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Archives of Orthopaedic and Trauma Surgery

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26.10.2018 | Knee Revision Surgery

Cemented conical stems can be removed more easily than cylindrical stems, regardless of cone angle in revision knee arthroplasty

verfasst von: Alexander Maslaris, Frank Layher, Olaf Brinkmann, Matthias Bungartz, Timo Zippelius, Georg Matziolis

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 12/2018

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Abstract

Background

According to literature, more than 30% of revised knee arthroplasties will require at least one re-revision. Practical experience has shown that there are considerable product-specific differences in the explantability of cemented long-stem prostheses. In the registers of successful implants, stem geometry varies considerably between the manufacturers. However, comparative data on explantability of the respective stems are missing. Objective of the present study was to identify a correlation between the geometry of a smooth cemented long stem and the necessary explantation energy required until failure of the implant–cement interface occurs.

Methods

Eight cemented stems with different conical profile angles (0°–3°) were explanted in a reproducible biomechanical setup each six times to evaluate the correlation between the stem design and the required explantation energy.

Results

The average explantation energy was highest in the case of the cylindrical stem, at 18.1 ± 3.6 J. At a cone angle of 0.25°, it was just 12.1 ± 2.1 J (p < 0.001) and dropped beyond 0.5° to an average of 5.7 ± 1.8 J (p < 0.001). Between 0.5° and 3°, no significant difference in the required extraction energy was observed.

Conclusions

Whereas smooth conical stems can mostly be removed easily, an early decision in favour of osteotomy or fenestration can be taken in the case of cylindrical cemented stems.

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Titel: Cemented conical stems can be removed more easily than cylindrical stems, regardless of cone angle in revision knee arthroplasty
verfasst von: Alexander Maslaris
Frank Layher
Olaf Brinkmann
Matthias Bungartz
Timo Zippelius
Georg Matziolis
Publikationsdatum: 26.10.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 12/2018
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3053-3

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Cemented conical stems can be removed more easily than cylindrical stems, regardless of cone angle in revision knee arthroplasty