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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2017

Open Access 01-11-2017 | Knee

Tibial component with and without stem extension in a trabecular metal cone construct

Authors: Marrigje F. Meijer, Alexander L. Boerboom, Martin Stevens, Inge H. F. Reininga, Dennis W. Janssen, N. Verdonschot, Sjoerd K. Bulstra

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2017

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Abstract

Purpose

The purpose of this study was to investigate stability and strain distribution of a tibial plateau reconstruction with a trabecular metal cone while the tibial component is implanted with and without a stem, and whether prosthetic stability was influenced by bone mineral density. Trabecular metal cones are designed to fill up major bone defects in total knee arthroplasty. Tibial components can be implanted in combination with a stem, but it is unclear whether this is necessary after reconstruction with a trabecular metal cone. Implanting a stem can give extra stability, but may have negative side effects.

Methods

Tibial revision arthroplasties with trabecular metal cones were performed after reconstruction of a 2B bone defect according to the Anderson Orthopedic Research Institute classification. Components were implanted in seven pairs of cadaveric tibiae; one tibia of each pair was implanted with stem and the other without. All specimens were loaded to one bodyweight alternating between the medial and lateral tibial component. Implant-bone micro-motions, bone strains, bone mineral density and correlations were measured and/or calculated.

Results

Tibial components without a stem showed only more varus tilt [difference in median 0.14° (P < 0.05)], but this was not considered clinically relevant. Strain distribution did not differ. Bone mineral density only had an effect on the anterior/posterior tilt [ρ: −0.72 (P < 0.01)].

Conclusion

Tibial components, with or without a stem, which are implanted after reconstruction of major bone defects using trabecular metal cones produce very similar biomechanical conditions in terms of stability and strain distribution. If in vivo studies confirm that a stem extension is not mandatory, orthopaedic surgeons can decide not to implant a stem.

Level of evidence

II.
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Metadata
Title
Tibial component with and without stem extension in a trabecular metal cone construct
Authors
Marrigje F. Meijer
Alexander L. Boerboom
Martin Stevens
Inge H. F. Reininga
Dennis W. Janssen
N. Verdonschot
Sjoerd K. Bulstra
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4271-2

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