Journal Article

Anatomical tibial component is related to more medial tibial stress shielding after total knee arthroplasty in Korean patients

Lee, Woo-Suk, Yang, Ick Hwan, Hong, Yong Jae, Kwon, Hyuck Min, Park, Kwan Kyu, Cho, Byung Woo

2021

Overview

Purpose This study aimed to investigate stress shielding of anatomical tibial components (ATCs) in comparison to conventional symmetric tibial components (STCs) in Korean patients which may be related to medial tibial bone loss. Method 78 knees in 59 patients with ATCs (Persona™) and 74 knees in 58 patients with STCs (NexGen LPS-Flex™) were retrospectively reviewed. Radiographic parameters and clinical outcomes in both groups were compared. Logistic regression analysis was performed to identify risk factors for medial tibial bone loss. Results Medial tibial bone loss was significantly greater in the ATC group (1.6 ± 1.3 mm) than in the STC group (0.4 ± 0.8 mm) ( p  < 0.001). The ATC group showed a shorter distance between the distal metal tip and anteromedial cortex and higher invading into the sclerotic bone lesion (ISBL) than the STC group ( p  = 0.034 and p  = 0.044, respectively). Multiple logistic regression analysis suggested ATC, a shorter distance to the anteromedial cortex, and the presence of ISBL as risk factors for medial tibial bone loss. The odds ratios of medial tibial bone loss according to type of prosthesis, distance to anteromedial cortex, and presence of ISBL were 6.25 (range 2.86–13.63, p  < 0.001), 0.69 (range 0.51–0.93, p  = 0.015), and 3.79 (range 1.56–9.21, p  = 0.003), respectively. Notwithstanding, there was no difference in clinical outcomes between the two groups. Conclusion In Korean patients, ATCs potentially causes greater medial tibial bone loss due to stress shielding than STCs. The design, however, does not yet appear to affect clinical outcomes at mid-term follow-up. Level of evidence Retrospective cohort study, level III.

• Publisher: Springer Berlin Heidelberg,John Wiley & Sons, Inc
• Subject: Aged / Arthroplasty (knee) / Arthroplasty, Replacement, Knee - adverse effects / Arthroplasty, Replacement, Knee - methods / Bone lesions / Bone loss / Bone Resorption - epidemiology / Bone Resorption - etiology / Clinical outcomes / Cortex / Female / Humans / Joint surgery / Knee / Knee - surgery / Knee Joint - surgery / Knee Prosthesis / Logistic Models / Male / Medicine / Medicine & Public Health / Orthopedics / Osteoarthritis, Knee - surgery / Prostheses / Radiography - methods / Regression analysis / Republic of Korea / Retrospective Studies / Risk analysis / Risk Factors / Stress shielding / Stress, Physiological / Surgical implants / Tibia - physiopathology / Tibia - surgery / Tibial components / Treatment Outcome