International Orthopaedics

, Volume 36, Issue 9, pp 1857–1863

Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

  • Claus L. Jensen
  • Michael M. Petersen
  • Henrik M. Schrøder
  • Bjarne Lund
Original Paper

Abstract

Purpose

Forty patients were enrolled in a prospective randomised study using conventional method or “Trabecular Metal Cone” (TM Cone) (Zimmer inc., Warsaw, USA) for reconstruction of bone loss of the proximal tibia during revision total knee arthroplasty (rTKA). The aim was to evaluate changes in bone mineral density (BMD) at the proximal tibia.

Material and methods

Thirty-six patients [median 67 years (range: 40–85 years)] received rTKA with NexGen® (Zimmer Warsaw, USA) revision system. Knee Society´s Knee Scoring System and the Anderson Orthopaedic Research Institute (AORI) bone classification was used. Changes in BMD were measured by dual energy X-ray absorptiometry (DEXA).

Results

Knee and function score improved in both groups. No significant changes between the groups were found. Changes in BMD within the two groups were quite similar. Overall decreases in BMD of 0.1 - 5.4 % were found in both groups (ROI 1–6) postoperative to 12 months of follow-up, except that ROI 7 showed an increase in BMD (0.8 - 1.3 %). After 24 months of follow-up, an increase in BMD was found along the stem (ROI 2–5) of 1.9 - 6.3 % , with significant changes in the TM Cone Group (ROI 3, 4, 5) . No significant changes in BMD between the groups were found.

Conclusions

The bone remodelling pattern was almost the same in the two groups after two years.

Reference

  1. 1.
    Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish Knee Arthroplasty Register 1975–1997. Acta Orthop Scand 72:503–513PubMedCrossRefGoogle Scholar
  2. 2.
    Benjamin J, Engh G, Parsley B, Donaldson T and Coon T (2001) Morselized bone grafting of defects in revision total knee arthroplasty. Clin Orthop Relat Res: 62–67Google Scholar
  3. 3.
    Berend KR, Lombardi AV (2009) Distal femoral replacement in nontumor cases with severe bone loss and instability. Clin Orthop Relat Res 467:485–492PubMedCrossRefGoogle Scholar
  4. 4.
    Black J (1994) Biological performance of tantalum. Clin Mater 16:167–173PubMedCrossRefGoogle Scholar
  5. 5.
    Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ (1999) Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 81:907–914PubMedCrossRefGoogle Scholar
  6. 6.
    Bobyn JD, Poggie RA, Krygier JJ, Lewallen DG, Hanssen AD, Lewis RJ, Unger AS, O’Keefe TJ, Christie MJ, Nasser S et al (2004) Clinical validation of a structual porous tantalum biomaterial for adult reconstruction. J Bone Joint Surg Am 86:123–129PubMedGoogle Scholar
  7. 7.
    Meneghini RM, Lewallen DG, Hanssen AD (2008) Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 90:78–84PubMedCrossRefGoogle Scholar
  8. 8.
    Mazess RB, Barden HS (1988) Measurements of bone by dual-photon absorptiometry (DPA) and dual-energy X-ray absorptiometry (DEXA). Ann Chir Gynaecol 77:197–203PubMedGoogle Scholar
  9. 9.
    Petersen MM, Nielsen PT, Lauritzen JB, Lund B (1995) Changes in bone mineral density of the proximal tibia following uncemented total knee arthroplasty. A 3-year follow-up of 25 knees. Acta Orthop Scand 66:513–516PubMedCrossRefGoogle Scholar
  10. 10.
    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 18:40–47PubMedCrossRefGoogle Scholar
  11. 11.
    Petersen MM, Gehrchen PM, Østgaard 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. J Arthroplasty 20:516–520PubMedCrossRefGoogle Scholar
  12. 12.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of The Knee Society clinical rating system. Clin Orthop 248:13–14PubMedGoogle Scholar
  13. 13.
    Engh GA, Ammeen DJ (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin N Am 29:205–217CrossRefGoogle Scholar
  14. 14.
    Gehrchen PM and Petersen MM (2008) Evaluation of a costum made software for measurements of bone mineral density around prostethetic implants. Improved metal exclusion facility. Nordic Ortopedic Federation 54th Congress, Amsterdam, Holland, June 11–13Google Scholar
  15. 15.
    Peters CL, Erickson J, Kloepper RG, Mohr RA (2005) Revision total knee arthroplasty with modular components inserted with metaphyseal cement and stems without cement. J Arthroplasty 20:302–308PubMedCrossRefGoogle Scholar
  16. 16.
    Engh GA, Ammeen DJ (2007) Use of structural allograft in revision total knee arthroplasty in knees with severe tibial bone loss. J Bone Joint Surg Am 89:2640–2647PubMedCrossRefGoogle Scholar
  17. 17.
    Trevisan C, Bigoni M, Denti M, Marinoni EC, Ortolani S (1998) Bone assessment after total knee arhroplasty by dual energy X-ray absorptiometry: analysis protocol and reproducibility. Calcif Tissue Int 62:359–361PubMedCrossRefGoogle Scholar
  18. 18.
    Petersen MM, Jensen NC, Gehrchen PM, Nielsen PK, Nielsen PT (1996) The relation between trabecular bone strength and bone mineral density assessed by dual photon and dual energy X-ray absorptiometry in the proximal tibia. Calcif Tissue Int 59:311–314PubMedCrossRefGoogle Scholar
  19. 19.
    Gehrchen PM, Petersen MM, Nielsen PK, Lund B (2000) Influence of region size on bone mineral measurements along femoral stems in THA. Hip Int 10:204–208Google Scholar
  20. 20.
    Hernandez-Vaquero D, Garcia-Sandoval MA, Fernandez-Carreira JM, Gava R (2008) Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study. Int Orthop 32:47–51PubMedCrossRefGoogle Scholar
  21. 21.
    Petersen MM, Olsen C, Lauritzen JB, Lund B (1995) Changes in bone mineral density of the distal femur following uncemented total knee arthroplasty. J Arthroplasty 10:7–11PubMedGoogle Scholar
  22. 22.
    Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br 83:283–288PubMedCrossRefGoogle Scholar
  23. 23.
    Finsen V (1988) Osteopenia after osteotomy of the tibia. Calcif Tissue Int 42:1–4PubMedCrossRefGoogle Scholar
  24. 24.
    Jarvinen M, Kannus P (1997) Injury of an extremity as a risk factor for the development of osteoporosis. J Bone Joint Surg Am 79:263–276PubMedGoogle Scholar
  25. 25.
    Completo A, Fonseca F, Simoes JA (2008) Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech 41:560–566PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Claus L. Jensen
    • 1
  • Michael M. Petersen
    • 1
  • Henrik M. Schrøder
    • 1
  • Bjarne Lund
    • 1
  1. 1.Department of Orthopaedic Surgery U, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark

Personalised recommendations