Skip to main content

Advertisement

SpringerLink
Log in

Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Metal allergy in total knee arthroplasty (TKA) is still a controversial topic. Oxinium, ceramic or titanium niobium nitride (TiNbN) coated implants are available for some knee systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the allergic patients receiving TiNbN-coated implants would require revision for metal allergy.

Materials and methods

This study was a retrospective, 2 to 1 matched pairs study with 40 titanium niobium nitride-coated TKA compared with 80 conventional cobalt chrome implants. No demographic differences between these groups were observed. The mean follow-up for this study was 2 years.

Results

No differences in clinical, radiological, or patient-reported outcome measurements were observed between the two groups. No patients have been revised at this short- to medium-term outcome evaluation.

Discussion

Metal allergy leading to contact or systemic dermatitis is especially linked to chrome and cobalt allergy. Nickel allergy because of knee implants rarely gives cutaneous symptoms, but could potentially lead to peri-prosthetic osteolysis and loosening. The use of titanium niobium nitride implants in case of a positive history of metal allergy could avoid this devastating complication.

Conclusion

The use of titanium niobium nitride-coated implants for primary knee osteoarthritis shows similar clinical and radiological outcomes as conventional TKA without revision for loosening at short- to medium-term follow-up.

Level of evidence Level IV study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Antonios D, Rouseau P, Larangé A, Kerdine-Römer S, Pallardy M (2010) Mechanisms of IL-AZ synthesis by human dendritic cells treated with the chemical sensitizer NiSO4. J Immunol 185:89–98

    Article  CAS  PubMed  Google Scholar 

  2. Basko-Plluska JL, Thyssen JP, Schalock PC (2011) Cutaneous and systemic hypersensitivity reactions to metallic implants. Dermatitis 22:65–79

    PubMed  Google Scholar 

  3. Beecker J, Gordon J, Pratt M (2009) An interesting case of joint prosthesis allergy. Dermatitis 20:4–9

    Google Scholar 

  4. Bergschmidt P, Bader R, Ganzer D, Hauzeur C, Lohmann CH, Krüger A, Rüther W, Tigani D, Rani N, Esteve JL, Prats FL, Zorzi C, Madonna V, Rigotti S, Benazzo F, Rossi SM, Mittelmeier W (2015) Prospective multi-centre study on a composite ceramic femoral component in total knee arthroplasty: five-year clinical and radiological outcomes. Knee 22:186–191

    Article  PubMed  Google Scholar 

  5. Bloemke AD, Clarke HD (2014) Prevalence of self-reported metal allergy in patients undergoing primary total knee arthroplasty. J Knee Surg. doi:10.1055/s-0034-1381959

    PubMed  Google Scholar 

  6. Caicedo MS, Desai R, McAllister K, Reddy A, Jacobs JJ, Hallab NJ (2008) Soluble and particulate Co–Cr–Mo alloy implant metals activate the inflammasome danger signaling pathway in human macrophages: a novel mechanism for implant debris reactivity. J Orthop Res 27:847–854

    Article  Google Scholar 

  7. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    PubMed  Google Scholar 

  8. Ezzet KA, Hermida JC, Colwell CW Jr, D’Lima DD (2004) Oxidized zirconium femoral components reduce polyethylene wear in a knee wear simulator. Clin Orthop Relat Res 428:120–124

    Article  PubMed  Google Scholar 

  9. Frigerio E, Pigatto PD, Guzzi G, Altomare G (2011) Metal sensitivity in patients with orthopedic implants: a prospective study. Contact Dermat 64:273–279

    Article  CAS  Google Scholar 

  10. Gao X, He RX, Yan SG, Wu LD (2011) Dermatitis associated with chromium following total knee arthroplasty. J Arthroplasty 26:665

    Article  PubMed  Google Scholar 

  11. Granchi D, Cenni E, Giunti A, Baldini N (2012) Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review. J Bone Joint Surg Br 94:1126–1134

    Article  CAS  PubMed  Google Scholar 

  12. Grosu I, Lavand’homme P, Thienpont E (2014) Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc 22:1744–1758

    Article  PubMed  Google Scholar 

  13. Hallab N, Merritt K, Jacobs JJ (2001) Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 83:428–436

    Article  PubMed  Google Scholar 

  14. Hallab NJ, Caicedo M, Epstein R, McAllister K, Jacobs JJ (2010) In vitro reactivity to implant metals demonstrates a person-dependant association with both T-cell and B-cell activation. J Biomed Mat Res 92:667–682

    Google Scholar 

  15. Innocenti M, Civinini R, Carulli C, Matassi F, Villano M (2010) The 5-year results of an oxidized zirconium femoral component for TKA. Clin Orthop Relat Res 468:1258–1263

    Article  PubMed Central  PubMed  Google Scholar 

  16. Innocenti M, Carulli C, Matassi F, Carossino AM, Brandi ML, Civinini R (2014) Total knee arthroplasty in patients with hypersensitivity to metals. Int Orthop 38:329–333

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kim YH, Park JW, Kim JS (2012) Comparison of the Genesis II total knee replacement with oxidized zirconium and cobalt–chromium femoral components in the same patients: a prospective, double-blind, randomized controlled study. J Bone Joint Surg Br 94:1221–1227

    Article  PubMed  Google Scholar 

  18. Kitagawa A, Chin T, Tsumura N, Iguchi T (2013) Metal sensitivity in patients before and after total knee arthroplasty (TKA): comparison between ceramic surfaced oxidized zirconium and cobalt–chromium implants. Hypersensitivity 1:3. doi:10.7243/2052-594X-1-3

    Article  Google Scholar 

  19. Lutzner J, Dinnebier G, Hartmann A, Gunther KP, Kirschner S (2009) Study rationale and protocol: prospective randomized comparison of metal ion concentrations in the patient’s plasma after implantation of coated and uncoated total knee prostheses. BMC Musculoskelet Disord 10:128

    Article  PubMed Central  PubMed  Google Scholar 

  20. Luetzner J, Krummenauer F, Lengel AM, Ziegler J, Witzleb WC (2007) Serum metal ion exposure after total knee arthroplasty. Clin Orthop Relat Res 461:136–142

    PubMed  Google Scholar 

  21. Magone K, Luckenbill D, Goswami T (2015) Metal ions as inflammatory initiators of osteolysis. Arch Orthop Trauma Surg 135:683–695

    Article  PubMed  Google Scholar 

  22. Munch HJ, Jacobsen SS, Olesen JT, Menné JT, Soballe K, Thyssen JP (2015) The association between metal allergy, total knee arthroplasty, and revision. Acta Orthop 86:1–6

    Article  Google Scholar 

  23. Mohammed A, Metcalfe A, Woodnutt D (2014) Medium-term outcome of titanium nitride, mobile bearing total knee replacement. Acta Orthop Belg 80:269–275

    PubMed  Google Scholar 

  24. Park SW, Kim H, In Y (2014) Fracture of titanium nitride-coated femoral component after total knee arthroplasty. Knee 21:871–874

    Article  PubMed  Google Scholar 

  25. Post ZD, Orozco FR, Ong AC (2013) Metal sensitivity after TKA presenting with systemic dermatitis and hair loss. Orthopedics 36:525–528

    Article  Google Scholar 

  26. Razak A, Ebinesan AD, Charalambous CP (2013) Metal allergy screening prior to joint arthroplasty and its influence on implant choice: a Delphi consensus study amongst orthopaedic arthroplasty surgeons. Knee Surg Relat Res. doi:10.5792/ksrr.2013.25.4.186

    PubMed Central  PubMed  Google Scholar 

  27. Seil R, Pape D (2011) Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1418–1432

    Article  PubMed  Google Scholar 

  28. Thienpont E, Berger Y (2013) No allergic reaction after TKA in a chrome–cobalt–nickel-sensitive patient: case report and review of the literature. Knee Surg Sports Traumatol Arthrosc 21:636–640

    Article  PubMed  Google Scholar 

  29. Thienpont E, Opsomer G, Koninckx A, Houssiau F (2014) Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint Score. J Arthroplasty 29:48–51

    Article  PubMed  Google Scholar 

  30. Thomsen M, Rozak M, Thomas P (2011) Pain in a chromium-allergic patient with total knee arthroplasty: disappearance of symptoms after revision with a special surface-coated TKA: a case report. Acta Orthop 82:386–388

    Article  PubMed Central  PubMed  Google Scholar 

  31. Thyssen JP, Menné T (2010) Metal allergy: a review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol 23:309–318

    Article  CAS  PubMed  Google Scholar 

  32. Van Hove RP, Brohet RM, van Royen BJ, Nolte PA (2014) No clinical benefit of titanium nitride coating in cementless mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:509–516

    Article  Google Scholar 

  33. Vaninbroukx M, Labey L, Innocenti B, Bellemans J (2009) Cementing the femoral component in total knee arthroplasty: which technique is the best? Knee 16:265–268

    Article  PubMed  Google Scholar 

  34. Van Opstal N, Verheyden F (2011) Revision of a tibial baseplate using a customized oxinium component in a case of suspected metal allergy: a case report. Acta Orthop Belg 77:691–695

    PubMed  Google Scholar 

  35. Verma SB, Mody B, Gawkrodger DJ (2006) Dermatitis on the knee following knee replacement: a minority of cases show contact allergy to chromate, cobalt or nickel but a causal association is unproven. Contact Dermat 54:228–229

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University Hospital Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium

    Emmanuel Thienpont

Authors
  1. Emmanuel Thienpont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emmanuel Thienpont.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thienpont, E. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty. Arch Orthop Trauma Surg 135, 1749–1754 (2015). https://doi.org/10.1007/s00402-015-2320-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2320-9

Keywords

Search

Navigation