植入物预涂层和脂肪污染对胫骨底板稳定性的影响。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2024-08-01 DOI:10.1016/j.knee.2024.07.007

Maya Maya Barbosa Silva , Jan-Erik Gjertsen , Irene Ohlen Moldestad , Ove Nord Furnes , Michelle Khan , Paul Johan Høl

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引用次数: 0

摘要

背景：约有5%的初级全膝关节置换术患者需要在10年内进行翻修，这通常是由于远端组件松动所致。在胫骨组件上涂一薄层 PMMA 骨水泥作为预涂层，旨在防止无菌性松动。本研究探讨了预涂层和脂肪污染对胫骨基底板稳定性的影响：研究了两组NexGen®有柄胫骨植入物（4号）：方法：研究了两组 NexGen® 茎突胫骨植入物（尺寸 4）：Option 植入物（N = 12）和 PMMA 预涂层植入物（N = 12）。每种植入物设计分为两个亚组（N = 6），其中一个亚组在植入物-水泥界面上有骨髓脂肪，另一个亚组没有污染。在机械试验机中，种植体承受了 20,000 次单轴加载，同时记录了胫骨基板的垂直微动和移动。随后，推出试验评估了骨水泥界面的固定强度。结果采用非参数统计进行比较，并以中位数和最小至最大范围表示：结果：与预涂层种植体相比，选项种植体在干燥条件下表现出更高的微动性（p = 0.03）。在污染条件下，两种设计的微动值相似。在干燥、无污染的条件下，两种设计的固定强度没有明显差异（p > 0.99）。然而，在污染条件下，无涂层 Option 种植体的失效负荷几乎是未受污染种植体的一半（3517 牛顿，2603-4367 牛顿 vs 7531 牛顿，5163-9000 牛顿；p = 0.002）。预涂层种植体对脂肪污染的敏感性较低（p = 0.30）：结论：NexGen®种植体PMMA预涂层可降低无菌松动和翻修手术的风险，以防最终出现骨髓脂肪污染。

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Effects of implant precoating and fat contamination on the stability of the tibial baseplate

Background

Approximately 5% of primary total knee arthroplasty patients require revision within 10 years, often due to distal component loosening. Application of a thin layer of PMMA cement as precoating on the tibial component aims to prevent aseptic loosening. This study investigates the impact of precoating and fat contamination on tibial baseplate stability.

Methods

Two groups of NexGen® stemmed tibial implants (size 4) were studied: Option implants (N = 12) and PMMA Precoat implants (N = 12). Each implant design was divided into two subgroups, (N = 6), with one subgroup featuring bone marrow fat at the implant-cement interface and the other without contamination. In a mechanical testing machine, the implants underwent uniaxial loading for 20,000 cycles, while recording vertical micromotion and migration of the tibial baseplates. Subsequently, a push-out test assessed fixation strength at the cement interfaces. Results were compared using non-parametric statistics and presented as median and min-to-max ranges.

Results

Option implants exhibited higher micromotion in dry conditions compared to precoated implants (p = 0.03). Under contamination, both designs demonstrated similar micromotion values. Fixation strength did not significantly differ between designs under dry, uncontaminated conditions (p > 0.99). However, under contaminated conditions, the failure load for the non-coated Option implant was nearly half that of the uncontaminated counterparts (3517 N, 2603–4367 N vs 7531 N, 5163–9000 N; p = 0.002). Precoat implants displayed less susceptibility to fat contamination (p = 0.30).

Conclusion

NexGen® implant PMMA precoating might reduce the risk of aseptic loosening and revision surgery in case of eventual bone-marrow fat contamination.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.