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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2013, Number 2

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Acta Ortop Mex 2013; 27 (2)

Use of trabecular metal in total knee arthroplasty in severely and morbidly obese patients (BMI > 35 kg/m2)

Núñez FA, Argüelles AA, Lozano LL, Popescu D, Maculé F, Suso V-S

Language: Spanish
References: 31
Page: 97-102
PDF size: 89.67 Kb.


ABSTRACT

The use of trabecular metal in the tibial surface may increase prosthetic survival in the population with severe or morbid obesity (BMI > 35 kg/m2). A prospective, descriptive study was conducted of patients with a BMI > 35 kg/m2 who underwent total knee replacement with a prosthesis with trabecular metal. Minimal follow-up was two years. The statistical analysis was done with Student’s t test; the Knee Society Score and the Western Ontario and McMaster Universities Osteoarthritis Index were applied preoperatively and postoperatively. The χ2 test was applied to the BMI values relating them with more or less radiolucent images. The total number of patients was 39, but three were excluded for not having the radiographic follow-up. Mean follow-up was 34 months (25-43); 35 were females, mean age was 69.4 years (57-81), mean BMI was 39.43 kg/m2 (35-55). All patients had grades 3 and 4 tricompartmental arthrosis. The KSS (R and F) and WOMAC scales, with a 95% confi dence interval, showed a statistically significant improvement in the assessment of preoperative results and at the end of the followup. Only a few studies measure long-term implant survival. Most authors define survival as the absence of the need to revise prosthetic implants. The end point of survival is the removal or exchange of prosthetic components. Trabecular metal (TM) is currently used in orthopedic surgery and its clinical applications are increasing more and more with good results.


REFERENCES

  1. Stickles B, Philips L, Brox WT, Owens B, Lanzer WL: Defi ning the Relationship Between Obesity and Total Joint Arthroplasty. Obes Res 2001; 9: 219-23.

  2. Vaishnav Rajgopal, Bourne R, Chesworth B, MacDonald SJ, McCalden RW, Rorabeck CH: The Impact of Morbid Obesity on Patient Outcomes After Total Knee Arthroplasty. Journal Arthroplasty 2008; 23: 795-800.

  3. Foran JRH, Mont M, Etienne G, Jones LC, Hungerford S: The Outcome of Total Knee Arthroplasty in Obese Patients. J Bone Joint Surg 2004; 86A: 1609-15.

  4. Foran JRH, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford S: Total Knee Arthroplasty in Obese Group. J Arthroplasty 2004; 19: 817-24.

  5. Unger AS, Duggan JP: Midterm results of a porous tantalum monoblock tibia components clinical and radiographic results of 108 knees J Arthroplasty 2011; 26(6): 855-60.

  6. Bobyn D, et al: Clinical Validation of a Structural Porous Tantalum Biomaterial for Adult Reconstruction. The Journal of Bone and Joint Surgery 2004; 86: 123-9.

  7. Minoda Y, et al: Comparison of Bone Mineral Density Between porous Tantalum and Cementd tibial Total knee Arthroplasty Components. The Journal of Bone and Joint Surgery 2010; 92: 700-6.

  8. Powell A, Teichtahl AJ, Wluka AE, Cicuttini FM: Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. Br J Sports Med 2005; 39: 4-5.

  9. Nevitt MC: Obesity outcomes in disease management: Clinical outcomes for osteoarthritis. Obes Res 2002; 10: 33-7.

  10. Felson DT, Anderson JJ, Maunmark A, Walker AM, Meenan RF: Obesity and knee osteoarthritis. The Framingham study. Ann Intern Med 1988; 109: 18-24.

  11. Spector TD, Hart DJ, Doyle DV: Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Disease 1994; 53: 565-8.

  12. Abbate LM, Stevens J, Schwartz TA, Renner JB, Helmick CG, Jordan JM: Anthropometric Measures, Body composition, Body fat distribution, and knee osteoarthritis in women. Obesity 2006; 4: 1274-81.

  13. Lachiewics PF: Cement versus cementless total knee replacement: is there a place for cementless fi xation in 2001? Curr Opin Orthop 2001; 12: 33.

  14. Dodd CA, Hungerford DS, Krackow KA: Total knee aerthroplasty fi xation. Comparison of the early results of paried cemented versus uncemented porous coated anatomic knee prostheses. Clin Orthop Relat Res 1990; 260: 66-70.

  15. Dumbar MJ, et al: Fixation of a trabecular metal knee Arthroplasty Component. A prospective Randomized Study. J Bone Joint Surg Am 2009; 91: 1578-86.

  16. Henricson A, Linder L, Nilsson KG: Trabecular metal tibial component in patients younger than 60 years. A prospective RSA study. J Bone Joint Surg [Br] 2008; 90-B: 1585-93.

  17. Winiarsky R, Barth P, Lotke P: Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998; 80(12): 1770-4.

  18. Cataldo MA, et al: Prosthetic Joint Infection: Recent Developments in Diagnosis y management. Journal of Infection 2010; 61: 443-8.

  19. Namba R, et al: Obesity and Perioperative Morbidity in Total Hip and Total Knee Arthroplasty Patients. The Journal of Arthroplasty 2005; 20(7 Suppl 3): 46-50.

  20. Malinzak RA, et al: Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009; 24(6 Suppl): 84-8.

  21. Dowsey MM, Choong PF: Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009; 467(6): 1577-81.

  22. Spicer DD, et al: Body Mass Index as a Predictor of Outcome in total Knee Replacement. Int Orthop 2001; 25: 246.

  23. Núñez M, Lozano L, Núñez E, Sastre S, Luis Del Val J, Suso S: Good Quality of Life in Severely Obeses Total knee Replacement Patients A Case-Control Study. Obes Surg 2011; 21(8): 1203-8.

  24. Nuñez M, Lozano L, Nuñez E, Segur JM, Sastre S: Factors Infl uencing Health-related Quality of Life after TKA in Patients who are Obese. Clin Orthop Relat Res 2011; 469(4): 1148-53.

  25. Vazquez-Vela J, Worland RL, Keenan J, Norambuena N: Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 2003; 85(1): 52-6.

  26. Nilsson KG, Kärrholm J, Ekelund L, Magnusson P: Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthritis and rheumatoid arthritis: randomized study using roentgen stereophotogrammetric analysis. J Arthroplasty 1991; 6: 265-78.

  27. Nilsson KG, Kärrholm J: Increased varus-valgus tilting of screw fi xated knee prostheses: stereoradiographic study of uncemented versus cemented tibial components. J Arthroplasty 1993; 8: 529-40.

  28. Önsten I, Nordqvist A, Carlsson ÅS, Besjakov J, Shott S: Hydroxyapatite augmentation of the porous coating improves fi xation of tibial components: a randomized RSA study in 116 patients. J Bone Joint Surg [Br] 1998; 80-B: 417-25.

  29. Nilsson KG, Kärrholm J, Carlsson L, Dalén T: Hydroxyapatite coating versus cemented fi xation of the tibial component in total knee arthroplasty: prospective randomized comparison of hydroxyapatite-coated and cemented tibial components with 5-year follow-up using radiostereometry. J Arthroplasty 1999; 14: 9-20.

  30. Carlson Å, Bjorkman A, Besjakov J, Önsten I: Cemented tibial component fi xation performs better than cementless fi xation: a randomized study comparing porous-coated, hydroxyapatite-coated and cemented tibial components over 5 years. Acta Orthop Scand 2005; 76: 362-9.

  31. Nilsson KG, Henricson A, Norgren B, Dalén T: Uncemented HA-coated implant is the optimum fi xation for TKA in the young patient. Clin Orthop 2006; 448: 129-38.




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