Abstract
Introduction
Cementless total knee arthroplasty (TKA) has several advantages compared to the cemented approach, including elimination of bone cement, a quicker and easier surgical technique, and potentially a stronger long-term fixation. However, to ensure the successful long-term biological fixation between the porous implant and the bone, initial press-fit stability is of great importance. Undesired motion at the bone-implant interface may inhibit osseointegration and cause failure of biological fixation. Initial stability of a cementless femoral implant is affected by implant geometry, bone press-fit dimension, and characteristics of the porous coating.
The purpose of this study was to compare the initial fixation stability of two types of porous femoral implants by quantifying the pull-out force using a paired cadaveric study design.
Methods
The two types of cementless TKA femoral implants evaluated in this study had identical implant geometry but different porous coatings (Figure 1). The first type had a conventional spherical-bead coating (Type A), while the second type had an innovative irregularly-shaped-powder coating (Type B). The porous coating thickness was equivalent for both types of implants, thus the dimensional press-fit with bone was also equivalent. Three pairs of cadaveric femurs were prepared using standard TKA surgical technique, with each pair of the femurs receiving one of each porous implant type.
An Instron 3366 load frame (Norwood, MA, USA) was used to pull the femoral implant out from the distal femur bone (Figure 2). The testing fixture was designed to allow free rotation between the implant and the actuator. The pullout was performed under a displacement control scheme (5 mm/min). Peak pull-out force was recorded and compared between the two implant groups.
Results
Mean pull-out force for the Type B porous femoral implants (512 ± 246 N) was greater than that of the Type A porous femoral implants (310 ± 185 N), although the difference was not statistically significant (p>0.05) (Figure 3).
Discussion
This paired cadaveric study showed that the innovative Type B porous coating provides equivalent and potentially greater pull-out force than the conventional Type A porous coating. Lack of statistical significance could be attributed to the limited sample size. Although pull-out testing is not a physiological loading scenario for TKA implant, it provides a relevant assessment of the implant-bone press-fit stability.
With all other factors the same, the greater pull-out force observed in the Type B implants is likely related to the higher roughness and friction of the new porous coating. Previous experiments have shown that the Type B porous coating has significantly greater friction against Sawbones surface (coefficient of friction 0.89) compared to Type A porous coating (coefficient of friction 0.50), which was consistent with the findings in this study.
Greater initial fixation stability is more favorable in cementless TKA as it reduces the risk of interface motion and better facilitates long-term biological fixation.
