DOS Afhandlingsdatabase
Titel på arbejdet | Cemented and uncemented trabecular metal total knee arthroplasty with asymmetrical tibial design. Comparison using model-based radiostereometric analysis, dual-energy x-ray absorptiometry, and computed tomography. |
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Navn | Müjgan Yilmaz |
Årstal | 2023 |
Afdeling / Sted | Rigshospitalet |
Universitet | Københavns universitet |
Subspeciale |
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Abstract / Summary | This thesis aims to evaluate the relatively newly introduced TKA. The fully cemented, uncemented, and hybrid fixated implants were evaluated with MBRSA measurements to determine the risk of aseptic loosening, DEXA measurements to determine the adaptive bone remodeling close to the implants, and CT scans to estimate the positioning of the tibial implants. TKA is today a very successful treatment with an implant survival of >90% after 10 years. Despite high implant survival TKA surgery tends to have a lower patient satisfaction when compared with other orthopedic procedures, with patient satisfaction of around 80%. The dissatisfaction is found to be multifactorial of which approximately 20% complain of persistent postoperative pain. When introducing new orthopedic implants for clinical use a phased instruction as described by Malchau is recommended. Migration studies are the first step to assessing the risk of aseptic loosening. Through this thesis, four different studies will be presented. Study I is a prospective study of the hybrid fixated TKA. We found acceptable values of migration for both the uncemented femoral implant as well as the cemented tibial implant although these were marginally higher. Study II was a randomized controlled trial comparing migration values of the fully cemented TKA components with the uncemented fixation. We did not find any significant difference between the two fixation types in the tibial implants. However, we did find a significant difference between the femoral implants although not reaching clinical relevance. For both the femoral and tibial implants and for both fixations types acceptable migration values were reported. In conclusion, the studies in this thesis assessed the risk of aseptic loosening in the femoral and tibial implants regardless of fixation mode and found a low risk of aseptic loosening, why the implants can be used in clinical settings. Positioning of the implant regarding coverage and rotation was acceptable. Longer follow-up is recommended to evaluate if the observed decrease in BMD will have any clinical implications long-term. |
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