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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 158 - 158
1 Sep 2012
Hennigar A Gross M Amirault D Laende E Dunbar MJ
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Purpose

To determine if minimally invasive surgery (MIS) for primary hip replacement surgery increases the risk of long term aseptic loosening as predicted by implant micromotion measured with radiostereometric analysis (RSA).

Method

Ninety patients undergoing primary THA for osteoarthritis (exclusion criteria: post-traumatic arthritis, rheumatoid arthritis, hip dysplasia, previous hip infection) were randomized to undergo THR surgery utilizing the standard direct lateral approach (n=45; 24 male; age=58 yrs; BMI=27) or MIS via a one-incision direct lateral approach using specific instrumentation (n=45; 23 male; age=55; BMI=29). Uncemented acetabular and femoral (ProfemurZ) components were used with ceramic on ceramic bearings. The femur was marked with 9 tantalum beads placed in the greater trochanter, lesser trochanter, and femoral shaft distal to the tip of the prosthesis. Post-operative care was be standardized according to the care maps at our institution. Primary outcome measure was femoral stem MTPM (maximum total point motion) measured using Model-based RSA. Stereo supine X-rays were taken before weight bearing and 3, 6, and 12 months postoperatively. At the same time intervals Harris Hip Score, Oxford-12, WOMAC, and SF36 questionnaires were administered. Rates of infection, dislocation and revision were recorded.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 186 - 186
1 Sep 2012
Fong J Dunbar MJ Wilson DA Hennigar A Francis P Glazebrook M
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Purpose

The purpose of this study was to assess the clinical outcomes over two years for total ankle arthroplasty (TAA) using Short Form-36, Foot Function Index and Ankle Osteoarthritis Scores, and to compare these with radiostereometric analysis longitudinal migration and inducible displacement results.

Method

Twenty patients undergoing TAA implanting the Mobility Total Ankle System (DePuy, Warsaw IN) were assessed at 3mth, 6mth, 1yr and 2yr followup periods by model-based radiostereometric analysis, MBRSA 3.2 (Medis specials, Leiden, The Netherlands), for longitudinal migration (LM) and inducible displacement (ID). The same subjects completed clinical outcome questionnaires at these followup periods for Short Form-36 (SF-36; Physical Component Scores (PCS) and Mental Component Scores (MCS)), Foot Function Index (FFI) and Ankle Osteoarthritis Scores (AOS). Descriptive statistics and Pearson correlations (alpha = 0.05) were calculated using Minitab 15 (Minitab Inc., State College PA).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 46 - 46
1 Sep 2012
Fong J Dunbar MJ Wilson DA Hennigar A Francis P Glazebrook M
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Purpose

The purpose of this study was to assess the biomechanical stability of the a total ankle arthroplasty system using longitudinal migration (LM) and inducible displacement (ID) measures. This study is the first study of its kind to assess total ankle arthroplasty (TAA) implant micromotion using model-based radiostereometric analysis (MBRSA).

Method

Twenty patients underwent TAA that implanted the Mobility(TM) (DePuy, Warsaw IN). The mean (SD) age was 60.4 (12.5) and BMI was 29.1 (2.8) kg/m2. One surgeon performed all surgeries. All patients included in this study had given informed consent. Capital Health Research Ethics Board had approved this study.

Uniplanar medial-lateral RSA X-ray exams were taken postop (double exam), at six wk, three mth, six mth, one yr and two yr followup times using a supine, unloaded position. Standing medial-lateral exams were taken at three mth, six mth, one yr and two yr followup intervals.

LM and ID micromotions were assessed using Model-based RSA 3.2 software (Medis specials, Leiden, The Netherlands). Implant micromotions (x, y, z, Rx, Ry, Rz, MTPM) were determined and assessed for each subject using model-based pose estimation, and the implant-based coordinate system. The Elementary Geometric Shapes module from the Model-based RSA 3.2 software was used to assess the micromotion of the tibial component spherical tip due to implant symmetry.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 49 - 49
1 Sep 2012
Konadu D Wilson JA Dunbar MJ Laende E Hennigar A Gross M
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Purpose

Aseptic loosening of the tibial component of total knee prosthesis is a common cause of revision surgery. While micromotion at the bone-implant interface can now be accurately measured with Radiostereometric Analysis (RSA), mechanisms responsible for loosening remain poorly understood. The purpose of this study was to investigate the association between bone density in the proximal tibia and post-operative knee implant migration.

Method

Fifty-one subjects who received total knee arthroplasty surgery with the Wright Medical Advance Biofoam (uncemented) implant were recruited. Bone density of seven regions of the proximal tibia (medial, lateral, anterior, posterior, and three regions below implant tip) was measured with DEXA post operatively at two, six, 12 and 24 weeks. RSA exams were also taken immediately post-operatively, and at six, 12 and 24 weeks. Correlations between bone mineral density and RSA migration were examined at 24 weeks post-operatively.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 89 - 89
1 Sep 2012
Amirault DJ Gross M Hennigar A Laende E Dunbar MJ
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Purpose

The foam metal backed Advance BioFoam Knee Arthroplasty components utilize a porous titanium coating on the underside of the tibial baseplate, intended to promote bone in-growth and provide a more robust bone-implant interface without cement. There is also a version of the Biofoam Advance that incorporates screwed fixation that allows for augmented fixation with up to four titanium screws; however, it is not clear that this augmentation is necessary. The purpose of this study was to employ radiostereometric analysis (RSA) to compare implant migration in a randomized controlled trial of this implant design with or without screw fixation.

Method

Fifty-one patients were randomized to receive a BioFoam total knee replacement (Wright Medical Technologies) with or without screw fixaiton. During surgery, eight tantalum markers, one millimetre in diameter, were inserted into the proximal tibia. Using a calibration box, stereo RSA radiographs were taken post-operatively and then again at six weeks and three, six and 12 months following surgery. Model Based RSA was used with 3D models of the tibial component to measure migration. Health status and functional outcome measures were recorded to quantify functional status of subjects before surgery and at each follow-up interval.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 93 - 93
1 Sep 2012
Wilson DA Dunbar MJ Richardson G Hennigar A
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Purpose

To evaluate the five year Radiostereometric Analysis (RSA) results of the NexGen LPS Trabecular Metal Tibial Monoblock component (TM) and the NexGen Option Stemmed cemented component (Cemented), (Zimmer, Warsaw IN).

Method

70 patients with osteoarthritis were included in a randomized series to receive either the TM implant or the cemented NG component. Surgery was performed by high volume arthoplasty specialists using standardized procedure. RSA exams were obtained postoperatively, at six months, one year, two years and five years. RSA outcomes were translations, rotations and maximum total point motion (MTPM) of the components. MTPM values were used to classify implants as ‘at risk’ or ‘stable’. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were gathered at all follow-ups.

An analysis of variance was used to test for differences in age, body mass index (BMI), and subjective measures between implant groups. The Kruskal-Wallis test was used to investigate differences in maximum total point motion between implant groups. An analysis of variance was used to test for differences in translations and rotations between groups. Fishers exact test was used to investigate differences in proportions of implants found to be at risk between groups.