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Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty

Cerquiglini, A; Henckel, J; Hothi, HS; Dall'Ava, L; Shearing, P; Hirschmann, MT; Hart, AJ; (2018) Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty. The Journal of Arthroplasty , 33 (9) pp. 3030-3037. 10.1016/j.arth.2018.04.010. Green open access

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Abstract

Background: Suboptimal total knee arthroplasty (TKA) position of both femoral and tibial components is thought to be linked with poor clinical outcomes, polyethylene wear and the “unexplained” painful knee arthroplasty. The aim of this study was to better understand the effect of implant orientation on knee implant performance. Methods: We analyzed 30 retrieved contemporary TKA implants. Implant positioning measurements in the coronal plane were made prior to revision using a diagnostic algorithm, based on 3D computed tomography (CT) images. Each retrieved polyethylene component was imaged using a micro-CT scanner and a high resolution computational 3D model of each component was digitally reconstructed. The difference in thickness between medial and lateral components was calculated. Statistical analysis was performed to investigate the association between component positioning and damage patterns. Results: We found a significant correlation between both the tibiofemoral and femoral angles and difference in thickness between polyethylene compartments: varus angulations were strongly associated with thinner medial compartments, whilst valgus angulations were associated with thinner lateral compartments. Moreover, suboptimal tibiofemoral orientations and tibial component angulations were associated to greater differences in thickness between polyethylene compartments. Conclusion: Our study is the first to compare accurate 3D CT measurements of prerevision TKA positioning in the coronal plane with postrevision retrieval analysis from innovative, accurate and highly reliable micro-CT–based method. Our results demonstrate the impact of component positioning on polyethylene damage and helps understanding of the in vivo performance of these implants. Level of Evidence: III.

Type: Article
Title: Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.arth.2018.04.010
Publisher version: http://doi.org/10.1016/j.arth.2018.04.010
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: total knee arthroplasty, implant orientation, malalignment, 3D computed tomography, polyethylene wear, microcomputed tomography
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Chemical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/10057763
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