38 knees. Acta Orthop Scand 70(6):603–608
Li MG, Nilsson KG (2001) No relationship between postoperative changes in bone density at the proximal tibia and the migration of the tibial component 2 years after total knee arthroplasty. J Arthroplasty 16(7):893–900
Henricson A, Linder L, Nilsson KG (2008) A trabecular metal tibial component in total knee replacement in patients younger than 60 years: a two-year radiostereophotogrammetric analysis. J Bone Joint Surg (Br) 90(12):1585–1593
Onsten I, Nordqvist A, Carlsson AS, Besjakov J, Shott S (1998) Hydroxyapatite augmentation of the porous coating improves fixation of tibial components. A randomised RSA study in 116 patients. J Bone Joint Surg (Br) 80(3):417–425
Ryd L (1986) Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation. Acta Orthop Scand Suppl 220:1–80
Ryd L, Albrektsson BE, Carlsson L, Dansgård F, Herberts P, Lindstrand A, Regnér L, Toksvig-Larsen S (1995) Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg (Br) 77:377
Ritter MA, Meneghini RM (2010) Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty 77(3):377–383
Schroder HM, Berthelsen A, Hassani G, Hansen EB, Solgaard S (2001) Cementless porous-coated total knee arthroplasty: 10-year results in a consecutive series. J Arthroplasty 25(4):507–513
Eriksen J, Christensen J, Solgaard S, Schrøder H (2009) The cementless AGC 2000 knee prosthesis: 20-year results in a consecutive series. Acta Orthop Belg 75(2):225–233
Meding JB, Galley MR, Ritter MA (2010) High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone. Clin Orthop Relat Res 468:441–447
Minoda Y, Kobayashi A, Iwaki H, Ikebuchi M, Inori F, Takaoka K (2010) Comparison of bone mineral density between porous tantalum and cemented tibial total knee arthroplasty components. J Bone Joint Surg Am 92(3):700–706
Minoda Y, Kobayashi A, Ikebuchi M, Iwaki H, Inori F, Nakamura H (2013) Porous tantalum tibial component prevents periprosthetic loss of bone mineral density after total knee arthroplasty for five years-a matched cohort study. J Arthroplasty 28:1760
Sumner DR, Turner TM, Dawson D, Rosenberg AG, Urban RM, Galante JO (1994) Effect of pegs and screws on bone ingrowth in cementless total knee arthroplasty. Clin Orthop Relat Res 309:150–155
Nilsson KG, Henricson A, Norgren B, Dalén T (2006) Uncemented HA-coated implant is the optimum fixation for TKA in the young patient. Clin Orthop Relat Res 448:129139
Acknowledgments
Financial support was received from Biomet (Warsaw, IA, USA), the Maggie og Svend ritzches Memorial Fund, and from Hillerød Hospital (research grant).
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The authors declare that they have no competing interests.
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Winther, N., Jensen, C., Petersen, M. et al. Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A prospective randomized study. International Orthopaedics (SICOT) 40, 285–294 (2016). https://doi.org/10.1007/s00264-015-2852-1
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DOI: https://doi.org/10.1007/s00264-015-2852-1