Abstract
Background
Cementless fixation remains controversial in TKA due to the challenge of achieving consistent skeletal attachment. Factors predicting durable fixation are not clearly understood, but we presumed bone ingrowth could be enhanced by the quantity of host bone and application of autograft bone chips.
Questions/purposes
We asked: (1) Did the amount of bone ingrowth exceed the amount of periprosthetic and host bone with the addition of autograft bone chips? (2) Did the amount of bone ingrowth increase with implantation time? And (3) did osteolysis along the porous-coated interface and screw tracts progress with implantation time?
Methods
We measured the amount of bone in the porous-coated, periprosthetic, and host bone regions in 19 postmortem retrieved cementless primary total knee implants. The amount of bone in apposition to the implant surface, and alternatively lysed bone, was analyzed radiographically to assess the progression of osteolysis.
Results
While bone ingrowth tended to be less than periprosthetic and host bone in all three components, it was only significantly less in the patellar component. Bone ingrowth increased in all three components over time, but progression of osteolysis did not.
Conclusions
Even after long-term followup, the amount of bone ingrowth did not surpass host bone levels, suggesting the amount of a patient’s host bone is a limiting factor in the amount of bone ingrowth achievable for this cementless design. It remains unknown whether compromised osteopenic bone could achieve the amount of bone attachment necessary to provide durable fixation over time.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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References
Bischoff UW, Freeman MA, Smith D, Tuke MA, Gregson PJ. Wear induced by motion between bone and titanium or cobalt-chrome alloys. J Bone Joint Surg Br. 1994;76:713–716.
Bloebaum RD, Bachus KN, Jensen JW, Hofmann AA. Postmortem analysis of consecutively retrieved asymmetric porous-coated tibial components. J Arthroplasty. 1997;12:920–929.
Bloebaum RD, Bachus KN, Jensen JW, Scott DF, Hofmann AA. Porous-coated metal-backed patellar components in total knee replacement. J Bone Joint Surg Am. 1998;80:518–528.
Bloebaum RD, Bachus KN, Momberger NG, Hofmann AA. Mineral apposition rates of human cancellous bone at the interface of porous coated implants. J Biomed Mater Res. 1994;28:537–544.
Bloebaum RD, Merrell M, Gustke K, Simmons M. Retrieval analysis of a hydroxyapatite-coated hip prosthesis. Clin Orthop Relat Res. 1991;267:97–102.
Bloebaum RD, Mihalopoulus NL, Jensen JW, Dorr LD. Postmortem analysis of bone growth into porous-coated acetabular components. J Bone Joint Surg Am. 1997;79:1013–1022.
Bloebaum RD, Rhodes DM, Rubman MH, Hofmann AA. Bilateral tibial components of different cementless designs and materials: microradiographic, backscattered imaging, and histologic analysis. Clin Orthop Relat Res. 1991;268:179–187.
Bloebaum RD, Rubman MH, Hofmann AA. Bone ingrowth into porous-coated tibial components implanted with autograft bone chips: analysis of ten consecutively retrieved implants. J Arthroplasty. 1992;7:483–493.
Bobyn JD, Cameron HU, Abdulla D, Pilliar RM, Weatherly GC. Biologic fixation and bone modeling with an unconstrained canine total knee prosthesis. Clin Orthop Relat Res. 1982;166:301–312.
Bobyn JD, Pilliar RM, Cameron HU, Weatherly GC. The optimum pore size for the fixation of porous-surfaced metal implants by the ingrowth of bone. Clin Orthop Relat Res. 1980;150:263–270.
Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81:907–914.
Collier JP, Colligan GA, Brown SA. Bone ingrowth into dynamically loaded porous-coated intramedullary nails. J Biomed Mater Res. 1976;10:485–492.
Collier JP, Mayor MB, Chae JC, Surprenant VA, Surprenant HP, Dauphinais LA. Macroscopic and microscopic evidence of prosthetic fixation with porous-coated materials. Clin Orthop Relat Res. 1988;235:173–180.
Deglurkar M, Davy DT, Stewart M, Goldberg VM, Welter JF. Evaluation of machining methods for trabecular metal implants in a rabbit intramedullary osseointegration model. J Biomed Mater Res B Appl Biomater. 2007;80:528–540.
Evanich CJ, Tkach TK, von Glinski S, Camargo MP, Hofmann AA. 6- to 10-year experience using countersunk metal-backed patellas. J Arthroplasty. 1997;12:149–154.
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;53:101–114.
Hofmann AA. Response of human cancellous bone to identically structured commercially pure titanium and cobalt chromium alloy porous-coated cylinders. Clin Mater. 1993;14:101–115.
Hofmann AA, Bachus KN, Bloebaum RD. Comparative study of human cancellous bone remodeling to titanium and hydroxyapatite coated implants. J Arthroplasty. 1993;8:157–166.
Hofmann AA, Bloebaum RD, Bachus KN. Progression of human bone ingrowth into porous-coated implants. Acta Orthop Scand. 1997;68:161–166.
Hofmann AA, Bloebaum RD, Koller KE, Lahav A. Does Celecoxib have an adverse effect on bone remodeling and ingrowth in humans? Clin Orthop Relat Res. 2006;452:200–204.
Hofmann AA, Bloebaum RD, Rubman MH, Bachus KN, Plaster R. Microscopic analysis of autograft bone applied at the interface of porous-coated devices in human cancellous bone. Int Orthop (SICOT). 1992;16:349–358.
Hofmann AA, Evanich JD, Ferguson RP, Camargo MP. Ten- to 14-year clinical followup of the cementless Natural Knee system. Clin Orthop Relat Res. 2001;388:85–94.
Hofmann AA, Murdock LE, Wyatt RW, Alpert JP. Total knee arthroplasty: two- to four-year experience using an asymmetric tibial tray and a deep trochlear-grooved femoral component. Clin Orthop Relat Res. 1991;269:78–88.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of The Knee Society Rating System. Clin Orthop Relat Res. 1989;248:13–14.
Jasty M, Bragdon CR, Haire T, Mulroy RD Jr, Harris WH. Comparison of bone ingrowth into cobalt chrome sphere and titanium fiber mesh porous coated cementless canine acetabular components. J Biomed Mater Res. 1993;27:639–644.
La Budde JK, Orosz JF, Bonfiglio TA, Pellegrini VD Jr. Particulate titanium and cobalt-chrome metallic debris in failed total knee arthroplasty: a quantitative histologic analysis. J Arthroplasty. 1994;9:291–304.
Nafei A, Nielsen S, Kristensen O, Hvid I. The press-fit Kinemax knee arthroplasty: high failure rate of non-cemented implants. J Bone Joint Surg Br. 1992;74:243–246.
Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty: a 15-year survivorship study. Clin Orthop Relat Res. 1993;286:94–102.
Sumner DR, Bryan JM, Urban RM, Kuszak JR. Measuring the volume fraction of bone ingrowth: a comparison of three techniques. J Orthop Res. 1990;8:448–452.
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.
Willie BM, Bloebaum RD, Bireley WR, Bachus KN, Hofmann AA. Determining relevance of a weight-bearing ovine model for bone ingrowth assessment. J Biomed Mater Res A. 2004;69:567–576.
Wright TM, Rimnac CM, Stulberg SD, Mintz L, Tsao AK, Klein RW, McCrae C. Wear of polyethylene in total joint replacements: observations from retrieved PCA knee implants. Clin Orthop Relat Res. 1992;276:126–134.
Acknowledgments
We express our gratitude to the donors and their families for participating in our IRB-approved implant retrieval program. We also thank Mrs Gwenevere Shaw, Richard Tyler Epperson, Jennifer Wescoat, and Brooke Kawaguchi for their contributions.
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The institution of one or more of the authors (RDB, KEK, BMW, AAH) has received, in any 1 year, funding from the Department of Veterans Affairs Salt Lake City Health Care System and the Department of Orthopaedics, University of Utah School of Medicine. Funding had also been received in support of the program from Intermedics Orthopedics Inc (San Diego, CA, USA), Sulzer Orthopedics (Winterthur, Switzerland), Centerpulse Orthopedics Inc (Austin, TX, USA), and Zimmer, Inc (Warsaw, IN, USA). Each author certifies that he or she, or a member of his/her immediate family, has not received compensation based on this work.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This project was performed at the Department of Veterans Affairs Salt Lake City Health Care System and the University of Utah School of Medicine.
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Bloebaum, R.D., Koller, K.E., Willie, B.M. et al. Does Using Autograft Bone Chips Achieve Consistent Bone Ingrowth in Primary TKA?. Clin Orthop Relat Res 470, 1869–1878 (2012). https://doi.org/10.1007/s11999-011-2214-2
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DOI: https://doi.org/10.1007/s11999-011-2214-2