Medial screws and cement: A possible mechanical augmentation in total knee arthroplasty

doi:10.1016/j.arth.2003.11.009

The Journal of Arthroplasty

Volume 19, Issue 5, August 2004, Pages 587-589

https://doi.org/10.1016/j.arth.2003.11.009 Get rights and content

Abstract

The purpose of this study was to determine whether screws placed beneath the medial tibial plateau in cemented total knee arthroplasty helps prevent collapse of the medial tibia. A previous study found that the AGC all-polyethylene tibial component had a 14% rate of collapse of the medial subchondral region in the first postoperative year. Of 536 implanted AGC all-polyethylene tibial components, 20 had screws inserted beneath the medial tibial plateau. No AGC all-polyethylene tibial components with screws failed because of aseptic loosening or collapse of the medial tibial plateau. The study included 125 cemented metal-backed total knee arthroplasties with screws inserted beneath the medial tibial plateau. We also found 2 cases of collapse of the medial tibial plateau and 1 case of collapse on the lateral side. No revisions were performed. The placement of screws beneath the medial tibial plateau to fill large defects is an excellent precaution against collapse of the medial tibia.

Section snippets

Materials and methods

Between June 18, 1990, and November 14, 1991, 536 primary total knee arthroplasties were implanted using AGC all-polyethylene tibial components (group 1). Twenty knees in 18 patients had screws inserted beneath the medial tibial plateau to correct bony defects. The typical size of the screw was 6.5 mm in diameter and 25 mm long. The cost to the patient was $120.00 per screw. A radiographic assessment was conducted for the group of AGC all-polyethylene tibial components with screws inserted

Results

Three knees in 3 patients (group 1) with all-polyethylene tibial components had no available radiographs on or before 3 postoperative years. At present, all 3 patients are deceased. However, telephone interviews conducted for 2 patients 4 years and 5 years postoperatively revealed that neither patient had a painful knee, and both patients had unlimited walking ability. The third patient died of cancer 8 months after surgery with no clinical or radiographic follow-up evaluation. This left 17

Discussion

A previous report on the survival of the AGC all-polyethylene tibial component indicated a 14% rate of collapse within the first postoperative year [3]. However, the results of the current study of 20 AGC all-polyethylene tibial components (17 with radiographic reviews) with screws inserted underneath the medial tibial plateau indicated no cases of collapse. One or 2 screws placed beneath the medial tibial plateau provided adequate support for the peripheral edge loading associated with the AGC

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There are more references available in the full text version of this article.

Cited by (40)

Primary total knee arthroplasty in patients with a significant bone defect in the medial tibial plateau: Case series and literature review
2023, International Journal of Surgery Case Reports
Total knee arthroplasty (TKA) can significantly enhance a patient's quality of life and knee function. As a result, it has become a popular procedure among orthopedic surgeons. However, there are some challenging cases that surgeons may encounter, such as treating bony defects in the tibial plateau in patients with advanced degeneration. If not managed properly, these cases can have serious consequences.
4 patients with severe knee joint degeneration and bone loss in the medial tibial plateau were included in the series. The patients underwent TKA using the cement and screws technique to compensate for the defect in the medial tibial plateau. After (12-24 months) follow-up, all patients showed a clear clinical and functional improvement.
Several ways exist to address bone loss in the tibial plateau in primary total knee joint arthroplasty. Among them, metal prostheses are frequently used. In certain situations, we may need to use more affordable techniques to ensure success for patients facing financial difficulties. This is particularly common in our country, and we may utilize methods such as the cement and screws technique. This study showed a clear improvement in the patient's clinical and functional outcomes according to The Western Ontario and McMaster Universities Arthritis Index (WOMAC) at the end of the follow-up period.
The cement and screw technique might be a good solution for moderate bone loss in the tibial plateau. It might be a safe and simple method for patients, and it's also a viable option for those who can't afford pricier alternatives like metal augmentation or structural allografts.
Difference Between Screw Cement Filling and Adequate Osteotomy With Thick Liner for Primary Total Knee Arthroplasty in Patients With Rand IIb Tibial Defects
2023, Journal of Arthroplasty
The effectiveness of 2 treatment options, screw-cement fill, and adequate osteotomy with a thick liner, in treating patients with Rand IIb tibial defects (tibial plateau defects to a depth of 5 to 10 millimeters) in primary total knee arthroplasty (TKA) has not yet been demonstrated. Therefore, we performed a retrospective study to evaluate the differences between these 2 treatments.
We retrospectively analyzed patients who underwent primary TKA for Rand IIb tibial plateau defects from 2015 to 2020 from a department database. Patients were categorized into the screw-cement and thick liner groups based on the different options used to repair tibial defects. We evaluated Knee Society Score, range of motion (ROM), Insall-Salvati index (ISI), and Forgotten Joint Score (FJS) in both groups. We also compared differences in prosthesis survival, stiffness, myasthenia, and joint clicking between the 2 groups at mean 2 years postoperatively (range, 2 to 2.3). A power analysis was performed on the number of cases in the cohort.
Postoperative femur-tibia mechanical axis (FTMA) correction was significantly higher in the screw-cement group than in the thick-liner group: 18.8 (±5.6°) versus 15.4 (±5.9°) (P < .01); At mean 2 years after surgery, the American Knee Society Functional Score improvement values were higher in the thick-liner group than in the screw-cement group: 36.3 (±12.4) versus 42.4 (±16.4) (P = .05). Postoperative ISI scores were 0.95 (±0.12) points in the screw-cement group and 0.89 (±0.13) points in the-thick liner group (P = .03). There were no statistically significant differences in the Knee Society Clinical Score, ROM, FJS, stiffness, myasthenia, joint clicking, and revision rate.
The results of this study showed no significant difference in clinical outcomes between the 2 reconstruction strategies of the screw cement fill technique and the adequate osteotomy and thick liner technique for Rand IIb tibial plateau defects. However, in patients who have FTMA deformities greater than 20° or in younger patients who need to preserve bone volume, we recommend the screw cement filling technique to ensure stable postoperative results and to prepare these patients for possible later surgery.
The optimal size of screw for using cement-screw technique to repair tibial defect in total knee arthroplasty: A finite element analysis
2023, Heliyon
Cement can be reinforced with cancellous screws for repairing tibial defect in total knee arthroplasty (TKA). However, it is still unknown which size (diameter, length) of screws is better, and the purpose of this study was to perform a finite element analysis (FEA) to determine it. Twelve FEA models were set to represent the cement-screw technique with different diameters (3.5 mm, 5 mm and 6.5 mm) and lengths (20 mm, 25 mm, 30 mm and 35 mm). Contact stresses on the surface of cancellous bone in different areas were calculated. Compared to screws with diameter of 3.5 mm, stresses on the surface of bone defect reduced 5.75% of 5 mm and 10.68% of 6.5 mm for the screw length of 20 mm, 4.23% of 5 mm and 9.16% of 6.5 mm for 25 mm, 6.65% of 5 mm and 12.30% of 6.5 mm for 30 mm, and 5.05% of 5 mm and 12.16% of 6.5 mm for 35 mm. Compared to screws with diameter of 5 mm, stresses on the surface of defect reduced 5.24%, 5.15%, 6.05%, and 7.49% of 6.5 mm for the screw length of 20, 25, 30, and 35 mm. However, it did not show any significant difference in other comparisons. For the treatment of tibial defect in TKA with cement-screw technique, longer screw may not achieve better stability, but the thicker screw can reduce more stresses on the surface of tibial defect and achieve better stability. However, the depth of bone defect must be considered when making a choice.
Flip Autograft Technique for Anterolateral Femoral Deficiency in Total Knee Arthroplasty
2022, Arthroplasty Today
Citation Excerpt :
However, the Anderson Orthopaedic Research Institute classification system has utility for preoperative planning in primary arthroplasty as well. Current options for addressing bony defects in knee arthroplasty include cement with or without screws for smaller defects [2], autologous bone graft, morselized or structural allograft, modular systems (stems, wedges, cones), and limb salvage systems [3]. Specific techniques are useful for the proximal tibia and distal and posterior femur defects, but there are limited options to address unilateral anterior femoral deficiency.
Anterolateral bone loss of the femur within the trochlear groove presents a unique and rare issue in primary total knee arthroplasty (TKA). Unlike distal and posterior femur bone loss for which most contemporary TKA systems have modular augments, the same does not exist for anterolateral bone loss. We present a technique in which a patient’s host bone from the standard distal femoral cuts was used to augment and provide a stable base for cementing of final femoral implants. Currently, the patient has 3-year follow-up with excellent results in terms of pain control with no evidence of component failure on the most recent radiographs. This technique provides a simple solution to a complex problem within primary TKA.
Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique
2021, Arthroplasty Today
Citation Excerpt :
Given the patients' severe deformity, both primary and CCK implants (NexGen Legacy Constrained Condylar Knee [LCCK]; Zimmer-Biomet, Warsaw, IN) with stem extensions were made available on the day of surgery. As the patient was noted to have significant posteromedial tibial bone loss, a universal small fragment system (DePuy Synthes, Raynham, MA) and bone cement (Biomet Bone Cement R; Zimmer-Biomet, Warsaw, IN) were made available for possible use of a screw and cement rebar technique [7,8]. Given the unknown degree of bone loss and bone quality preoperatively, trabecular metal modular augments and cones were also made available.
Blount disease is an acquired, asymmetrical disorder of proximal tibial growth that results in a complex three-dimensional proximal tibial deformity, with tibial varus being the dominating feature. Although the exact pathophysiology is unknown, Blount disease is separated into 2 clinical variants, infantile and adolescent, based on the onset of symptoms occurring before or after the age of 10 years. If recognized and treated early, affected patients generally have a favorable prognosis; however, if neglected, it can lead to progressive malalignment and premature osteoarthritis. We present a patient with bilateral neglected Blount disease who underwent successful bilateral total knee arthroplasty performed in a staged fashion using a gap balancing technique with constrained condylar knee implants.
Patellar Rebar Augmentation in Revision Total Knee Arthroplasty
2021, Journal of Arthroplasty
In revision total knee arthroplasty, osteolysis, mechanical abrasion, and infection may leave patellar bone stock severely attenuated with cavitary and/or segmental rim deficiencies that compromise fixation of patellar implant pegs. The purpose of this study was to retrospectively review the use of cortical “rebar” screws to augment cement fixation in revision patelloplasty.
From 2006 to 2018, dorsal patellar rebar technique was used for patellar reconstruction in 128 of 1037 revision total knee arthroplasty cases (12.3%). Follow-up was achieved with serial radiographs and prospective comparison of Knee Society Scores (KSSs) for clinical outcome. Complications and implant failures requiring reoperation or modified rehabilitation were also assessed.
Of the 128 patellar revisions performed using the rebar technique, 69 patients were women and 59 patients were men. The average age of the group was 69.5 years (range, 32-83 years). The mean follow-up of the cohort was 37 months (range, 13-109 months). The most common causes for revision were kinematic conflict, periprosthetic joint infection, and aseptic loosening. The median number of rebar screws used was 5 (range, 1-13). Preoperative KSSs for the study cohort averaged 50 (range, 0-90) At latest follow-up, mean KSS was 85 (range, 54-100). There were 4 patellar-related complications (3.1%) with no implant failures at study conclusion. Retrieval analysis revealed rigid fixation of the reconstructed patellar component in all cases.
Patellar rebar screw augmentation is a useful technique when there are significant cavitary deficiencies and limited segmental rim deficiencies. This technique allows the surgeon to extend indications for patellar revision arthroplasty.

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¹: No benefits or funds were received in support of this study.

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Original articlesMedial screws and cement: A possible mechanical augmentation in total knee arthroplasty1

Abstract

Section snippets

Materials and methods

Results

Discussion

J Arthroplasty

J Arthroplasty

The cemented all-poly tibia

Orthopedics

Original articles
Medial screws and cement: A possible mechanical augmentation in total knee arthroplasty¹