Comparison of Bone Mineral Density Between Porous Tantalum and Cemented Tibial Total Knee Arthroplasty Components
Comparison of Bone Mineral Density Between Porous Tantalum and Cemented Tibial Total Knee Arthroplasty Components
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DOI：
10.2106/jbjs.h.01349
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发表时间：
2010-03-01
影响因子：
5.3
通讯作者：
Takaoka, Kunio
中科院分区：
文献类型：
--
作者：
Minoda, Yukihide;Kobayashi, Akio;Takaoka, Kunio
背景：多孔钽最近被介绍为全膝关节置换术的金属植入材料。它的孔隙度、低弹性模量和高摩擦特性有望提供生理负荷转移和骨存量的相对保存。然而，据我们所知，金属小梁胫骨组件对骨密度的影响尚未见报道。本研究的目的是比较使用未骨水泥金属小梁和骨水泥胫骨假体的患者假体周围骨矿物质密度。方法：术前2周、术后2周、术后6、12、18和24个月，28个膝关节接受金属小梁胫骨组件和28个膝关节接受钴铬骨水泥胫骨组件进行双x线吸收仪扫描，评估假体周围骨矿物质密度。所有手术均由一名外科医生通过髌旁内侧入路进行。结果：两组术前股骨颈、腕、腰椎和膝关节的骨密度无显著差异。两组患者术后胫骨骨密度均下降。然而，术后24个月时，使用金属小梁假体的膝关节胫骨外侧骨矿物质密度的下降明显小于使用骨水泥假体的膝关节（平均值和标准差，-6.7% +/- 22.9%比-36.8% +/- 24.2%;p = 0.002）。术后24个月，两组在膝关节学会评分、膝关节活动度或腰椎骨密度方面无显著差异。两组均未发现假体移位或假体周围骨折。结论：全膝关节置换术后使用金属小梁胫骨假体的膝关节比使用骨水泥胫骨假体的膝关节在胫骨外侧平台的骨密度下降更少。需要进一步的研究来确定使用多孔钽胫骨假体进行全膝关节置换术是否能实现长期临床疗效。
Background: Porous tantalum was recently introduced as a metallic implant material for total knee arthroplasty. Its porosity, low modulus of elasticity, and high frictional characteristics were expected to provide physiologic load transfer and relative preservation of bone stock. However, to our knowledge, the effect of a Trabecular Metal tibial component on bone mineral density has not been reported. The purpose of the present study was to compare the periprosthetic bone mineral density between patients managed with uncemented Trabecular Metal and cemented tibial components.Methods: Twenty-eight knees receiving a Trabecular Metal tibial component and twenty-eight knees receiving a cemented cobalt-chromium tibial component had dual x-ray absorptiometry scans at two weeks preoperatively and at two weeks and six, twelve, eighteen, and twenty-four months postoperatively, to assess periprosthetic bone mineral density. All of the operations were performed by one surgeon through a medial parapatellar approach.Results: None of the differences between the two groups in terms of preoperative bone mineral density in the femoral neck, wrist, lumbar spine, or knee were significant. In both groups, the bone mineral density in the tibia decreased postoperatively. However, the postoperative decrease in bone mineral density in the lateral aspect of the tibia was significantly less in knees with Trabecular Metal components than in knees with cemented tibial components at twenty-four months (mean and standard deviation, -6.7% +/- 22.9% compared with -36.8% +/- 24.2%; p = 0.002). At twenty-four months postoperatively, there was no significant difference between the two groups in terms of the Knee Society score, range of motion of the knee, or bone mineral density in the lumbar spine. No prosthetic migration or periprosthetic fracture was detected in either group.Conclusions: The decrease in bone mineral density of the lateral tibial plateau was less in knees with a Trabecular Metal tibial component following total knee arthroplasty than in knees with a cemented tibial component. Additional research is needed to determine whether long-term clinical benefits are realized with the use of porous tantalum tibial components for total knee arthroplasty.