Early migration and late aseptic failure of proximal femoral prostheses. Knee joint loading and tibial component loosening. RSA and gait analysis in 45 osteoarthritic patients before and after TKA. Early Migration of the Tibial Component of the Buechel-Pappas Total Ankle Prosthesis Effect of bioactive coating of the tibial component on migration pattern in uncemented total knee arthroplasty: a randomized RSA study of 14 knees presented according to new RSA-guidelines The beneficial effect of hydroxyapatite lasts Early Inducible Displacement of Tibial Components in Total Knee Prostheses Inserted with and without Cement. A Randomized Study with Roentgen Stereophotogrammetric Analysis* Good diagnostic performance of early migration as a predictor of late aseptic loosening of acetabular cups: results from ten years of follow-up with Roentgen stereophotogrammetric analysis (RSA). Migration of a cemented fixed-bearing, polished titanium tibial baseplate (Genesis II) at ten years : a radiostereometric analysis. The stability of three different cementless tibial components. A randomized radiostereometric study in 45 knee arthroplasty patients. Similar early migration when comparing CR and PS in Triathlon™ TKA: A prospective randomised RSA trial. Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. Contributing factors to medial tibial stress syndrome: a prospective investigation. Fixation of the tibial component using CMW-1 or Palacos bone cement with gentamicin: Similar outcome in a randomized radiostereometric study of 51 total knee arthroplasties Correlations between biochemical markers of bone turnover and bone density responses in patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate. Denosumab reduces early migration in total knee replacement Causes for revision of dual-mobility and standard primary total hip arthroplasty Clodronate prevents prosthetic migration: A randomized radiostereometric study of 50 total knee patients
The  vertical migration of four configurations of a proximal femoral prosthesis , followed for up to nine years , was measured on st and ard radiographs . The same implant was used without cement ( group 1 ) and with cement ( group 2 ) . The migration of both groups was linear from six months onwards . The mean migration rate and the incidence of late aseptic loosening were both greater in group 1 . Survival analysis of the two groups , however , showed no statistically significant difference . In both groups , hips later destined for revision migrated more rapidly from the initial postoperative period onwards , than did the remainder . A threshold migration of 1.2 mm/year during the first two years after implantation detected hips likely to fail with a specificity of 86 % and a sensitivity of 78 % . This ' migration test ' was applied to the results in two further groups of patients in which a modified femoral prosthesis had been implanted without hydroxyapatite coating ( group 3 ) and with hydroxyapatite coating  ( group 4 ) . The test distinguished between the four groups and suggested that at least two fixation procedures should be ab and oned . We conclude that vertical migration measured on st and ard radiographs in the first two years after implantation can be used to predict late aseptic loosening . New prosthetic configurations should be evaluated by migration measurements before their general release . Our observations support the view that one cause of late aseptic loosening is imperfect initial fixation We report a prospect i ve study of gait and tibial component migration  in 45 patients with osteoarthritis treated by total knee arthroplasty ( TKA ) .  Migration  was measured over two years using roentgen stereophotogrammetry . We used the previously established threshold of 200 microm migration in the second postoperative year to distinguish two groups : a risk group of 15 patients and a stable group of 28 patients . We performed  gait analysis before operation and at six months and at two years after TKA . On all three occasions we found significant differences between the two groups in the mean sagittal plane moments of the knee joint . The risk group walked with higher peak flexion moments than the stable group . The two groups were not discriminated by any clinical or radiological criteria or other gait characteristics . The relationship which we have found between gait with increased flexion moments and risk of tibial component loosening warrants further study as regards the aetiology of prosthetic loosening and possible methods of influencing its incidence Interest in mobile-bearing total ankle arthroplasty has increased in recent years . Clinical studies show favorable but varying results , with survival rates between 70 % and 90 % at 10-year followup . Design -specific differences in early migration patterns might explain variations in the results and modes of failure . Using radiostereometric analysis ( RSA ) we prospect ively followed 15 RA patients with a cementless mobile-bearing total ankle arthroplasty .  The American Orthopaedic Foot and Ankle Society ankle score and radiostereometric radiographs  were evaluated immediately postoperatively , 6 weeks postoperatively , 3 months , 6 months , and 12 months postoperatively and yearly thereafter . The postoperative clinical results improved . We observed increased migration of the tibial component during the first 3 months , but this stabilized by the 6 month followup . The mean lateral-medial migration was 0.8 mm , distal-proximal migration was 0.9 mm , and posteroanterior migration was −0.5 mm . The latter implies the total result ant migration was in anterior and valgus tilting of this tibial component . However , migration stabilized at 6 months postoperatively . We believe the surgical technique ( anterior cortical window for placement ) and the method of tibial fixation likely explain this migration . Level of Evidence : Therapeutic , Level IV . See Guidelines for Authors for a complete description of levels of evidence Background Bioactive coating of uncemented  total knee arthroplasty ( TKA ) is believed to increase bone ingrowth and enhance early fixation of the TKA . In a prospect i ve r and omized study using radiostereometric analysis ( RSA ) we examined migrations of the tibial implant , in an uncemented TKA with and without bioactive coating . The study was performed according to new RSA guidelines , and focus was put on some important method ological issues . Material s and methods Twenty-three patients with osteoarthrosis of the knee received an uncemented Duracon TKA either with bioactive ( hydroxyapatite or periapatite ) coating ( + HA ) or without bioactive coating ( −HA ) . Patients had RSA examinations postoperatively and at 3 , 6 and 12 months . Nine patients were excluded during the study result ing in 14 knees for final analysis . Results At 12 months follow-up we found no significant differences in migrations between the two groups . However , in general the −HA group migrated more than the + HA group , and we found a significant larger variation in migration pattern in the −HA group . In the + HA group the tibia component stabilized after 6 months , whereas the −HA group showed continuous migration . Subsidence and posterior tilt were the main migration patterns in both groups . Conclusions Bioactive coating of TKA seems to enhance early stabilization of the tibia component . Similar results are found in previous studies Background and purpose In contrast to early migration , the long-term migration of hydroxyapatite- ( HA- ) coated tibial components in TKA has been scantily reported . This r and omized controlled trial investigated the long-term migration measured by radiostereometric analysis ( RSA ) of HA-coated , uncoated , and cemented tibial components in TKA . Patients and methods 68 knees were r and omized to HA-coated ( n = 24 ) , uncoated ( n = 20 ) , and cemented ( n = 24 ) components .  All knees were prospect ively followed for 11–16 years , or until death or revision .  RSA  was used to evaluate migration at yearly intervals . Clinical and radiographic evaluation was according to the Knee Society system . A generalized linear mixed model ( GLMM , adjusted for age , sex , diagnosis , revisions , and BMI ) was used to take into account the repeated-measurement design . Results The present study involved 742 RSA analyses . The mean migration at 10 years was 1.66 mm for HA , 2.25 mm for uncoated and 0.79 mm for the cemented group ( p < 0.001 ) . The reduction of migration by HA as compared to uncoated components was most pronounced for subsidence and external rotation . 3 tibial components were revised for aseptic loosening ( 2 uncoated and 1 cemented ) , 3 for septic loosening ( 2 uncoated and 1 cemented ) , and 1 for instability ( HA-coated ) . 2 of these cases were revised for secondary loosening after a period of stability : 1 case of osteolysis and 1 case of late infection . There were no statistically significant differences between the fixation groups regarding clinical or radiographic scores .  Interpretation HA reduces migration of uncemented tibial components . This beneficial effect lasts for more than 10 years . Cemented components showed the lowest migration . Longitudinal follow-up of TKA with RSA allows early detection of secondary loosening The  fixation of tibial components r and omized to insertion with or without cement in  twenty-six knees was examined for inducible displacement at six weeks and one year postoperatively with use of roentgen stereophotogrammetric analysis . Furthermore , migration was studied during the first two postoperative years . Inducible displacement was found in all knees at both the six-week and the one-year follow-up examination , but no differences were detected with respect to the type of fixation ( p > 0.05 ) . All tibial components  migrated for as long as one year postoperatively , after which most stabilized . No difference was found between the groups with respect to migration during the first two years postoperatively ( p > 0.05 ) , with the exception of subsidence of the component , which was found to be 0.0 ± 0.1 millimeter ( mean and st and ard error of the mean ) for the components inserted with cement and 0.5 ± 0.1 millimeter for the components inserted without cement ( p < 0.01 ) . Migration after one year was the same for both groups . We found a relationship between inducible displacement at six weeks and at one year as well as one between inducible displacement and migration at one year . To our knowledge , the present study is the first in which the micromotion of an interference-fit prosthesis was found to be similar to that of a device inserted with cement . The results of the present study emphasize the importance of the initial prosthetic fixation BACKGROUND Excessive early migration of femoral stems following total hip arthroplasty and tibial components following total knee arthroplasty is associated with their long-term survival and allows reliable early evaluation of implant performance . However , a similar relationship involving acetabular components following hip arthroplasty has not been evaluated . This prospect i ve , long-term study with clinical and Roentgen stereophotogrammetric analysis ( RSA ) follow-up establishes the existence of this relationship and its associated diagnostic performance . METHODS Thirty-nine consecutive patients ( forty-one hips ) who underwent total hip arthroplasty with a cemented Exeter stem and a cemented Exeter all-polyethylene cup had prospect i ve clinical and RSA follow-up . Patients were evaluated postoperatively at six weeks , at three , six , and twelve months , and annually thereafter . Conventional anteroposterior and lateral radiographs were made at six weeks and at two , five , and ten years postoperatively as well as when indicated . The mean duration of follow-up ( and st and ard deviation ) was 9.4 ± 3.2 years . No patients were lost to follow-up ; fifteen patients died during the follow-up period . RESULTS Eleven acetabular components were observed to be loose on conventional radiographs after a mean of seventy-six months ( range , twelve to 140 months ) . During the first two postoperative years , the failed acetabular components showed markedly greater and more rapid cranial translation and sagittal rotation . Both cranial translation ( hazard ratio = 19.9 [ 95 % confidence interval , 4.94 to 80.0 ] , p < 0.001 ) and sagittal rotation ( hazard ratio = 11.1 [ 95 % confidence interval , 2.83 to 43.9 ] , p = 0.001 ) were strong risk factors for late aseptic loosening . Eight of the eleven failed components showed a distinctive pattern of excessive cranial translation combined with excessive sagittal rotation . The associated diagnostic performance of two-year cranial translation and /or sagittal rotation for predicting late aseptic loosening of the acetabular component was good ( area under the receiver operating characteristic curve , 0.88 [ 95 % confidence interval , 0.74 to 1.00 ; p < 0.001 ] and 0.84 [ 95 % confidence interval , 0.68 to 1.00 ; p = 0.001 ] , respectively ) . CONCLUSIONS Early migration , as measured by RSA at two years postoperatively , has good diagnostic capabilities for the detection of acetabular components at risk for future aseptic loosening , and this method appears to be an appropriate means of assessing the performance of new implants or implant-related changes AIMS The purpose of the present study was to examine the long-term fixation of a cemented fixed-bearing polished titanium tibial baseplate ( Genesis ll ) . PATIENTS AND METHODS Patients enrolled in a previous two-year prospect i ve trial ( n = 35 ) were recalled at ten years . Available patients ( n = 15 ) underwent radiostereometric analysis ( RSA ) imaging in a supine position using a conventional RSA protocol . Migration of the tibial component in all planes was compared between initial and ten-year follow-up . Outcome scores including the Knee Society Score , Western Ontario and McMaster Universities Arthritis Index , 12-item Short Form Health Survey , Forgotten Joint Score , and University of California , Los Angeles Activity Score were recorded . RESULTS At ten years , the mean migration of the tibial component was less than 0.1 mm and 0.1 ° in all planes relative to the post-operative RSA exam . Maximum total point movement increased with time ( p = 0.002 ) from 0.23 mm ( sd 0.18 ) at six weeks to 0.42 mm ( sd 0.20 ) at ten years . CONCLUSION The low level of tibial baseplate migration found in the present study correlates to the low rate of revision for this implant as reported in individual studies and in joint replacement registries . TAKE HOME MESSAGE Overall , the implant was found to be well fixed at ten years , supporting its continued clinical use and the predictive power of RSA for determining long-term fixation of implants . Cite this article : Bone Joint J 2016;98-B:616 - 21 We conducted a prospect i ve , r and omized study of 45 patients to evaluate 3 different uncemented tibial component design s in total knee arthroplasty . The stability of the components was assessed by  radiostereometry ( RSA ) , both as migration during 2 years and as inducible displacement at 2 years . The PCA resurfacing , the Tricon stem and the Tricon-M prosthesis groups showed a similar level of migration at 2 years , about 1.4 mm . In response to externally applied rotatory forces , the Tricon groups rotated more than the PCA group , interpreted as a consequence of the more conforming articular surface in the Tricon design . The series was divided into one group of continuously migrating prostheses with a poor prognosis ( unstable , one third ) and another group of prostheses in which migration stopped after 1 year ( stable , two thirds ) . With this classification , no differences between the prostheses design groups were revealed . However , the unstable group showed a larger inducible displacement by provocation , an association hitherto not established OBJECTIVES The objective of this study was to compare the early migration of the cruciate retaining and posterior stabilising versions of the recently introduced Triathlon ™ total knee system , with a view to predicting long term fixation performance . METHODS Sixty patients were prospect ively r and omised to receive either Triathlon ™ posterior stabilised cemented knee prosthesis or Triathlon ™ cruciate retaining cemented knee prosthesis . Tibial component migration was measured by radiostereometric analysis postoperatively and at three months , one year and two years . Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score . RESULTS There were no differences in rotation around the three coordinal axes or in the maximum total point motion ( MTPM ) during the two year follow-up . The posterior stabilised prosthesis had more posterior-anterior translation at three months and one year and more caudal-cranial translation at one year and two years . There were no differences in functional outcome between the groups . CONCLUSION The tibial tray of the Triathlon ™ cemented knee prosthesis showed similar early stability . LEVEL OF EVIDENCE Level I. ARTICLE SUMMARY Article focus : This was a prospect i ve r and omised trial aim ing to compare the single radius posterior stabilised ( PS ) Triathlon ™ total knee arthroplasty ( TKA ) to the cruciate retaining Triathlon ™ TKA system with regard to fixation . Strengths and limitations of this study : Strength of this study was that it is a r and omised prospect i ve trial using an objective measuring tool . The sample size of 25 - 30 patients was reportedly sufficient for the screening of implants using RSA [ 1 ] . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00436982 BACKGROUND Bicondylar tibial plateau fractures are complex injuries , historically associated with high complication rates . The purpose of this study was : 1 ) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures . 2 ) To compare the biomechanics of this plating system with a double plate construct . METHODS AND MATERIAL S Thirty-eight patients who sustained a complex tibial plateau fracture ( OTA type 41C ) at one of three level-one trauma centers were stabilized using the Less Invasive Stabilization System ( L.I.S.S. ) . The cohort of patients was evaluated clinical ly and radiographically for outcomes at a mean 15 months . In phase 2 of this study a model of a bicondylar tibial plateau fractures was made in six matched pairs of embalmed , human tibia and r and omized to fixation with either a L.I.S.S plate or a st and ard double plate construct . The tibias were then subjected to an axial cyclic load of 500N for 10 cycles ( 3Hz ) to approximate 2 months in vivo and displacements measured . RESULTS Thirty-six of /38 ( 95 % ) patients united at 4 months after surgery with no loss of fixation nor infection . Two patients underwent prophylactic autogenous bone grafting for bone loss and united by 3 months postgrafting . Significant loss of knee range of motion ( < 90 ) was seen in five patients .Biomechanically , no differences in permanent inferior displacement of the medial fragment were found in initial axial loading and after 10 cycles between the two plate constructs . However , when loaded to 500N the L.I.S.S plate construct demonstrated almost twice the displacement of the medial fragment compared with the dual plate construct . No specimen lost fixation during cycling . CONCLUSION The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results PURPOSE To conduct a prospect i ve , multisite , cohort study investigating the possible risk factors for medial tibial stress syndrome ( MTSS ) in college athletes . METHODS One hundred and forty-six healthy , collegiate athletes from NCAA Division I and Division II institutions participated in the study . Subjects first completed a health history question naire to establish previous history of injury and underwent a physical examination to assess their ankle/foot strength , ankle/foot range of motion , tibial varum , and navicular drop before the start of their respective athletic season . Athletes were instructed to report to a certified athletic trainer if they developed pain on their tibia . If MTSS was present , subjects were then placed into the symptomatic group . Independent t-tests and chi-square analyses were used to determine whether differences existed between MTSS and healthy athletes for the continuous and the discrete dependent variables , respectively . The significant dependent variables were then used in the discriminant function analysis . RESULTS Twenty-nine subjects developed MTSS during this study . Athletes that had been participating in athletic activity for fewer than 5 yr were significantly more likely to develop MTSS ( P = 0.002 ) . Additionally , athletes with a previous history of MTSS ( P = 0.0001 ) , a previous history of stress fracture ( P = 0.039 ) , and the use of orthotics ( P = 0.031 ) were more likely to develop MTSS compared with those who did not develop MTSS . CONCLUSION This study established that the factors most influencing MTSS development were previous history of MTSS and stress fracture , years of running experience , and orthotic use . These data demonstrate the importance of establishing a thorough history before the start of the season so that athletes who might be at risk for MTSS development can be identified We studied CMW-1 bone cement with gentamicin in the laboratory and in a r and omized clinical study . Palacos bone cement containing gentamicin was used as the control . In the pre clinical evaluation , the CMW cement had slightly less mechanical strength . In the clinical study , 51 patients ( 51 knees ) operated on with total knee arthroplasty were studied for 2 years . We used radiostereometric analysis to measure migration of the tibial components , r and omized to fixation with either of the two types of cement . The extent and pattern of migration were similar in both groups , and we found no differences in the number , size and extent of radiolucent lines or clinical outcome . No complications occurred . Our findings suggest a need for more studies of CMW-1 bone cement containing gentamicin in a larger cohort of patients The purpose of this post hoc analysis was to determine whether baseline concentrations or early changes in serum bone turnover markers were correlated with changes in bone mineral density ( BMD ) at 18 months in patients with glucocorticoid-induced osteoporosis ( GIO ) treated with teriparatide ( n=80 ; 20 mug/day ) or alendronate ( n=77 ; 10 mg/day ) . Bone markers included type I collagen N-terminal propeptide ( PINP ) , type I collagen C-terminal propeptide ( PICP ) , bone alkaline phosphatase ( bone ALP ) , and cross-linked C-telopeptide of type I collagen ( Sbeta-CTX ) . The relationship between baseline and early changes in markers and the 18-month changes in lumbar spine ( LS ) and femoral neck ( FN ) BMD was evaluated using Spearman correlation analysis . In the teriparatide group , increases in LS and FN BMD at 18 months were not significantly correlated with baseline marker concentrations ( P>0.05 ) but were correlated with the increases in PINP at 1 and 6 months ( P<0.05 ) . In the alendronate group , the increase in FN BMD at 18 months was positively correlated with baseline marker concentrations ( P<0.05 ) and negatively correlated with change in PINP and Sbeta-CTX at 1 and 6 months . In addition , in the alendronate group , the increase in LS BMD was negatively correlated with change in Sbeta-CTX at 1 month ( P<0.05 ) . Increases in BMD at the spine and hip were independent of baseline bone turnover in the teriparatide group , while increases in hip BMD were dependent on baseline bone turnover in the alendronate group . With both therapies , early changes in some bone turnover markers were correlated with 18-month gains in BMD in patients with GIO Background and purpose — Aseptic loosening is a main cause of late revision in total knee replacement ( TKR ) . Migration of implants as measured by radiostereometric analysis ( RSA ) can predict future loosening . This migration is associated with bone resorption . Denosumab is a human monoclonal antibody that binds to receptors on osteoclast precursors and osteoclasts . This prevents osteoclast formation , result ing in less bone resorption in cortical and trabecular bone . We investigated whether denosumab can reduce migration of TKR , as measured with RSA . Patients and methods — In this 2-center , r and omized , double-blind  placebo-controlled  trial , 50 patients with osteoarthritis of the knee were treated with an injection of either denosumab ( 60 mg ) or placebo 1 day after knee replacement surgery and again after 6 months . RSA was performed postoperatively and after 6 , 12 , and 24 months . The primary effect variable was RSA maximal total point motion ( MTPM ) after 12 months . We also measured other RSA variables and the knee osteoarthritis outcome score ( KOOS ) . Results — The primary effect variable , MTPM after 12 months , showed that migration in the denosumab group was statistically significantly less than in the controls . Denosumab  MTPM 12 months was reduced by one-third ( denosumab : median 0.24 mm , 10 % and 90 % percentiles : 0.15 and 0.41 ; placebo : median 0.36 mm , 10 % and 90 % percentiles : 0.20 and 0.62 ) . The secondary MTPM variables ( 6 and 24 months ) also showed a statistically significant reduction in migration . There was no significant difference in MTPM for the period 12–24 months . KOOS sub-variables were similiar between denosumab and placebo after 12 and 24 months . Interpretation — Denosumab reduces early migration in total knee replacement , as in previous trials using bisphosphonates . As migration is related to the risk of late loosening , denosumab may be beneficial for long-term results Introduction The causes for revision of primary total hip arthroplasty ( THA ) are various and quite well known . The developing use of dual-mobility THA ( DM-THA ) seems a relevant option to decrease the risk of instability . Due to lack of long-term follow-up , this innovative retentive concept is suspected to increase the risk of polyethylene ( PE ) wear . the aim of the study was to analyse the causes for  DM-THA revision and assess whether or not its occurrence is different from that of fixed-st and ard ( FS ) THA , particularly for aseptic loosening or wear and /or osteolysis . Material s and methods The SoFCOT group conducted an observational prospect i ve multicentre study from 1 January 2010 to 31 December 2011 . Inclusion criteria comprised an exhaustive collection of 2044 first-revision THAs with 251 DM-THAs and 1793 FS-THAs . After excluding complications linked to patient factors ( infection and periprosthetic fractures ) , we performed a matched case – control study ( matching ratio 1:1 ) comparing two groups of 133 THAs . Results Revisions for aseptic loosening or osteolysis/wear were as frequent in DM-THA ( 58.7 % ) as in FS-THA ( 57.1 % ) ( p 0.32 ) ; 7.5 % of DM-THA were revised for dislocation versus 19.5 % of FS-THA ( p 0.007 ) . Discussion Revision for osteolysis/wear and aseptic loosening were as frequent in DM-THA as in FS-THA ;  revision for dislocation was less frequent in DM-THA . This confirms the efficiency of the DM concept regarding the risk of dislocation . Causes for revision were different between groups , and revisions for dislocation were less frequent in DM-THA . Only prospect i ve comparative studies could provide reliable information that may support broader use of the DM concept In a double-blind study , we r and omized 50 patients to receive peroral clodronate medication or placebo from 3 weeks before until 6 months after a total knee replacement with a cemented NexGen implant .  Migration of the tibial components was measured by radiostereometry at 1 year . Clodronate reduced prosthetic migration , as measured by maximum total point motion , from 0.40 mm to 0.29 mm ( p = 0.01 ) . This confirms that the early postoperative migration is related to bone resorption and thus the biology of the bone bed . Since early migration is related to late loosening , 6 months of clodronate medication might reduce the risk of loosening
INTERPRETATION There was a clinical ly relevant association between early migration of TKPs and late revision for loosening .
PURPOSE We performed two parallel systematic review s and meta-analyses to determine the association between early migration of tibial components and late aseptic revision .