Subscribe to RSS
DOI: 10.1055/s-2007-989293
© Georg Thieme Verlag KG Stuttgart · New York
Mittelfristige radiologische Ergebnisse nach bikondylärem ungekoppeltem Kniegelenkersatz mit Femurkomponenten aus Zirkonium und Chrom-Kobalt
Radiological Mid-term Results of Total Knee Arthroplasty with Femoral Components of Different MaterialsPublication History
Publication Date:
10 April 2008 (online)
![](https://www.thieme-connect.de/media/zfo/200802/lookinside/thumbnails/10.1055-s-2007-989293-1.jpg)
Zusammenfassung
Studienziel: Ziel der Arbeit ist es, die mittelfristigen radiologischen Ergebnisse unterschiedlicher Femurkomponenten aus Zirkonium und Chrom-Kobalt eines designgleichen Kniegelenkersatzes darzustellen. Methode: Durchschnittlich 4 Jahre postoperativ wurden 31 Patienten mit einer Genesis-II-Knieendoprothese mit oberflächenkeramisierter Femurkomponente aus einer Zirkonium-Niob-Legierung und 32 Kniegelenke mit Standardfemurkomponenten aus einer Kobalt-Chrom-Legierung klinisch und radiologisch nach dem Roentgenographic Evaluation and Scoring System der Knee Society ausgewertet. Ergebnisse: Bei korrekter Implantatlage fanden sich statistisch signifikant häufiger Säume beim Gelenkersatz mit der oberflächenkeramisierten Femurkomponente in den Zonen 1 und 4 des Tibiaimplantates. Schlussfolgerungen: Die Ergebnisse stehen denen biomechanischer Studien des gleichen Prothesentyps am Kniesimulator entgegen, in denen der Abrieb in der Zirkoniumoxid-Gruppe um 85 % im Vergleich zur CoCr-Gruppe reduziert werden konnte. Eine Erklärung für die hohe Zahl bislang allerdings klinisch nicht relevanter Säume, könnte die Beobachtung sein, dass Zirkoniumionen die Mineralisierung von vorhandenem Osteoid im angrenzenden Interface durch negativen Einfluss auf die Entwicklung und Funktion von Matrixvesikeln hemmen.
Abstract
Aim: The present work aimed at evaluating the radiological mid-term results of femoral components of different materials in an identically designed total knee system. Method: 31 knees with zirconium femoral components and 32 standard femoral components were evaluated about 4 years following surgery using the Roentgenographic Evaluation and Scoring System of the Knee Society. Results: In both groups, the implant position was correct. There was a statistically significant higher rate of radiolucent lines in zones 1 and 4 at the tibia site in the zirconium group. Conclusion: Our clinical results disagree with the results of biomechanical studies of the same type of prosthesis. However, there are some findings from animal studies showing that zirconium ions may inhibit the mineralisation of osteoid, which could be an explanation for the higher rate of radiolucent lines seen in the present study.
Schlüsselwörter
Knie‐TEP - Zirkoniumoxid - Saumbildung
Key words
total knee arthroplasty - zirconium - radiolucent line
Literatur
- 1 Khaw F M, Kirk L M, Gregg P J. Survival analysis of cemented Press-Fit Condylar total knee arthroplasty. J Arthroplasty. 2001; 16 161-167
- 2 Buechel F F. Cementless meniscal bearing knee arthroplasty: 7- to 12-year outcome analysis. Orthopedics. 1994; 17 833-836
- 3 Fehring T K, Griffin W L. Revision of failed cementless total knee implants with cement. Clin Orthop Relat Res. 1998; 356 34-38
- 4 Ranawat C S, Flynn Jr W F, Deshmukh R G. Impact of modern technique on long-term results of total condylar knee arthroplasty. Clin Orthop Relat Res. 1994; 309 131-135
- 5 Rasquinha V J, Ranawat C S, Cervieri C L, Rodriguez J A. The press-fit condylar modular total knee system with a posterior cruciate-substituting design. A concise follow-up of a previous report. J Bone Joint Surg [Am]. 2006; 88 1006-1010
- 6 Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975 - 1997: an update with special emphasis on 41 223 knees operated on in 1988 - 1997. Acta Orthop Scand. 2001; 72 503-513
- 7 Lonner J H, Siliski J M, Scott R D. Prodromes of failure in total knee arthroplasty. J Arthroplasty. 1999; 14 488-492
- 8 Bert J M, Reuben J, Kelly F, Gross M, Elting F. The incidence of modular tibial polyethylene insert exchange in total knee arthroplasty when polyethylene failure occurs. J Arthroplasty. 1998; 13 609-614
- 9 Castro F P, Chimento G, Munn B, Levy R, Timon S, Barrack R. An analysis of Food and Drug Administration medical device reports relating to total joint components. J Arthroplasty. 1997; 12 765-771
- 10 Robinson E J, Mulliken B D, Bourne R B, Roraback C H, Alvarex C. Catastrophic osteolysis in total knee replacement. A report of 17 cases. Clin Orthop Relat Res. 1995; 321 98-105
- 11 Engh G A, Koralewicz L M, Pereles T R. Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg [Am]. 2000; 82 516-523
- 12 White S E, Whiteside L A, McCarthy D S, Anthony M, Poggie R A. Simulated knee wear with cobalt chromium and oxidized zirconium knee femoral components. Clin Orthop Relat Res. 1994; 309 176-184
- 13 Fink U. Sicherheitsaspekte bei der Beschichtung von Titangleitkomponenten. Orthopäde. 1997; 26 160-165
- 14 Ezzet K A, Hermida J C, Colwell Jr C W, D'Lima D D. Oxidized zirconium femoral components reduce polyethylene wear in a knee wear simulator. Clin Orthop Relat Res. 2004; 428 120-124
- 15 Spector B M, Ries M D, Bourne R B. et al . Wear performance of ultra-high molecular weight polyethylene on oxidized zirconium total knee femoral components. J Bone Joint Surg [Am]. 2001; 83 (Suppl 2) 80-86
- 16 Walker P S, Blunn G W, Lilley P A. Wear testing of materials and surfaces for total knee replacement. J Biomed Mater Res. 1996; 33 159-175
- 17 Ewald F C. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; 248 9-12
- 18 Insall J N, Dorr L D, Scott R D, Scott W N. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989; 248 13-14
- 19 Pellengahr C, Mayer W, Maier M, Muller P E, Schulz C, Dürr H R, Trouillier H, Steinborn M, Jansson V, Refior H J. Resurfacing knee arthroplasty in patients with allergic sensitivity to metals. Arch Orthop Trauma Surg. 2003; 123 139-143
- 20 Nielsen N H, Menne T. Nickel sensitization and ear piercing in an unselected Danish population. Glostrup Allergy Study. Contact Dermatitis. 1993; 29 16-21
- 21 Goh C L. Prevalence of contact allergy by sex, race and age. Contact Dermatitis. 1986; 14 237-240
- 22 Raphael B, Haims A H, Wu J S, Katz L D, White L M, Lynch K. MRI comparison of periprosthetic structures around zirconium knee prostheses and cobalt chrome prostheses. Am J Roentgenol. 2006; 186 1771-1777
- 23 Werner F W, Ayers D C, Maletsky L P, Rullkoetter P J. The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech. 2005; 38 349-355
- 24 Insall J N, Hood R W, Flawn L B, Sullivan D J. The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg [Am]. 1983; 65 619-628
- 25 Lotke P A, Ecker M L. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg [Am]. 1977; 59 77-79
- 26 Uematsu O, Hsu H P, Kelley K M, Ewald F C, Walker P S. Radiographic study of Kinematic total knee arthroplasty. J Arthroplasty. 1987; 2 317-326
- 27 Bargren J H, Blaha J D, Freeman M A. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res. 1983; 173 178-183
- 28 Soudry M, Mestriner L A, Binazzi R, Insall J N. Total knee arthroplasty without patellar resurfacing. Clin Orthop Relat Res. 1986; 205 166-170
- 29 Schurman D J. Functional outcome of GUEPAR Hinge knee arthroplasty evaluated with ARAMIS. Clin Orthop Relat Res. 1981; 155 118-132
- 30 Whiteside L A, Amador D D. The effect of posterior tibial slope on knee stability after Ortholoc total knee arthroplasty. J Arthroplasty. 1988; 3 51-57
- 31 Zenz P, Schwägerl W, Jantsch S. Zwei- bis Fünfjahresergebnisse nach Implantation der zementfreien APS-Knietotalendoprothese. Z Orthop Ihre Grenzgeb. 1992; 130 317-322
- 32 Laskin R S. An oxidized Zirconium ceramic surfaced femoral component for total knee arthroplasty. Clin Orthop Relat Res. 2003; 416 191-196
- 33 Bal B S, Greenberg D D, Buhrmester L, Aleto T J. Primary TKA with a zirconia ceramic femoral component. J Knee Surg. 2006; 19 89-93
- 34 Marx A, Saxler G, Landgraeber S, Loer F, Holland-Letz T, von Knoch M. Comparison of subtraction arthrography, radionuclide arthrography and conventional plain radiography to assess loosening of total knee arthroplasty. Biomed Tech. 2005; 50 143-147
- 35 Bach C M, Steingruber I E, Peer S, Nogler M, Wimmer C, Ogon M. Radiographic assessment in total knee arthroplasty. Clin Orthop Relat Res. 2001; 385 144-150
- 36 Reckling F W, Asher M A, Dilion W. Longitudinal study of the radiolucent line at the bone cement interface following total joint-replacement prostheses. J Bone Joint Surg [Am]. 1977; 59 355-358
- 37 Ecker M L, Lotke P A, Windsor R E, Cella J P. Long-term results after total condylar knee arthroplasty. Significance of radiolucent lines. Clin Orthop Relat Res. 1987; 216 151-158
- 38 Farron A, Rakotomanana R L, Zambelli P Y, Leyvraz P F. Total knee prosthesis. Clinical and numerical study of micromovements of the tibial implant. Rev Chir Orthop Reparatrice Appar Mot. 1995; 80 28-35
- 39 Arora J, Ogden A C. Osteolysis in a surface-cemented, primary, modular Freeman-Samuelson total knee replacement. J Bone Joint Surg [Br]. 2005; 80 1502-1506
- 40 Lachiewicz P F, Soileau E S. The rates of osteolysis and loosening associated with a modular posterior stabilized knee replacement. Results at five to fourteen years. J Bone Joint Surg [Am]. 2004; 86 525-530
- 41 Huddleston J I, Wiley J W, Scott R D. Zone 4 femoral radiolucent lines in hybrid versus cemented total knee arthroplasties: are they clinically significant?. Clin Orthop Relat Res. 2005; 441 334-339
- 42 Tsukamoto R, Chen S, Asano T, Ogino M, Shoji H, Nakamura T, Clarke I C. Improved wear performance with crosslinked UHMWPE and zirconia implants in knee simulation. Acta Orthopaedica. 2006; 77 505-511
- 43 Ries M D, Salehi A, Widding K, Hunter G. Polyethylene wear performance of oxidized zirconium and cobalt-chromium knee components under abrasive conditions. J Bone Joint Surg [Am]. 2002; 84 (Suppl 2) 129-135
- 44 Ito A, Tateishi T, Niwa S, Tange S. In-vitro evaluation of the cytocompatibility of wear particles generated by UHMWPE/zirconia friction. Clin Mater. 1993; 12 203-209
- 45 Green T R, Fisher J, Stone M, Wroblewski B M, Ingham E. Polyethylene particles of a “critical size” are necessary for the induction of cytokines by macrophages in vitro. Biomaterials. 1998; 19 2297-2302
- 46 Warashina H, Sakano S, Kitamura S, Yamauchi K I, Yamaguchi J, Ishiguro N, Hasegawa Y. Biological reaction to alumina, zirconia, titanium and polyethylene particles implanted onto murine calvaria. Biomaterials. 2003; 24 3655-3661
-
47 Fisher J, Matthews J B, Besong A A, Tipper J L, Stone M H, Ingham E.
A novel method for the predictions of functional biological activity of polyethylene wear debris generated in vivo and in vitro. Transactions of the sixth World Biomaterials Congress. Society for Biomaterials, Minneapolis, USA. 2000: abstr. 186 - 48 Jones S M, Pinder I M, Moran C G, Malcolm A J. Polyethylene wear in uncemented knee replacements. J Bone Joint Surg [Br]. 1992; 74 18-22
- 49 Bernstein A, Gildenhaar D, Nöbel D, Berger G. Biocompatibility screening of different calcium phosphate ceramics. Biomaterialien. 2003; 2 89
- 50 Bernstein A, Gildenhaar D, Nöbel D, Berger G. In vitro Untersuchungen von neuen calciumphosphathaltigen Materialien für Implantatbeschichtungen. Biomaterialien. 2003; 3 207
- 51 Nöbel D. Untersuchungen zur Osteointegration und Resorbierbarkeit von Implantatbeschichtungen für den Knochenersatz. Halle Univ Med Fak und Leipzig Univ Veterinärmed Fak Diss. 2006
- 52 Gross U, Müller-Mai C, Berger G, Ploska U. The tissue response to a novel calcium zirconium phosphate ceramics. Key Eng Mater. 2003; 240/242 629-632
- 53 Gross U, Müller-Mai C, Berger G, Ploska U. Do calcium zirconium phosphate ceramics inhibit mineralization?. Key Eng Mater. 2004; 254/256 635-638
- 54 Galante J, Rostoker W. Corrosion-related failures in metallic implants: an experimental study. Clin Orthop Relat Res. 1972; 86 237-244
- 55 Thomsen P, Larsson C, Ericson L E, Sennerby L, Lausmaa J, Kasemo B. Structure of the interface between rabbit cortical bone and implants of gold, zirconium and titanium. J Mater Sci Mater Med. 1997; 8 653-665
Dr. med. Felix Göbel
Zentrum für Erkrankungen und Verletzungen der Haltungs- und Bewegungsorgane (ZHBO)
Martin-Luther-Universität Halle-Wittenberg
Magdeburger Straße 22
06097 Halle
Email: felix.goebel@medizin.uni-halle.de