, Volume 470, Issue 7, pp 1869-1878
Date: 17 Dec 2011

Does Using Autograft Bone Chips Achieve Consistent Bone Ingrowth in Primary TKA?

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Topic
Knee

Abstract

Background

Cementless fixation remains controversial in TKA due to the challenge of achieving consistent skeletal attachment. Factors predicting durable fixation are not clearly understood, but we presumed bone ingrowth could be enhanced by the quantity of host bone and application of autograft bone chips.

Questions/purposes

We asked: (1) Did the amount of bone ingrowth exceed the amount of periprosthetic and host bone with the addition of autograft bone chips? (2) Did the amount of bone ingrowth increase with implantation time? And (3) did osteolysis along the porous-coated interface and screw tracts progress with implantation time?

Methods

We measured the amount of bone in the porous-coated, periprosthetic, and host bone regions in 19 postmortem retrieved cementless primary total knee implants. The amount of bone in apposition to the implant surface, and alternatively lysed bone, was analyzed radiographically to assess the progression of osteolysis.

Results

While bone ingrowth tended to be less than periprosthetic and host bone in all three components, it was only significantly less in the patellar component. Bone ingrowth increased in all three components over time, but progression of osteolysis did not.

Conclusions

Even after long-term followup, the amount of bone ingrowth did not surpass host bone levels, suggesting the amount of a patient’s host bone is a limiting factor in the amount of bone ingrowth achievable for this cementless design. It remains unknown whether compromised osteopenic bone could achieve the amount of bone attachment necessary to provide durable fixation over time.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The institution of one or more of the authors (RDB, KEK, BMW, AAH) has received, in any 1 year, funding from the Department of Veterans Affairs Salt Lake City Health Care System and the Department of Orthopaedics, University of Utah School of Medicine. Funding had also been received in support of the program from Intermedics Orthopedics Inc (San Diego, CA, USA), Sulzer Orthopedics (Winterthur, Switzerland), Centerpulse Orthopedics Inc (Austin, TX, USA), and Zimmer, Inc (Warsaw, IN, USA). Each author certifies that he or she, or a member of his/her immediate family, has not received compensation based on this work.
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.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This project was performed at the Department of Veterans Affairs Salt Lake City Health Care System and the University of Utah School of Medicine.