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. 2023 Jun 12:22:101132.
doi: 10.1016/j.artd.2023.101132. eCollection 2023 Aug.

High Rates of Aseptic Loosening in Modern Posterior-stabilized Femoral Components From a Single Manufacturer

Asa Shnaekel  1 , J Craig Morrison  1
Affiliations

High Rates of Aseptic Loosening in Modern Posterior-stabilized Femoral Components From a Single Manufacturer

Asa Shnaekel et al. Arthroplast Today. .

Abstract

Background: Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures in the United States. There are concerns and reports of early aseptic loosening due to debonding at the cement-implant interface in a specific posterior-stabilized femoral design. This study describes failure at the cement-implant interface with 2 femoral implant designs produced by a single manufacturer.

Methods: This is a review of failed primary total knee arthroplasties performed with Optetrak Logic and Truliant posterior-stabilized femoral components between 2010 and 2020. Cases with revision surgery performed for femoral component loosening were reviewed.

Results: Seventeen of 896 knees were revised for femoral component loosening. The mean time from index arthroplasty to revision was 73 months. Patients presented with knee pain and recurrent aseptic effusions. More than half of patients had no evidence of component loosening on plain radiographs. Bone scans were positive in 77% of patients with loosening. Femoral components were easily disimpacted from the cement mantle at the time of revision surgery. Patients were treated with femoral only revision or femoral and tibial revision. Two complications occurred in this series.

Conclusions: Providers should maintain vigilance in the surveillance of patients with these implants. Clinicians should have a low threshold for additional diagnostic testing if these patients develop pain and/or recurrent effusions. Isolated femoral or complete revision both seem to be acceptable treatment strategies for this failure mechanism.

Keywords: Exactech; Femoral aseptic loosening; Optetrak logic; Revision total knee arthroplasty; Truliant.

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Figures

Figure 1
Figure 1
AP and lateral radiographs of the knee with Exactech components.
Figure 2
Figure 2
Intraoperative photograph showing intact cement mantle after femoral component removal.
Figure 3
Figure 3
Photograph of the femoral component backside after extraction.
Figure 4
Figure 4
Photograph of the backside of the Truliant femoral implant after changes to the backside to increase roughness.
See this image and copyright information in PMC

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  • Fellows.
    Golladay GJ. Golladay GJ. Arthroplast Today. 2023 Aug 14;22:101210. doi: 10.1016/j.artd.2023.101210. eCollection 2023 Aug. Arthroplast Today. 2023. PMID: 37663069 Free PMC article. No abstract available.

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