Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1661–1669

Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty

  • Bradley I. Richmond
  • Simon V. Hadlow
  • Tim G. Lynskey
  • Cameron G. Walker
  • Jacob T. Munro
Clinical 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.

References

  1. 1.
    Abu-Rajab RB, Watson WS, Walker B, Roberts J, Gallacher SJ, Meek RM. Peri-prosthetic bone mineral density after total knee arthroplasty: cemented versus cementless fixation. J Bone Joint Surg Br. 2006;88:606–613.PubMedCrossRefGoogle Scholar
  2. 2.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: Australian Orthopaedic Association; 2010.Google Scholar
  3. 3.
    Berger RA, Meneghini RM, Jacobs JJ, Sheinkop MB, Valle Della CJ, Rosenberg AG, Galante JO. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005;87:999–1006.PubMedCrossRefGoogle Scholar
  4. 4.
    Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008;16:9–18.PubMedGoogle Scholar
  5. 5.
    Gillies RM, Hogg MC, Kohan L, Cordingley RL. Adaptive bone remodelling of all polyethylene unicompartmental tibial bearings. ANZ J Surg. 2007;77:69–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Gulati A, Chau R, Pandit HG, Gray H, Price AJ, Dodd CA, Murray DW. The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg Br. 2009;91:896–902.PubMedCrossRefGoogle Scholar
  7. 7.
    Gulati A, Pandit H, Jenkins C, Chau R, Dodd CA, Murray DW. The effect of leg alignment on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br. 2009;91:469–474.PubMedCrossRefGoogle Scholar
  8. 8.
    Hamilton WG, Ammeen D, Engh CA Jr, Engh GA. Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplasty. 2010;25:735–740.PubMedCrossRefGoogle Scholar
  9. 9.
    Hvid I, Bentzen SM, Jørgensen J. Remodeling of the tibial plateau after knee replacement: CT bone densitometry. Acta Orthop Scand. 1988;59:567–573.PubMedCrossRefGoogle Scholar
  10. 10.
    Iesaka K, Tsumura H, Sonoda H, Sawatari T, Takasita M, Torisu T. The effects of tibial component inclination on bone stress after unicompartmental knee arthroplasty. J Biomech. 2002;35:969–974.PubMedCrossRefGoogle Scholar
  11. 11.
    Klemme WR, Galvin EG, Petersen SA. Unicompartmental knee arthroplasty: sequential radiographic and scintigraphic imaging with an average five-year follow-up. Clin Orthop Relat Res. 1994;301:233–238.PubMedGoogle Scholar
  12. 12.
    Kress AM, Schmidt R, Vogel T, Nowak TE, Forst R, Mueller LA. Quantitative computed tomography-assisted osteodensitometry of the pelvis after press-fit cup fixation: a prospective ten-year follow-up. J Bone Joint Surg Am. 2011;93:1152–1157.PubMedCrossRefGoogle Scholar
  13. 13.
    Levitz CL, Lotke PA, Karp JS. Long-term changes in bone mineral density following total knee replacement. Clin Orthop Relat Res. 1995;321:68–72.PubMedGoogle Scholar
  14. 14.
    Lindstrand A, Stenström A, Ryd L, Toksvig-Larsen S. The introduction period of unicompartmental knee arthroplasty is critical: a clinical, clinical multicentered, and radiostereometric study of 251 Duracon unicompartmental knee arthroplasties. J Arthroplasty. 2000;15:608–616.PubMedCrossRefGoogle Scholar
  15. 15.
    Lonner JH, Klotz M, Levitz C, Lotke PA. Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty. 2001;16:107–111.PubMedCrossRefGoogle Scholar
  16. 16.
    Munro JT, Pandit S, Walker CG, Clatworthy M, Pitto RP. Loss of tibial bone density in patients with rotating- or fixed-platform TKA. Clin Orthop Relat Res. 2010;468:775–781.PubMedCrossRefGoogle Scholar
  17. 17.
    New Zealand Joint Registry. Eleven Year Report. Christchurch, New Zealand: New Zealand Orthopaedic Association; 2010.Google Scholar
  18. 18.
    Petersen MM, Gehrchen PM, Østgaard SE, Nielsen PK, Lund B. 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. 2005;20:516–520.PubMedCrossRefGoogle Scholar
  19. 19.
    Price A, Waite J, Svard U. Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2005;435:171-180.PubMedCrossRefGoogle Scholar
  20. 20.
    Regnér LR, Carlsson LV, Kärrholm JN, Hansson TH, Herberts PG, Swanpalmer J. Bone mineral and migratory patterns in uncemented total knee arthroplasties: a randomized 5-year follow-up study of 38 knees. Acta Orthop Scand. 1999;70:603–608.PubMedCrossRefGoogle Scholar
  21. 21.
    Reilly K, Munro J, Pandit S, Kress A, Walker C, Pitto RP. Inter-observer validation study of quantitative CT-osteodensitometry in total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127:729–731.PubMedCrossRefGoogle Scholar
  22. 22.
    Sadoghi P, Leithner A, Weber P, Friesenbichler J, Gruber G, Kastner N, Pohlmann K, Jansson V, Wegener B. Radiolucent lines in low-contact-stress mobile-bearing total knee arthroplasty: a blinded and matched case control study. BMC Musculoskelet Disord. 2011;12:142.PubMedCrossRefGoogle Scholar
  23. 23.
    Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. J Bone Joint Surg Br. 2012;94:1321–1329.PubMedCrossRefGoogle Scholar
  24. 24.
    Sawatari T, Tsumura H, Iesaka K, Furushiro Y, Torisu T. Three-dimensional finite element analysis of unicompartmental knee arthroplasty: the influence of tibial component inclination. J Orthop Res. 2005;23:549–554.PubMedCrossRefGoogle Scholar
  25. 25.
    Schmidt R, Pitto RP, Kress A, Ehremann C, Nowak TE, Reulbach U, Forst R, Müller L. Inter- and intraobserver assessment of periacetabular osteodensitometry after cemented and uncemented total hip arthroplasty using computed tomography. Arch Orthop Trauma Surg. 2005;125:291–297.PubMedCrossRefGoogle Scholar
  26. 26.
    Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93:1057–1063.PubMedCrossRefGoogle Scholar
  27. 27.
    Shetty NR, Hamer AJ, Kerry RM, Stockley I, Eastell R, Wilkinson JM. Bone remodelling around a cemented polyethylene cup: a longitudinal densitometry study. J Bone Joint Surg Br. 2006;88:455–459.PubMedGoogle Scholar
  28. 28.
    Soininvaara TA, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM, Kröger HP. Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients. Acta Orthop Scand. 2004;75:600–605.PubMedCrossRefGoogle Scholar
  29. 29.
    Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Unicompartmental knee replacement: a minimum 15 year followup study. Clin Orthop Relat Res. 1999;367:61–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Stewart HD, Newton G. Long-term results of the Manchester knee: surface arthroplasty of the tibiofemoral joint. Clin Orthop Relat Res. 1992;278:138–146.PubMedGoogle Scholar
  31. 31.
    Therbo M, Petersen MM, Varmarken JE, Olsen CA, Lund B. Influence of pre-operative bone mineral content of the proximal tibia on revision rate after uncemented knee arthroplasty. J Bone Joint Surg Br. 2003;85:975–979.PubMedCrossRefGoogle Scholar
  32. 32.
    Warming L, Hassager C, Christiansen C. Changes in bone mineral density with age in men and women: a longitudinal study. Osteoporos Int. 2002;13:105–112.PubMedCrossRefGoogle Scholar
  33. 33.
    Weale AE, Murray DW, Baines J, Newman JH. Radiological changes five years after unicompartmental knee replacement. J Bone Joint Surg Br. 2000;82:996–1000.PubMedCrossRefGoogle Scholar
  34. 34.
    Zannoni C, Viceconti M, Pierotti L, Cappello A. Analysis of titanium induced CT artifacts in the development of biomechanical finite element models. Med Eng Phys. 1998;20:653-659.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Bradley I. Richmond
    • 1
    • 2
  • Simon V. Hadlow
    • 2
  • Tim G. Lynskey
    • 2
  • Cameron G. Walker
    • 3
  • Jacob T. Munro
    • 4
  1. 1.Department of OrthopaedicsMiddlemore HospitalAuckland, ManukauNew Zealand
  2. 2.Department of OrthopaedicsTaranaki Base HospitalNew PlymouthNew Zealand
  3. 3.Department of Engineering ScienceUniversity of AucklandAucklandNew Zealand
  4. 4.Auckland Bioengineering InstituteUniversity of AucklandAucklandNew Zealand

Personalised recommendations