Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study

Kılıçarslan, Kasım; Şahin, Ali; Alkan, Hilmi; Firat, Ahmet; Veizi, Enejd; subaşı, özay

doi:10.14744/scie.2022.09327

Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study

Enejd VEİZİ, (Ankara Şehir Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

özay subaşı, (Erzincan Bin ali Yıldırım Üniversitesi, Mengücek Gazi Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Erzincan, Türkiye)

Ali ŞAHİN, (Ankara Şehir Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Hilmi ALKAN, (Ankara Şehir Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Ahmet FIRAT, (Ankara Şehir Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Kasım KILIÇARSLAN (Ankara Şehir Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Southern Clinics of Istanbul Eurasia

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Yıl: 2022 Cilt: 33 Sayı: 4 Sayfa Aralığı: 351 - 359 Metin Dili: İngilizce DOI: 10.14744/scie.2022.09327 İndeks Tarihi: 16-05-2023

Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study

Öz:

Objective: Unicondylar knee arthroplasty (UKA) is a surgical procedure primarily used for the resurfacing of the medial compartment and many studies have previously analyzed the changes taking place on the surrounding osseous tissues after the procedure. The purpose of this study is to investigate the effects of bone strain in the medial tibial metaphysis after a cementless unicondylar replacement. Methods: Patients treated with a cementless UKA between March 2015 and March 2019 was selected for this study. Inclusion criteria were a minimum of 1 and a maximum of 2 years follow-up and presence of standard radiographs of the operated knee at yearly intervals. A total of 109 patients were included in the study. Two lines at a distance of 5 and 7 cm from the lateral tibial eminence were horizontally drawn and the medial cortical thickness and the total cortical distance were measured. A cortex-to-metaphysis (CTM) ratio was estab- lished. The increase of density in the metaphysis was analyzed though the “reactive triangle” phenomenon. We initially hypothesized that some degree of increase in sclerosis would be detected in the medial tibial metaphysis and that the increase would be greater in patients with an implant underhanging, since more cancellous bone would come under strain. Results: The CTM ratio showed a decreasing pattern during the 1st post-operative year for all measured levels. An increase in density at the metaphyseal area just below the keel was observed in 58% of patients during the 1 st post-operative year and in 80% during the 2 nd year. The increase in the density was correlated with the absence of coronal overhanging. Patients with coronal overhanging of the tibial implant showed an increase in CTM ratio. Conclusion: Increased strain after a unicondylar procedure leads to cortical and cancellous bone changes in the proximal tibial metaphysis. These changes depend on the presence or absence of coronal overhanging.

Anahtar Kelime:

Çimentosuz Unikondiler Diz Artroplastisi Sonrası Proksimal Tibial Korteksin Kalınlaşma Paterni; Radyolojik Bir Çalışma

Öz:

Amaç: Unikondiler diz artroplastisi (UDA) öncelikle medial kompartmanın yüzey değişimi için kullanılır ve orta-uzun vadeli sonuçlar umut vericidir. Daha önce birçok çalışmada tibial komponentin etrafındaki kemik dokularda meydana gelen değişiklikler analiz edilmiştir ve bu de- ğişikliklerin, bölgesel olarak artan strese bağlı olduğu bildirilmiştir. Bu çalışmanın amacı, çimentosuz UDA sonrası tibia metafizinin medialinde kemiğin yeniden şekillenme paternini araştırmaktır. Gereç ve Yöntem: Bu geriye dönük çalışma Mart 2015 ile Mart 2019 arasında çimentosuz UDA ile tedavi edilen hastalarımız ile yürütüldü. Dahil edilme kriterleri, en az bir olmak üzere, en fazla iki yıl takipli ve yıllık standart ayakta çekilen direkt radyografilerinin mevcut olmasıydı. Toplam 109 hasta dahil edildi. Lateral tibial eminentia’nın 5 ve 7cm aşağısında iki adet horizontal seviye belirlendi. Bu seviyelerde total metafi- zier kalınlık ve medial korteks kalınlıkları ölçüldü. Korteks-metafiz oranı (KM) belirlendi ve ölçüm için seri radyografiler kullanıldı. Metafizdeki fokal sklerotik odakların varlığı ‘reaktif üçgen’ fenomeni olarak değerlendirildi. Hipotezimiz, tüm hastalarda belirli bir düzeye kadar sklerotik değişikliklerin meydana geleceği ve bu değişikliklerin küçük boyuttaki tibial komponentlerde daha fazla olacağı yönündeydi. Bulgular: KM oranı, ölçülen tüm seviyeler için ameliyat sonrası ilk yıl boyunca azalan bir patern gösterdi. Ameliyat sonrası birinci yılda has- taların %58’inde, ikinci yılda ise %80’inde tibial komponentin (keel) hemen altındaki metafiz alanında yoğunluk artışı gözlemlendi. Bu yoğunluk artışı grafiye fokal sklerotik bir alan olarak yansıdı ve koronal planda implant taşmaması ile ilişkilendirildi. Tibial komponentin görece büyük olduğu hastalarda KM oranında artış görüldü. Sonuç: Unikondiler diz artroplastisi prosedüründen sonra artan kemikteki gerilim stresi, proksimal tibial metafizde kortikal ve kansellöz kemik değişikliklerine yol açar. Bu değişiklikler koronal planda tibial komponentin taşmamasıyla ilişkilidir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Veizi E, subaşı ö, Şahin A, Alkan H, Firat A, Kılıçarslan K (2022). Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. , 351 - 359. 10.14744/scie.2022.09327
Chicago	Veizi Enejd,subaşı özay,Şahin Ali,Alkan Hilmi,Firat Ahmet,Kılıçarslan Kasım Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. (2022): 351 - 359. 10.14744/scie.2022.09327
MLA	Veizi Enejd,subaşı özay,Şahin Ali,Alkan Hilmi,Firat Ahmet,Kılıçarslan Kasım Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. , 2022, ss.351 - 359. 10.14744/scie.2022.09327
AMA	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. . 2022; 351 - 359. 10.14744/scie.2022.09327
Vancouver	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. . 2022; 351 - 359. 10.14744/scie.2022.09327
IEEE	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K "Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study." , ss.351 - 359, 2022. 10.14744/scie.2022.09327
ISNAD	Veizi, Enejd vd. "Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study". (2022), 351-359. https://doi.org/10.14744/scie.2022.09327

APA	Veizi E, subaşı ö, Şahin A, Alkan H, Firat A, Kılıçarslan K (2022). Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. Southern Clinics of Istanbul Eurasia, 33(4), 351 - 359. 10.14744/scie.2022.09327
Chicago	Veizi Enejd,subaşı özay,Şahin Ali,Alkan Hilmi,Firat Ahmet,Kılıçarslan Kasım Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. Southern Clinics of Istanbul Eurasia 33, no.4 (2022): 351 - 359. 10.14744/scie.2022.09327
MLA	Veizi Enejd,subaşı özay,Şahin Ali,Alkan Hilmi,Firat Ahmet,Kılıçarslan Kasım Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. Southern Clinics of Istanbul Eurasia, vol.33, no.4, 2022, ss.351 - 359. 10.14744/scie.2022.09327
AMA	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. Southern Clinics of Istanbul Eurasia. 2022; 33(4): 351 - 359. 10.14744/scie.2022.09327
Vancouver	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study. Southern Clinics of Istanbul Eurasia. 2022; 33(4): 351 - 359. 10.14744/scie.2022.09327
IEEE	Veizi E,subaşı ö,Şahin A,Alkan H,Firat A,Kılıçarslan K "Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study." Southern Clinics of Istanbul Eurasia, 33, ss.351 - 359, 2022. 10.14744/scie.2022.09327
ISNAD	Veizi, Enejd vd. "Remodeling Pattern of the Medial Tibial Metaphysis after a Cementless Unicondylar Knee Replacement; a Radiological Study". Southern Clinics of Istanbul Eurasia 33/4 (2022), 351-359. https://doi.org/10.14744/scie.2022.09327