Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty
Abstract Background Total knee arthroplasty (TKA) is one of the most common orthopaedic procedures and the number of patients which undergo TKA will continue to rise in the coming years. Consecutively, the number of necessary revision surgeries will increase. One of the main reasons for revision sur...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05465-0 |
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| author | Dominic Schaefer Artur Barsumyan Kambiz Roshanghias Jan Adriaan Graw Christian Soost Wolfgang Richter Jonas Knoche Arne Ohrndorf Rene Burchard |
| author_facet | Dominic Schaefer Artur Barsumyan Kambiz Roshanghias Jan Adriaan Graw Christian Soost Wolfgang Richter Jonas Knoche Arne Ohrndorf Rene Burchard |
| author_sort | Dominic Schaefer |
| collection | DOAJ |
| description | Abstract Background Total knee arthroplasty (TKA) is one of the most common orthopaedic procedures and the number of patients which undergo TKA will continue to rise in the coming years. Consecutively, the number of necessary revision surgeries will increase. One of the main reasons for revision surgery is aseptic loosening because of a so-called stress-shielding effect. Typically, revision of a primary TKA is done from a bicondylar surface replacement to a stem-anchored prosthesis, which, due to higher stress-shielding, have a shorter survival time than non-stem-anchored systems. Similar to endoprosthetic treatment in pediatric tumor orthopedics, non-ingrown cementless stems can be used. The study aim was to investigate whether this concept can also be applied to reduce stress-shielding in the tibial metaphysis after revision TKA in adults. Methods Six tibial biomechanical bone with stemmed tibial TKA components were implanted using surface cementing and a floating-embedded stem or classic full cementing. After implantation, axial force was applied in such a way that the same load was generated as during walking. Two high-resolution cameras and illumination spots were used to record changes on the bone surface circumferentially in three regions of interest and from three different views. Results With regard to the fixation method, a significant difference could be demonstrated in the metaphyseal and in the middle region around the stem (p < 0.001). At the tip of the stems, the reduction of strain energy density showed a stress shielding reduction for the floating-stemmed models in two of three views (ventromedial p = 0.002, lateral p = 0.398, and dorsal: p = 0.027). Conclusions In revision surgery after TKA, the use of floating-embedded, uncemented stems without bony ingrowth shows significant reduction of metaphyseal stress-shielding within the proximal tibia. This technique could be a viable alternative to prevent early aseptic loosening and should be examined in future in-vivo studies. |
| format | Article |
| id | doaj-art-c01d63d6bb8a425a9e1b10a3c42d1e4a |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-c01d63d6bb8a425a9e1b10a3c42d1e4a2025-01-19T12:32:38ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-01-0120111010.1186/s13018-025-05465-0Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplastyDominic Schaefer0Artur Barsumyan1Kambiz Roshanghias2Jan Adriaan Graw3Christian Soost4Wolfgang Richter5Jonas Knoche6Arne Ohrndorf7Rene Burchard8Department of Engineering, School of Science, University of SiegenUniversity of MarburgDepartment of Orthopaedics and Traumatology, University of Giessen and MarburgDepartment of Anesthesiology and Intensive Care Medicine, Ulm University HospitalDepartment of Statistics, School of Economic Disciplines, University of SiegenDepartment of Engineering, School of Science, University of SiegenDepartment of Engineering, School of Science, University of SiegenDepartment of Engineering, School of Science, University of SiegenUniversity of MarburgAbstract Background Total knee arthroplasty (TKA) is one of the most common orthopaedic procedures and the number of patients which undergo TKA will continue to rise in the coming years. Consecutively, the number of necessary revision surgeries will increase. One of the main reasons for revision surgery is aseptic loosening because of a so-called stress-shielding effect. Typically, revision of a primary TKA is done from a bicondylar surface replacement to a stem-anchored prosthesis, which, due to higher stress-shielding, have a shorter survival time than non-stem-anchored systems. Similar to endoprosthetic treatment in pediatric tumor orthopedics, non-ingrown cementless stems can be used. The study aim was to investigate whether this concept can also be applied to reduce stress-shielding in the tibial metaphysis after revision TKA in adults. Methods Six tibial biomechanical bone with stemmed tibial TKA components were implanted using surface cementing and a floating-embedded stem or classic full cementing. After implantation, axial force was applied in such a way that the same load was generated as during walking. Two high-resolution cameras and illumination spots were used to record changes on the bone surface circumferentially in three regions of interest and from three different views. Results With regard to the fixation method, a significant difference could be demonstrated in the metaphyseal and in the middle region around the stem (p < 0.001). At the tip of the stems, the reduction of strain energy density showed a stress shielding reduction for the floating-stemmed models in two of three views (ventromedial p = 0.002, lateral p = 0.398, and dorsal: p = 0.027). Conclusions In revision surgery after TKA, the use of floating-embedded, uncemented stems without bony ingrowth shows significant reduction of metaphyseal stress-shielding within the proximal tibia. This technique could be a viable alternative to prevent early aseptic loosening and should be examined in future in-vivo studies.https://doi.org/10.1186/s13018-025-05465-0Total knee arthroplastyRevision surgeryStress shieldingAseptic loosening |
| spellingShingle | Dominic Schaefer Artur Barsumyan Kambiz Roshanghias Jan Adriaan Graw Christian Soost Wolfgang Richter Jonas Knoche Arne Ohrndorf Rene Burchard Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty Journal of Orthopaedic Surgery and Research Total knee arthroplasty Revision surgery Stress shielding Aseptic loosening |
| title | Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| title_full | Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| title_fullStr | Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| title_full_unstemmed | Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| title_short | Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| title_sort | floating embedded stems reduce tibial stress shielding in total knee revision arthroplasty |
| topic | Total knee arthroplasty Revision surgery Stress shielding Aseptic loosening |
| url | https://doi.org/10.1186/s13018-025-05465-0 |
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