Flat vs. concave tibial joint surface in total knee arthroplasty: randomized evaluation of 39 cases using radiostereometry.

40 patients with non-inflammatory arthrosis and minor preoperative deformity (< or =5 degrees ) were operated on with an AMK type (DePuy, Johnson & Johnson) total knee arthroplasty (TKA). The posterior cruciate ligament was retained. The patients were divided into those with a flat (terminology of the manufacturer: standard) or a concave (terminology of the manufacturer: constrained) polyethylene insert (20 in each group). Radiostereometric (RSA) examinations were done postoperatively and after 3,12 and 24 months. The median absolute rotations of the tibial inserts varied between 0.12 and 0.24 (range 0.00-1.54) degrees, with no differences between the 2 groups. The median maximum total-point motions (flat/concave = 0.41/0.42 mm), the maximum subsidence or lift-off did not differ. The Hospital for Special Surgery knee score and the patients' opinion about the operation, based on their preoperative expectations, showed little, if any, differences. At 2 years, 10 of 20 patients with flat and 13 of 19 with concave inserts regarded their knee function as normal or almost so.

Concave versus posterior-stabilized tibial joint surface in total knee arthroplasty: randomized evaluation of 47 knees.

Forty-seven knees in 43 patients with severe deformities randomly received AMK total knee arthroplasty with concave (C, n = 25) or posterior-stabilized (PS, n = 22) polyethylene insert and with resection of the posterior cruciate ligament. Radiostereometric examinations were done postoperatively and after 3, 12, and 24 months. Two patients (1 C, 1 PS) underwent revision surgery. At the 2-year follow-up, the median absolute rotations of the tibial inserts ranged from 0.13 degrees to 0.26 degrees (C vs PS; P =.1-.7). The maximum total point motion was almost identical in the 2 groups (C, 0.38; PS, 0.39; P =.9). Maximum subsidence, lift-off, and Hospital for Special Surgery scores did not differ (P =.1-.6). Recipients of 20 of 24 knees with concave design and 14 of 19 knees with posterior-stabilized design reported that their knee could be regarded as normal or almost normal. Variations of the configuration of the polyethylene insert did not alter the outcome in the short term.

Does metal backing improve fixation of tibial component in unicondylar knee arthroplasty? A randomized radiostereometric analysis.

In a prospective, randomized study, patients with medial gonarthrosis stage I to III according to Ahlbäck were allocated to a unicondylar knee arthroplasty (Miller-Galante, Zimmer, Inc., Warsaw, IN) with an all-polyethylene tibial component or metal-backed tibial component of the same design. The purpose of the study was to evaluate if metal backing enhanced tibial component fixation. A total of 45 knees (42 patients; 23 metal-backed components and 22 all-polyethylene components) were examined. We used radiostereometric analysis to measure micromotion of the tibial component over a period of 2 years after surgery. Hospital for Special Surgery score was used for clinical evaluation. We found no statistically significant differences in clinical results or migration of the tibial component over a 2-year follow-up period. These findings do not support better fixation of metal-backed tibial components. Because of these findings, we advocate all-polyethylene tibial components in unicondylar knee arthroplasties because of optimal biomechanical strength at a given height of tibial component, avoiding potential problems of modularity and minimizing the amount of interfaces, at a lower cost.

Tibial component fixation in porous- and hydroxyapatite-coated total knee arthroplasty: a radiostereo metric evaluation of migration and inducible displacement after 5 years.

A total of 51 knees (45 patients) with osteoarthrosis were stratified in a randomized study to receive a hydroxyapatite-coated Freeman-Samuelson (FS HA) or a porous-coated Miller-Galante II (MG II) uncemented total knee arthroplasty. Repeated clinical, radiographic, and radiostereometric analysis (RSA) evaluations of the tibial components were done for 5 years. The clinical outcome was equal at the 5-year follow-up (mean Hospital for Special Surgery score, 93). Standard radiographs displayed more zones around the tibial stem in the MG II group. RSA revealed that the FS HA components migrated less (smaller maximum total point motion and maximum subsidence) after 5 years and showed less inducible displacements at the 1-year follow-up. The stability of the implants obtained is equal to or better than cemented implants after 5 years. Key words: knee prosthesis, cementless, hydroxyapatite, radiostereometry, inducible displacement.

In vivo kinematics of total knee arthroplasty: flat compared with concave tibial joint surface.

This study evaluated the influence of the geometric configuration of the tibial joint area on the kinematics of the knee. Twenty-two patients with noninflammatory arthritis and minor preoperative deformity were studied. They each received an AMK total knee replacement with retention of the posterior cruciate ligament. Eleven patients without any knee abnormalities were used as controls. The patients were stratified to either the flat (terminology of the manufacturer: standard) or concave (terminology of the manufacturer: constrained) polyethylene insert (n = 11 in each group). Knee kinematics were assessed 1 year after the operation by having the patient ascend a platform corresponding to an extension of the knee from 50 to 70 degrees of flexion. During this motion, two film-exchangers simultaneously exposed six to 13 pairs of serial stereoradiographs. The concave geometric configuration of the tibial insert resulted paradoxically in increased anterior-posterior translations compared with the flat insert but no significant change of rotations and translations in the other directions. Compared with normal knees, the most obvious abnormality was increased anterior-posterior translations (p < 0.004). At 50 degrees of flexion, the implants with the flat tibial polyethylene insert had displaced 2 times and the concave ones had displaced 2.5 times more posteriorly than the normal knees (p < or = 0.001). Less internal tibial rotation was also recorded in the flexed positions for both types of inserts compared with the normal knees (p < 0.02). Four knees in four patients, who reported symptoms of instability and abnormal knee function, showed significantly increased proximal displacement of the center of the tibial plateau in the flexed position. The findings suggest that current prosthetic designs and surgical technique do not restore normal knee kinematics and indicate that design improvements should rely on in vivo kinematic studies.

Bone mineral and migratory patterns in uncemented total knee arthroplasties: a randomized 5-year follow-up study of 38 knees.

We measured the amount of bone mineral in the medial tibial condyle 1 week postoperatively, after 1 year and after 4-5 years in 38 arthrotic knees randomized to a Freeman-Samuelson hydroxyapatite-coated (FS HA) or a Miller-Galante II (MG II) total knee arthroplasty. Clinically excellent results were recorded in both groups after 5 years. At the last follow-up, the overall decrease in bone mineral was 26%, as measured by triple-energy X-ray absorptiometry. The decrease was larger in FS HA knees than in MG II knees after 4-5 years, indicating stress-shielding of the proximal tibia. Radiostereometry at 1 and 5 years showed smaller maximum total point motion, maximum subsidence and varus or valgus tilt in the FS HA group. There was a tendency towards a reversed relationship between subsidence and change in bone mineral after 1 year, but not after 4-5 years. Distal fixation of the stem in the Freeman-Samuelson hydroxyapatite-coated (FS HA) components might explain the more pronounced loss of bone mineral in the medial tibial condyle.

Ceramic coating improves tibial component fixation in total knee arthroplasty.

Forty uncemented total knee arthroplasties (36 patients) were randomly allocated to a Miller-Galante II prosthesis with or without hydroxyapatite/tricalcium phosphate (HA/TCP) coating on the titanium fiber mesh on the undersurface of the tibial component. The patients were followed for 2 years with repeated radiostereometric examinations. After 2 years, the HA/TCP tibial components displayed smaller anterior-posterior tilt and less subsidence. The mean value of maximal total point motion was small: 0.5 mm in both groups. At 24 months, there were more radiolucent lines under the tibial tray and around the stem in the uncoated group, but the clinical results did not differ. HA/TCP coating on the undersurface of the tibial component improved the stability and seemed to improve the quality of the interface between the tibial component and the bone.

Clinical and radiologic survivorship of cementless tibial components fixed with finned polyethylene pegs.

One hundred twenty patients (22 men, 98 women; 144 knees) with uncemented Freeman-Samuelson total knee arthroplasty were followed prospectively. Eighty-one patients had rheumatoid arthritis and 39 patients had osteoarthrosis. The mean follow-up period was 6.8 years. Three different types of tibial components were used: a high-density polyethylene component without stem, a metal-backed tibial component without stem, and a metal-backed tibial component with stem. Progressive varus tilting turned out to be an early sign of failure and occurred in 22% of the tibial components. Revision of the tibial component was done in 17 knees. Survival analysis with revision as endpoint revealed a survival rate of 79% at a follow-up period of 10 years. Cementless fixation of this design using macrointerlocking pegs and no other stabilization resulted in poor fixation and a high revision rate and cannot be recommended.

Genomic distribution of P elements in Drosophila willistoni and a search for their relationship with chromosomal inversions.

According to the recent-invasion hypothesis, Drosophila melanogaster may have acquired its P elements in a fairly recent process of horizontal transmission between species. Drosophila willistoni has been identified as the potential donor species in that transfer process. A most remarkable feature of D. willistoni is its extensive chromosomal polymorphism due to inversions-the adaptiveness of which has been the subject of many classical studies on evolutionary genetics. In this article, we further extend the study of P elements in D. willistoni, focusing on the possible role they may play in the generation of chromosomal inversions. Our results may be summarized as follows. P-homologous sequences were detected in South American populations of D. willistoni. In two of them, a recently collected wild population and an old laboratory stock, the P insertion sites were located in the polytene chromosomes. Several hybridization sites were mapped in all major chromosome arms of the natural population, which was also chromosomally polymorphic; in the laboratory population, nearly devoid of inversions, hybridization sites were found to be confined to the chromocenter. In the wild population, 10 of the 24 P hybridized sites coincided with several inversions break points and another five sites located themselves very close to those points. The results are discussed within the context of evolutionary hypotheses.

Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses.

The tibial components in 143 patients with total knee replacements performed before 1988 were assessed for micromotion using roentgen stereophotogrammetric analysis (RSA) over a period of 13 years. The fixation of the prostheses remained clinically sound in all cases, although revision had been required for other reasons in seven. In a second group taken from all cases with RSA available on our full database to 1990, 15 tibial components had been followed by RSA from the insertion until, 1 to 11 years after the initial arthroplasty, they were revised for mechanical loosening of the tibial component; 12 of these comprised all the loosenings in the base group, thus making a total of 155 consecutive cases, while an additional three were inserted after the base material had been compiled. The mean migration in the first group was about 1 mm at one year, but subsequent migration was slower, reaching a mean of about 1.5 mm after ten years. About one-third migrated continuously throughout follow-up, while two-thirds ceased to migrate after one to two years. In the revision group, 14 components had migrated continuously and at one year significantly more than those in the first group. One revision case lacked the crucial one-year follow-up and could not be classified. These findings suggest that mechanical loosening begins early in the postoperative period. Clinical symptoms which necessitate revision, seen at this stage in 20% of abnormally migrating tibial components, may not appear until up to ten years after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone response to hydroxyapatite-coated and commercially pure titanium implants in the human arthritic knee.

Rough and smooth commercially pure (c.p.) titanium implants and hydroxyapatite-coated (HA-C) implants were inserted in arthritic human knees and left in situ in order to compare the response of bone to these three implants. Radiographic examination alone could not determine if bone apposition had occurred. After 3 and 6 months, histomorphometric analyses of undecalcified sections, 10 microns thick, revealed a statistical significance in the amount of bone apposition to rough-surfaced and HA-C implants as compared with smooth uncoated implants. Most of the rough-surfaced c.p. titanium implants and the HA-C implants had achieved bone apposition on the order of 50%. No statistically significant differences in apposition were seen between the rough-surfaced and HA-C implants. The smooth c.p. titanium implants were mostly encapsulated in fibrous tissue.

The effect of a stem on the tibial component of knee arthroplasty. A roentgen stereophotogrammetric study of uncemented tibial components in the Freeman-Samuelson knee arthroplasty.

We studied the effect of a metal tray with an intramedullary stem on the micromotion of the tibial component in total knee arthroplasty. Of 32 uncemented Freeman-Samuelson knee arthroplasties performed in London and Gothenburg, nine had a metal backing and stem added to the tibial component. Micromotion of the tibial components, expressed as migration and inducible displacement, was analysed using roentgen stereophotogrammetric analysis up to two years follow-up. The addition of a metal back and a 110 mm stem to the standard polyethylene component significantly reduced both migration over two years and inducible displacement.

Blood-to-tissue transport of albumin in rat fibrosarcomas at two different implantation sites.

Albumin clearance and blood flow were measured in normal tissues and in fibrosarcomas by means of a multiple tracer method in intact male rats. Sarcomas implanted in testes had higher albumin clearances than the same tumours implanted in skeletal muscle, 59 and 26 microliters min-1 per 100 g, respectively. Albumin extraction (defined as the ratio of albumin clearance to plasma flow) was found to be 1 x 10(-4) - 14 x 10(-4) in normal tissues. Fibrosarcomas in muscle showed high extractions (24 x 10(-4)), especially in the central portions (96 x 10(-4)), where the extraction was similar to that in tumours implanted in the testes (111 x 10(-4)). The high albumin extraction in poorly perfused central parts of the muscle-implanted tumours and in the similarly insufficiently perfused testicular sarcomas is probably due to an increased endothelial permeability of the exchange vessels and not to an increased capillary exchange surface area compared with the better-perfused peripheral parts of the muscle-implanted tumours. The latter tissue also had a high albumin clearance, however, in the range of that of maximally dilated skeletal muscle vasculature, possibly reflecting a large functional capillary surface area.

Transcapillary passage of albumin in mammary tumours and in normal lactating mammary glands of the rat.

A triple-isotope technique was used to obtain albumin clearances and blood flow in DMBA induced mammary tumours, normal lactating mammary glands and various other tissues of the rat. Albumin clearance was high both in tumours (0.0337 ml/min/100 g) and in lactating mammary glands (0.0414 ml/min/100 g). Albumin extraction (defined as the ratio of clearance over plasma flow) was exceptionally high in tumours (23 X 10(-4)) and lactating glands (18 X 10(-4)) as compared to all other tissues (1-7 X 10(-4)). This probably reflects an increased capillary permeability to macromolecules and/or a change in the relation between blood flow and available capillary surface area, both in the physiological, hormonally induced gland and in the abnormal neoplasia derived from the same tissue. Increased extravasation of albumin, together with other changes (e.g. impaired lymph formation) may be important factors behind the production of increased tumour interstitial pressure, which tend to reduce nutritional blood flow in tumours.