Predictors of early aseptic loosening of prosthetic components following primary total knee arthroplasty
- Authors: Gurazhev M.B.1, Lukinov V.L.1, Baitov V.S.1, Gofer A.S.1, Ivanov E.A.1, Pavlov V.V.1, Korytkin A.A.1, Pronskikh A.A.1
-
Affiliations:
- Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
- Issue: Vol 31, No 3 (2025)
- Pages: 35-49
- Section: СLINICAL STUDIES
- URL: https://journals.rcsi.science/2311-2905/article/view/326959
- DOI: https://doi.org/10.17816/2311-2905-17595
- ID: 326959
Cite item
Abstract
Background. Aseptic loosening of the knee prosthesis components is one of the most common causes of revision surgery. The acceptable range of angular values for postoperative alignment of the lower limb and the frontal positioning of the prosthetic components remains a subject of debate.
The aim of the study — to identify the predictors of the early aseptic loosening of prosthetic components following primary total knee arthroplasty.
Methods. The study group included 31 patients with aseptic loosening of prosthetic components. The comparison group consisted of 55 patients with no signs of loosening over a follow-up period of at least 8 years. Baseline characteristics (sex, age, body mass index, and operated side) were compared, along with preoperative and postoperative angular alignment of the lower limbs, specifically, the anatomical femorotibial angle (aFTA) and the hip-knee-ankle angle (HKA), as well as reference angles for prosthetic component positioning.
Results. Patient age over 60.5 years and BMI over 27.5 were associated with a 2.9-fold and 2.6-fold increased risk of prosthetic loosening, respectively. Preoperative varus deformity, with an HKA angle exceeding 9.5° and an aFTA over 6.5°, increased the risk of loosening by 9.6 and 23.1 times, respectively. Postoperative residual deformity exceeding 0.5° in either direction, as measured by the aFTA, increased the risk of loosening by 8.7 times. Valgus positioning of the tibial component was associated with a 2.8-fold increased risk of component loosening.
Conclusions. In elderly and overweight patients with pronounced varus deformity of the lower limb, personalized preoperative planning should be prioritized to prevent early aseptic loosening of prosthetic components. In cases where postoperative residual deformity or valgus positioning of the tibial component is detected, enhanced clinical follow-up with radiographic monitoring every 6 months is recommended. If radiolucent lines progress and pain is present, early consideration of revision surgery is advisable, as it may increase the likelihood of a successful conservative revision.
Full Text
##article.viewOnOriginalSite##About the authors
Mikhail B. Gurazhev
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: Tashtagol@inbox.ru
ORCID iD: 0000-0002-6398-9413
Russian Federation, Novosibirsk
Vitaliy L. Lukinov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: vitaliy.lukinov@gmail.com
ORCID iD: 0000-0002-3411-508X
Cand. Sci. (Phys.-Math.)
Russian Federation, NovosibirskVladislav S. Baitov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: VBaitov@list.ru
ORCID iD: 0000-0002-9427-7072
Cand. Sci. (Med.)
Russian Federation, NovosibirskAnton S. Gofer
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: a.hofer.ortho@gmail.com
ORCID iD: 0009-0000-3886-163X
Russian Federation, Novosibirsk
Evgeniy A. Ivanov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: Ivanov.evgeniy90@bk.ru
ORCID iD: 0009-0007-8429-282X
Russian Federation, Novosibirsk
Vitaliy V. Pavlov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: pavlovdoc@mail.ru
ORCID iD: 0000-0002-8997-7330
Dr. Sci. (Med.), Associate Professor
Russian Federation, NovosibirskAndrey A. Korytkin
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: andrey.korytkin@gmail.com
ORCID iD: 0000-0001-9231-5891
Cand. Sci. (Med.)
Russian Federation, NovosibirskAleksandr A. Pronskikh
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics
Email: proal_88@mail.ru
ORCID iD: 0000-0003-1197-556X
Scopus Author ID: 6503950260
Dr. Sci. (Med.)
Russian Federation, NovosibirskReferences
- Klit J., Jacobsen S., Rosenlund S., Sonne-Holm S., Troelsen A. Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J Arthroplasty. 2014;29(5):912-917. https:// doi.org/10.1016/j.arth.2013.09.035.
- Dong Z., Li Y., Wang X., Tian H. A Case of TKA Failure in Patient with Primary Hyperparathyroidism. Orthop Surg. 2023;15(11):3006-3011. https:// doi.org/10.1111/os.13892.
- Khan M., Osman K., Green G., Haddad F.S. The epidemio-logy of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J. 2016;98-B(1 Suppl A):105-112. https://doi.org/10.1302/0301-620X.98B1.36293.
- Мурылев В.Ю., Усубалиев Б.Т., Музыченков А.В., Куковенко Г.А., Елизаров П.М., Корешкова Д.А. Остеопороз и асептическое расшатывание компонентов эндопротеза после эндопротезирования суставов. Кафедра травматологии и ортопедии. 2022;41(4):67-73. https:// doi.org/10.17238/2226-2016-2022-4-67-73. Murylev V.Y., Usubaliev B.T., Muzichenkov A.V., Kukovenko G.A., Elizarov P.M., Germanov V.G. et al. Osteoporosis and aseptic loosening of endoprosthesis components after joint replacement. Department of Traumatology and Orthopedics. 2022;41(4):67-73. (In Russian). https:// doi.org/10.17238/2226-2016-2022-4-67-73.
- Laskin R.S., Beksaç B. Computer-assisted navigation in TKA: where we are and where we are going. Clin Orthop Relat Res. 2006;452:127-131. https:// doi.org/10.1097/01.blo.0000238823.78895.dc.
- Omichi Y., Hamada D., Wada K., Tamaki Y., Shigekiyo S., Sairyo K. Robotic-assisted total knee arthroplasty improved component alignment in the coronal plane compared with navigation-assisted total knee arthroplasty: a comparative study. J Robot Surg. 2023;17(6):2831-2839. https:// doi.org/10.1007/s11701-023-01708-6.
- Kim Y.H., Park J.W., Kim J.S., Park S.D. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2014;38(2):379-385. https://doi.org/10.1007/s00264-013-2097-9.
- MacDessi S.J., Griffiths-Jones W., Harris I.A., Bellemans J., Chen D.B. Coronal Plane Alignment of the Knee (CPAK) classification. Bone Joint J. 2021;103-B(2):329-337. https:// doi.org/10.1302/0301-620X.103B2.BJJ-2020-1050.R1.
- Abdel M.P., Oussedik S., Parratte S., Lustig S., Haddad F.S. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J. 2014;96-B(7):857-862. https://doi.org/10.1302/0301-620X.96B7.33946.
- Matassi F., Pettinari F., Frasconà F., Innocenti M., Civinini R. Coronal alignment in total knee arthroplasty: a review. J Orthop Traumatol. 2023;24(1):24. https:// doi.org/10.1186/s10195-023-00702-w.
- von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808. https://doi.org/10.1136/bmj.39335.541782.AD.
- Paley D., Pfeil J. Principles of deformity correction around the knee. Orthopade. 2000;29(1):18-38. (In German). https://doi.org/10.1007/s001320050004.
- Ewald F.C. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;(248):9-12.
- Kim Y.H., Park J.W., Kim J.S., Park S.D. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2014;38(2):379-385. https://doi.org/10.1007/s00264-013-2097-9.
- Lee B.S., Cho H.I., Bin S.I., Kim J.M., Jo B.K. Femoral Component Varus Malposition is Associated with Tibial Aseptic Loosening After TKA. Clin Orthop Relat Res. 2018;476(2):400-407. https:// doi.org/10.1007/s11999.0000000000000012.
- Miralles-Muñoz F.A., Rubio-Morales M., Bello-Tejada L., González-Parreño S., Lizaur-Utrilla A., Alonso-Montero C. Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2768-2775. https://doi.org/10.1007/s00167-021-06627-3.
- Rivière C., Iranpour F., Auvinet E., Howell S., Vendittoli P.A., Cobb J. et al. Alignment options for total knee arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2017;103(7):1047-1056. https:// doi.org/10.1016/j.otsr.2017.07.010.
Supplementary files
