How to reduce osteopenia in total knee arthroplasty?
Osteopenia of the front half of the distal femur is a well-known problem after total knee arthroplasty (TKA) with secondary issues after years, especially when must be addressed fractures or revisions for loosening. Stress shielding has been recognized as a cause in different biomechanical studies of the bone.
It was logical to look for a solution by changing the design to minimize stress shielding behind the femoral shield.
Patients and methods
It was proved that radiological measure of bone density was reliable although not so early and accurate as densitometry. We used a shield without posterior fixation of the trochlea in a series of 21 TKA with radiological measures, preoperative, at 3 months and at 5 years. We compared the results with those of a series of classical TKA in the same category of age and sex.
The TKA without trochlea posterior fixation presented a significantly reduced osteopenia compared to the classical design of the femoral shield.
It seems that the non-fixation of the posterior surface of the trochlea may reduce osteopenia in TKA and so the risk of fractures and complications when revision surgery.
Level of evidence
KeywordsTotal knee arthroplasty Osteopenia Biomechanics Prosthesis design
Patrick Furno, Jacques Hummer, and Didier Mainard are acknowledged for their cooperation.
Compliance with ethical standards
Conflicts of interest
The author declares that funds are coming in due to the licensed patent to FH Orthopedics, 68,990 Heimsbrunn, France, but he did not receive any financial support for this study.
- 3.Cameron HU, Cameron G (1987) Stress-relief osteoporosis of the anterior femoral condyles in total knee replacement: a study of 185 patients. Orthop Rev 16:449–456Google Scholar
- 5.Hirsh DM, Bhalla S, Roffman M (1981) Supracondylar fracture of the femur following total knee replacement. J Bone Joint Surg 63A:I62Google Scholar
- 9.Mintzer CM, Robertson DD, Rackemann S, Ewald FC, Scott RD, Spector M (1990) Bone loss in the distal anterior femur after total knee arthroplasty. Clin Orthop Relat Res 260:135–143Google Scholar
- 17.Van Loon CJ, de Waal Malefijt MC, Buma P, Verdonschot N, Veth RP (1999) Femoral bone loss in total knee arthroplasty. A review. Acta Orthop Belg 65(2):154–163Google Scholar
- 18.Wolff J (1892) Das Gesetz der Transformation der Knochen. Verlag von August Hirschwald, BerlinGoogle Scholar