Aseptic loosening, periprosthetic joint infection are two major complications of hip and knee arthroplasty. In this article, we will try to show you how saw blades can cause these complications.
Aseptic loosening is defined as the failure of integration between a prosthesis and bone in the absence of infection. The most common revision cause of total knee arthroplasty is aseptic loosening.
Sharkey et al. (2013) emphasized that aseptic loosening was the most common cause in 39.9% of all total knee arthroplasty revisions. Michael Pita et al. examined 18,065 total knee arthroplasties between 2007 and 2012 in New York in 2017 and found that 21.2% was caused by aseptic loosening. A study conducted in Sweden showed that aseptic loosening was the most common complication after knee arthroplasty and it’s generating for about 44% of total knee revisions. (Robertsson O. et al., 2001) Lombardi Jr et al. (2014) found that 31.2% of 844 total knee arthroplasty revisions in Brazil were due to aseptic loosening.
A surgical failure in a bone shaping procedure with saw blade can result in aseptic loosening. We can collect these surgical failures under 2 main headings;
Cause: Misalignment of the cutting guide
Solution:
Cause: Insufficient fixation of the cutting guide
Solution:
Cause: Dislocation of the cutting guide which is fixed enough, due to vibrations of cutting guide while the surgical power tools are used.
Solution:
Cause: Saw blade teeth are not sharp and durable enough.
Solution:
Cause: Wrong saw blade thickness selection.
Solution:
Cause: The saw blade teeth are not sharp and durable enough and correspondingly the cutting process time is prolonged.
Solution:
Cause: Inadequate surgical power tools oscillation rate and correspondingly lengthening of the cutting process.
Solution:
Cause: In the cutting process with surgical power tools, the surgeon does not apply enough force and correspondingly the cutting process time is prolonged.
Solution:
Click here to learn how to choose a saw blade.
Periprosthetic joint infection is another major complication that can be caused by surgical saw blades after aseptic loosening. In 2014, guests of Ceranews magazine (Issue 1) Dr. Andrej Trampuz and Dr. Olivier Borens explained the consequences of joint infection after arthroplasty as follows: “Prosthesis infections often mean severe loss of quality of life for the patient, chronic pain, immobility and two additional surgeries generally associated with bone, muscle and soft tissue loss. It is necessary to add hospitalization, which usually take a few weeks or even months to this.”
In order to avoid the risk of bio-incompatible materials that may cause infection, including surgical saw blades which contact with the bone, the following should be considered;
Cause: The saw blade is not biocompatible.
Solution:
Cause: Other equipment and materials (Implant, bone cement, instrument sets, etc.) not being biocompatible.
Solution:
Cause: Falling the bio-incompatible metal powders into the cutting area as a result of too much contact between the saw blade and bio-incompatible cutting guide.
Solution:
Click here to find more articles about prosthetic joint infection via PubMed website.
Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing todaydhas anything changed after 10 years?. J Arthroplasty 2013;29:1774e8.
Pitta M, Esposito CI, Li Z, Lee Y-y, Wright TM, Padgett DE, Failure After Modern Total Knee Arthroplasty: A Prospective Study of 18,065 Knees, The Journal of Arthroplasty (2017), doi: 10.1016/j.arth.2017.09.041.
Robertsson O, et al. The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997. Acta Orthop Scand. 2001;72(5):503e513.
Lombardi Jr A, Berend K, Adams J.. Why knee replacements fail in 2013: Patient, surgeon, or implant? Bone Joint J 2014; 96(11SuppleA): 101–4.
Doç. Dr. Andrej Trampuz ve Prof. Dr. Olivier Borens. 2014. Periprostetik Eklem Enfeksiyonu – Konuk Yorumu. Ceranews Sayı 1/2014 Ortopedik Durum Bilgileri Dergisi. Almanya. www.ceranews.de
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