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Uncemented Fixation

Is Uncemented Fixation Reliable Enough to Replace Cemented?
  • Peter S. Walker
Chapter
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Abstract

In parallel with using cement for fixing knee components to the bone, other investigators were convinced that a better method was to coat the components with a porous surface so that the bone would grow into the pores, forming a rigid and long-lasting bond. The feasibility was first demonstrated using porous ceramics, but this proved to be impractical because of fabrication problems of the components themselves. Another approach was to use crimped and sintered metal fibers, forming pads which could be sintered into pockets in solid metal components. Alternately, a porous layer was formed directly on the metal substrate by sintering a layer of small metal beads on the surfaces of the components. The earliest designs using these methods were the Miller-Galante (MG) knee and the porous-coated anatomic (PCA) knee. It was soon found that in order for ingrowth to occur, initial rigidity of the components to the bone was needed, which was not easy to achieve in the knee. Experiments by Volz showed that interface motions could be minimized if components were initially screwed in place, and this was successful until the screws themselves caused other problems. Today, new surfaces show promise for achieving the same reliability as cemented fixation, but more time is needed to compare long-term results.

Keywords

Porous ingrowth. Bone ingrowth. Porous surfaces. Interface micromotion. Pore size. Long-term fixation. Uncemented fixation. Trabecular metal. Press-fit fixation 

References

  1. Bargar WL. CORR Insights(R): the Mark Coventry Award: trabecular metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2015;473(1):43–4.CrossRefGoogle Scholar
  2. Bloebaum RD, Rubman MH, Hofmann AA. Bone ingrowth into porous-coated tibial components implanted with autograft bone chips. J Arthroplast. 1992;7(4):483–93.CrossRefGoogle Scholar
  3. Buechel FF, Pappas MJ. New Jersey low contact stress knee replacement system. Ten-year evaluation of meniscal bearings. Orthop Clin North Am. 1989;20(2):147–77.PubMedGoogle Scholar
  4. Cheng CL, Gross AE. Loosening of the porous coating in total knee replacement. J Bone Joint Surg. 1988;70(3):377–81.CrossRefGoogle Scholar
  5. Collins DN, Heim SA, Nelson CL, Smith P, 3rd. Porous-coated anatomic total knee arthroplasty. A prospective analysis comparing cemented and cementless fixation. Clin Orthop Relat Res 1991(267):128-136.Google Scholar
  6. Freeman MA, McLeod HC, Levai JP. Cementless fixation of prosthetic components in total arthroplasty of the knee and hip. Clin Orthop Relat Res. 1983;(176):88–94.Google Scholar
  7. Galante J, Rostoker W, Lueck R, Ray RD. Sintered fiber metal composites as a basis for attachment of implants to bone. J Bone Joint Surg Am. 1971;53(1):101–14.CrossRefGoogle Scholar
  8. Goodman S, Aspenberg P. Effect of amplitude of micromotion on bone ingrowth into titanium chambers implanted in the rabbit tibia. Biomaterials. 1992;13(13):944–8.CrossRefGoogle Scholar
  9. Harwin SF, Patel NK, Chughtai M, et al. Outcomes of newer generation cementless total knee arthroplasty: beaded periapatite-coated vs highly porous titanium-coated implants. J Arthroplast. 2017;32(7):2156–60.CrossRefGoogle Scholar
  10. Hungerford DS, Kenna RV. Preliminary experience with a total knee prosthesis with porous coating used without cement. Clin Orthop Rel Res. 1983(176):95–107.Google Scholar
  11. Joseph J, Kaufman EE. Preliminary results of Miller-Galante uncemented total knee arthroplasty. Orthopedics. 1990;13(5):511–6.PubMedGoogle Scholar
  12. Klawitter JJ, Bhatti NA. Ceramic prosthetic implant suitable for a knee joint plateau. US patent 4,000,525. Filed Aug. 21, 1975, Issued Jan 4, 1977.Google Scholar
  13. Klawitter J, Hulbert S. Application of porous ceramics for the attachment of load bearing internal orthopedic applications. J Biomed Mater Res. 1971;5(6):161–229.CrossRefGoogle Scholar
  14. Kraay MJ, Meyers SA, Goldberg VM, Figgie HE 3rd, Conroy PA. “Hybrid” total knee arthroplasty with the Miller-Galante prosthesis. A prospective clinical and roentgenographic evaluation. Clin Orthop Relat Res. 1991;(273):32–41.Google Scholar
  15. Landon GC, Galante JO, Maley MM. Noncemented total knee arthroplasty. Clin Orthop Relat Res. 1986;(205):49–57.Google Scholar
  16. Lembert E, Galante J, Rostoker W. Fixation of skeletal replacement by fiber metal composites. Clin Orthop Relat Res. 1972;87:303–10.CrossRefGoogle Scholar
  17. Meneghini RM, Hanssen AD. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. 2008;21(4):307–14.CrossRefGoogle Scholar
  18. Martens M, Ducheyne P, De Meester P, Mulier JC. Skeletal fixation of implants by bone ingrowth into surface pores. Arch Orthop Trauma Surg. 1980;97(2):111–6.CrossRefGoogle Scholar
  19. Newman JM, Sodhi N, Khlopas A, et al. Cementless total knee arthroplasty: a comprehensive review of the literature. Orthopedics. 2018;41(5):263–73.CrossRefGoogle Scholar
  20. Pilliar RM. Powder metal-made orthopedic implants with porous surface for fixation by tissue ingrowth. Clin Orthop Relat Res. 1983;(176):42–51.Google Scholar
  21. Ryd L. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation. Acta Orthop Scand Suppl. 1986;220:1–80.PubMedGoogle Scholar
  22. Saers JPP, Cazorla-Bak Y, Shaw CN, Stock JT, Ryan TM. Trabecular bone structure variation throughout the lower limb. J Human Evol. 2016;97:97–108.CrossRefGoogle Scholar
  23. Selvik G. Roentgen stereophotogrammetry: a method for the study of the kinematics of the skeletal system. Reprint from the original 1974 thesis. Acta Orthopaedica Scandinavica Supplementum no. 232, Vol. 60.1989Google Scholar
  24. Small SR, Ritter MA, Merchun JG, Davis KE, Rogge RD. Changes in tibial bone density measured from standard radiographs in cemented and uncemented total knee replacements after ten years’ follow-up. Bone Joint J. 2013;95-b(7):911–6.CrossRefGoogle Scholar
  25. Spector M. Historical review of porous-coated implants. J Arthroplast. 1987;2(2):163–77.CrossRefGoogle Scholar
  26. Volz RG, Nisbet JK, Lee RW, McMurtry MG. The mechanical stability of various noncemented tibial components. Clin Orthop Relat Res. 1988;(226):38–42.Google Scholar
  27. Volz RG, Benjamin JB. The current status of total joint replacement. Investig Radiol. 1990;25(1):86–92.CrossRefGoogle Scholar
  28. Walker PS, Hsu HP, Zimmerman RA. A comparative study of uncemented tibial components. J Arthroplast. 1990;5(3):245–53.CrossRefGoogle Scholar
  29. Whiteside LA. Long-term followup of the bone-ingrowth Ortholoc knee system without a metal-backed patella. Clin Orthop Relat Res. 2001;388:77–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Peter S. Walker
    • 1
  1. 1.Department of Orthopedic SurgeryNew York UniversityNew YorkUSA

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