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Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study

Knee Surgery, Sports Traumatology, Arthroscopy volume 20, pages 1087–1091 (2012)Cite this article

Abstract

Purpose

Periprosthetic tibial plateau fractures represent a rare but serious complication in unicompartmental knee arthroplasty and are associated with extended sagittal tibial bone cuts. These can occur during the surgery, weaken the posterior cortex of the tibia and are associated with periprosthetic tibial plateau fractures. Although excellent long-term results have been reported with cemented unicompartmental knee arthroplasty, there is high interest in cementless fixation. The aim of the study was to compare fracture loads of cementless and cemented unicompartmental knee arthroplasty.

Methods

Tibial components of the Oxford Uni were implanted in six paired fresh-frozen tibiae with a defined extended saw cut (10°) at the dorsal cortex of each specimen. In one set, surgery was performed with cement fixation, and in the other, cementless components were implanted. Vertical loads were then applied under standardised conditions to fracture the specimens.

Results

Median loads of 3.7 (0.7–6.9) kN led to fractures in the cemented group, whereas cementless fixated tibiae fractured with a median load of 1.6 (0.2–4.3) kN (P = 0.02).

Conclusion

The loading capacity in tibiae with cementless components is significantly less compared to cemented fixation. The results show that in case of an extended sagittal bone cut patients especially those with poor bone quality who are treated with a cementless unicompartmental knee arthroplasty are at higher risk for periprosthetic tibial fractures.

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Conflict of interest

The study was partially supported by Biomet, and the authors of the study disclose the following financial relationships to the company: Dr. Clarius serves as a paid consultant for Aesculap and Biomet and has received research or institutional support from Biomet. However, Aesculap or Biomet did not exert an influence on the study methods, results, or interpretation of the data. The study was supported by a research fund of the University of Heidelberg.

Author information

Affiliations

  1. Center for Musculoskeletal Surgery, University of Berlin, Charitéplatz 1, 10117, Berlin, Germany

    J. B. Seeger, E. Röhner & S. Tohtz

  2. Laboratory of Biomechanics and Implant Research, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    J. B. Seeger, D. Haas, S. Jäger & M. Clarius

  3. Department of Orthopaedic and Trauma Surgery, Vulpius Klinik GmbH, Vulpiusstraße 29, 74906, Bad Rappenau, Germany

    M. Clarius

Authors
  1. J. B. Seeger
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  2. D. Haas
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  3. S. Jäger
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  4. E. Röhner
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  5. S. Tohtz
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  6. M. Clarius
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Correspondence to M. Clarius.

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Seeger, J.B., Haas, D., Jäger, S. et al. Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc 20, 1087–1091 (2012). https://doi.org/10.1007/s00167-011-1698-3

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  • DOI: https://doi.org/10.1007/s00167-011-1698-3

Keywords

  • Tibial plateau fracture
  • Periprosthetic
  • Cementless
  • Unicompartmental knee
  • Saw cut
  • Fracture load