Citation for published version (APA): Gerritsma-Bleeker, C. L. E. (2005). Long-term follow-up of the SKI knee prosthesis s.n.

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1 University of Groningen Long-term follow-up of the SKI knee prosthesis Gerritsma-Bleeker, Catharina Louise Emilie IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2005 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Gerritsma-Bleeker, C. L. E. (2005). Long-term follow-up of the SKI knee prosthesis s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:

2

3 Long-term Follow-up of the SKI Knee Prosthesis C.L.E. Gerritsma-Bleeker

4 CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG Gerritsma, C.L.E. Long-term Follow-up of the SKI Knee Prosthesis Proefschrift Groningen. - Met lit. opg. - Met samenvatting in het Nederlands. ISBN Copyright 2005 C.L.E. Gerritsma All rights are reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanically, by photocopying, recording, or otherwise, without the written permission of the author. Layout: Kader Desktop Publishing, Zuidlaren NL Printed by: Drukkerij De Regenboog, Groningen NL

5 RIJKSUNIVERSITEIT GRONINGEN Long-term Follow-up of the SKI Knee Prosthesis Proefschrift ter verkrijging van het doctoraat in de Medische Wetenschappen aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus, dr. F. Zwarts, in het openbaar te verdedigen op woensdag 9 februari 2005 om uur door Catharina Louise Emilie Gerritsma-Bleeker geboren op 22 september 1968 te Groningen

6 Promotores: Copromotor: Beoordelingscommissie: Prof. Dr. J.R. van Horn Prof. Dr. R.L. Diercks Dr. N.J.A. Tulp Prof. Dr. H.J. Grootenboer Prof. Dr. J.W. Groothoff Prof. Dr. M.H. van Rijswijk

7 Paranimfen: Dr. D. Eygendaal Dr. H. van de Belt Financial support for the publication of this thesis is gratefully acknowledged: Biomet Nederland BV Stichting Anna-Fonds te Leiden Bauerfeind Benelux B.V. Brink Orthopedie BV DePuy, a Johnson & Johnson Company ID medical b.v. Endocare B.V. Endo Plus B.V. GlaxoSmithKline Janssen-Cilag B.V. Martini Ziekenhuis Mathys Orthopaedics bv Nederlandse Orthopaedische Vereniging Noordelijk Centrum voor Gezondheidsvraagstukken Reumafonds RX medical b.v. Smith & Nephew Sprofit bvba Stryker Nederland BV Zimmer Netherlands B.V.

8 The best of prophets of the future is the past. Lord George Byron Aan mijn ouders, Marco, Floor en Nynke.

9 Contents CHAPTER 1: HISTORY AND DESIGN OF THE TOTAL KNEE PROSTHESIS Resection arthroplasy and early designs of total knee prosthesis The modern era of knee arthroplasty Hinged prostheses Meniscal bearing and rotating platform knees Total condylar type prostheses General design criteria for knee prostheses Design of the femoral component Design of the tibial component Design of the patellar component Fixation Design of the SKI prosthesis The operation procedure at Groningen University Hospital Locking of the screw CHAPTER 2: STUDY POPULATION AND AIMS OF THE STUDY Study population Aims of the study CHAPTER 3: SURVIVAL AND COMPLICATIONS Introduction Material and methods Patients Revisions and survival analysis Complications Statistical analysis Results Revisions Survival analysis Survival of the SKI prosthesis after exchange of the polyethylene Complications Complications related to the prosthesis or knee Complications not related to the prosthesis Wound problems and superficial infection Deep infection Manipulation of the knee under anesthesia Screw loosening Wear Aseptic loosening of the prosthesis Discussion Conclusions CHAPTER 4: CLINICAL PERFORMANCE OF THE SKI PROSTHESIS Introduction Material and methods Scoring systems Statistical analysis Results Knee Score Pain Pain Score VAS Score Anterior knee pain... 82

10 4.3.3 Range of motion Flexion Flexion contractures Stability and alignment Function Score Total Score Scores in patients with degenerative arthritis and rheumatoid arthritis Scores before and after polyethylene exchange Discussion Conclusions CHAPTER 5: RADIOGRAPHIC EXAMINATION: ALIGNMENT AND WEAR Introduction Technique of radiographic examination Reliability of the radiographic measurements Determination of the original thickness of the polyethylene insert Radiographic measurement of the thickness of the polyethylene insert Determination of the intraclass correlation coefficient Discussion Conclusions Short or full-length leg radiographs? Results Discussion Conclusions Wear and wear rate Materials and methods Patient characteristics Determining the amount of wear and wear rate Statistical analysis Results Presence of wear Wear rate Discussion Conclusions Wear and alignment of the prosthesis Material and Methods Patient characteristics Alignment of the prosthesis Statistical analysis Results Angle a Angle b Angle g Angle s Discussion Conclusions Wear and alignment of the limb Materials and methods Patient characteristics Alignment of the limb Statistical analysis Results Femoro-tibial angle Weight Bearing Ratio Discussion Conclusions

11 CHAPTER 6: RADIOGRAPHIC EXAMINATION: THE EVALUATION OF RADIOLUCENCY Introduction Material and methods Patients Measurement of radiolucency Scoring system Statistical analysis Results Prostheses without clinical signs of loosening Radiolucency around the femoral component Radiolucency around the tibial component (anteroposterior view) Radiolucency around the tibial component (lateral view) Radiolucency around the patellar component Anterior knee pain, radiolucency and osteophytes Radiolucency around the total prosthesis Factors that may influence the amount of radiolucency Factors that may influence the increase of radiolucency Prostheses with clinical signs of loosening Radiolucency around the femoral component Radiolucency around the tibial component (anteroposterior view) Radiolucency around the tibial component (lateral view) Radiolucency around the total prosthesis Discussion Conclusions CHAPTER 7: RETRIEVAL STUDY Introduction Material and methods Patient characteristics Wear rate Modes of damage Location of wear Severity of wear Marks of the screw Backside wear Analysis of the metal tibial baseplates and the femoral components Statistical analysis Results Analysis of retrieved polyethylene inserts Wear rate Modes of damage, severity and location Burnishing Scratching Pitting Surface deformation Delamination Abrasion Bone-Cement debris Total Score for each section Wear and primary diagnosis Wear and body weight Wear and service life Marks of the screw Wear and screw loosening Backside wear

12 7.4.2 Analysis of retrieved metal tibial baseplates Analysis of retrieved femoral components Discussion Conclusions CHAPTER 8: GENERAL OVERVIEW OF RESULTS AND CONCLUSIONS Long-term survival and clinical performance of the SKI prosthesis Complications Screw loosening: incidence, factors contributing to it and consequences Survival and clinical performance after polyethylene exchange Determining the amount of wear in vivo Wear characteristics and factors contributing to wear Determining alignment on a short radiograph Alignment of the prosthesis and the leg Alignment of the prosthesis and wear Radiographic long-term results Lessons we can learn from the SKI prosthesis SUMMARY SAMENVATTING REFERENCES APPENDICES PREVIOUS DISSERTATIONS PUBLIC HEALTH AND PUBLIC HEALTH SERVICES RESEARCH DANKWOORD CURRICULUM VITAE

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