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J Knee Surg 2022; 35(14): 1595-1603
DOI: 10.1055/s-0041-1729549
Original Article

Early Aseptic Loosening with Increased Presence and Severity of Backside Burnishing in the Optetrak Logic Posterior-Stabilized Total Knee Arthroplasty Femoral Component

Michael-Alexander Malahias
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
David A. Iacobelli
2   Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York City, New York
,
Lisa Torres
3   Department of Biomechanics, Hospital for Special Surgery, New York City, New York
,
Carolena Rojas Marcos
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Allina A. Nocon
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Timothy M. Wright
3   Department of Biomechanics, Hospital for Special Surgery, New York City, New York
,
Peter K. Sculco
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Thomas P. Sculco
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
› Author Affiliations Funding T.M.W. reports grants from Orthobond; personal fees from Exactech; and other from AJRR, OREF, and Knee Society outside the submitted work. T.P.S. reports grants from Intellijoint; and personal fees from Lima Corporate, DePuy; and grants from EOS Imaging outside the submitted work.
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Abstract

Concerns persist that the Optetrak Logic posterior-stabilized (PS) total knee arthroplasty (TKA) femoral component might correlate with early failures due to aseptic loosening. The primary aim of this study was to examine if the use of the Optetrak Logic PS femoral component is associated with early (<5 years) and more extensive aseptic loosening compared with other PS femoral components. This is a single-institution retrieval analysis and revision registry study (based on prospectively collected data) of 27 failed primary PS TKA patients with loose femoral components that underwent revision TKAs between 2016 and 2019. Patients were stratified by components type: Group A (n = 16) received the Optetrak Logic PS femoral component, while Group B (n = 11) received other PS femoral components. Burnishing (macroscopic polishing of the component's backside) was observed and graded as a marker for relative motion at the cement-implant interface. No significant differences were found between the two groups regarding the baseline demographic, radiographic, and clinical characteristics. Mean length of implantation for Group A (3.8 ± 2.9 years) was significantly shorter (p < 0.001) than that of Group B (12.0 ± 6.7 years). A significant difference (p = 0.009) was found in presence of backside femoral burnishing between Group A (15 of 16 patients; 93.8%) and group B (5 of 11 patients; 45.6%). Furthermore, we found a significant difference (p < 0.001) in the severity of burnishing between Group A (13 of 16 patients with severe degree of burnishing; 81.3%) and Group B (1 of 11 patients with severe degree of burnishing; 9.1%). In contrast to Group B, a distinctive macroscopic pattern found in Logic retrieved femoral components (Group A) was the total absence of cement in the backside surface. The use of the Optetrak Logic PS TKA femoral component was associated with early aseptic loosening and increased presence and severity of backside burnishing with early cement-implant interface debonding compared with other commercially available types of PS TKA femoral components. The earlier failure rate with this implant is of concern.

Keywords

total knee arthroplasty - femoral aseptic loosening - Exactech Optetrak - revision arthroplasty - retrieval analysis


Publication History

Received: 11 August 2020

Accepted: 12 March 2021

Article published online:
30 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Abdel MP, Morrey ME, Jensen MR, Morrey BF. Increased long-term survival of posterior cruciate-retaining versus posterior cruciate-stabilizing total knee replacements. J Bone Joint Surg Am 2011; 93 (22) 2072-2078
    CrossrefPubMedSearch in Google Scholar
  • 2 Angibaud LD, Kubo MB, Steffens JG, Steilar CA, Myers SL, Rice J. Intercondylar femoral notch preparation for stabilized knee arthroplasty - volumetric bone resection according to two methods. Paper presented at: 56th Annual Meeting of the Orthopaedic Research Society. New Orleans, LA Accessed March 6–9, 2010 at: https://www.ors.org/Transactions/56/2067.pdf
    PubMed
  • 3 Indelli PF, Marcucci M, Graceffa A, Charlton S, Latella L. Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation. J Orthop Surg Res 2014; 9: 54
    CrossrefPubMedSearch in Google Scholar
  • 4 Pugh L, Ruel A, Lipman J, Wright T, Gessell M, Westrich G. Reduction in bone volume resection with a newer posterior stabilized total knee arthroplasty design. HSS J 2013; 9 (02) 157-160
    CrossrefPubMedSearch in Google Scholar
  • 5 Lombardi Jr AV, Mallory TH, Waterman RA, Eberle RW. Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty. J Arthroplasty 1995; 10 (05) 643-650
    PubMedSearch in Google Scholar
  • 6 Graceffa A, Indelli PF, Basnett K, Marcucci M. Analysis of differences in bone removal during femoral box osteotomy for primary total knee arthroplasty. Joints 2014; 2 (02) 76-80
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Gilbert SL, Rana AJ, Lipman JD, Wright TM, Westrich GH. Design changes improve contact patterns and articular surface damage in total knee arthroplasty. Knee 2014; 21 (06) 1129-1134
    CrossrefPubMedSearch in Google Scholar
  • 8 Data of file at Exactech. 051K. Intercondylar femoral notch preparation for posterior stabilized knee arthroplasty – volumetric bone resection according to two methods. Accessed 2020 at: https://www.exac.com/wp-content/uploads/2019/04/712-29-40-Rev-A-Logic-CC-DR_3631394.pdf
    PubMed
  • 9 Report A. 2019 Australian Orthopaedic Association National Joint Replacement Registry. Pages 394–398. Accessed 2020 at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=6681253&pc=JWH
    PubMedSearch in Google Scholar
  • 10 Bollars P, Luyckx JP, Innocenti B, Labey L, Victor J, Bellemans J. Femoral component loosening in high-flexion total knee replacement: an in vitro comparison of high-flexion versus conventional designs. J Bone Joint Surg Br 2011; 93 (10) 1355-1361
    CrossrefPubMedSearch in Google Scholar
  • 11 Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br 2007; 89 (11) 1457-1461
    CrossrefPubMedSearch in Google Scholar
  • 12 Cho SD, Youm YS, Park KB. Three- to six-year follow-up results after high-flexion total knee arthroplasty: can we allow passive deep knee bending?. Knee Surg Sports Traumatol Arthrosc 2011; 19 (06) 899-903
    CrossrefPubMedSearch in Google Scholar
  • 13 Jung WH, Jeong JH, Ha YC, Lee YK, Koo KH. High early failure rate of the Columbus posterior stabilized high-flexion knee prosthesis. Clin Orthop Relat Res 2012; 470 (05) 1472-1481
    CrossrefPubMedSearch in Google Scholar
  • 14 Konopka J, Weitzler L, Westrich D, Wright TM, Westrich GH. The effect of constraint on post damage in total knee arthroplasty: posterior stabilized vs posterior stabilized constrained inserts. Arthroplast Today 2017; 4 (02) 200-204
    CrossrefPubMedSearch in Google Scholar
  • 15 Lombardi Jr AV, Berend KR, Leith JR, Mangino GP, Adams JB. Posterior-stabilized constrained total knee arthroplasty for complex primary cases. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 90-102
    PubMedSearch in Google Scholar
  • 16 Buller LT, Rao V, Chiu Y-F, Nam D, McLawhorn AS. Primary total knee arthroplasty performed using high-viscosity cement is associated with higher odds of revision for aseptic loosening. J Arthroplasty 2020; 35 (6S): S182-S189
    CrossrefPubMedSearch in Google Scholar
  • 17 Zelle J, Janssen D, Van Eijden J, De Waal Malefijt M, Verdonschot N. Does high-flexion total knee arthroplasty promote early loosening of the femoral component?. J Orthop Res 2011; 29 (07) 976-983
    CrossrefPubMedSearch in Google Scholar
  • 18 van de Groes S, de Waal-Malefijt M, Verdonschot N. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques. Knee 2014; 21 (01) 209-215
    CrossrefPubMedSearch in Google Scholar