We know that tibial components are the most vulnerable to loosening. We know that infection always needs to be excluded. We know that the problem is multifactorial and involves surgical, implant and patient factors. However, what should we do to minimise the risk of aseptic, tibial component loosening ?
Any other major changes in the body like other diseases: thyroid, diebetes, blood pressure and the side effects their medicines or gaining or losing too much weight are like to change the metabolism of bone. Initial knee replacement was designed for the biomechanics at that time. As architecture and topography changes at micro level, the contact between non-living bone (replaced knee) and rest of natural tibia and femoral bones, may be causing loosening of knee.
This may help; Sis potential etiological factors may be related to tibial component loosening;
flexion/extension gap mismatch, component malposition, isolated ligament insufficiency, extensor mechanism insufficiency, component loosening, and global instability.
Song et al. The Journal of Arthroplasty
Volume 29, Issue 2, February 2014, Pages 360-364
I have the impression that this aseptic loosening of the tibial component is due to the poor quality of the underlying bone
https://www.orthobullets.com/recon/12754/tka-aseptic-loosening
TKA Aseptic Loosening
Dear Alister J. Hart. Maybe the answer will show bizarre. However, I recommend disconnect from a mechanistic approach, and clear and standard answers might get from experts in the field. Even assuming that all the answers are correct, they are the result and not the reason. The fact that all the knowledge accumulated over many years does not allow the problem to be resolved. Only to open our mind can we understand that nature is stronger than any straight engineering solution that is detached from the laws of nature. Recently I introduced a new fractal wrist biomechanics theory at the IFSSH conference in Berlin. In my opinion, the biomechanics of almost all joints can be explained based on fractal theory. So it will be possible to understand why abnormal spreading of the energy causes loosening or more correctly damaging the bone-to-implant area. If this interests you, I can try to explain my points about knee joint because to this day I have not found any other logical explanation for the cause (reasons, not results) of the loosening of the implants.
Interesting aspect to consider, Dr Gorelick. The fractal theory aspects of the bone/ implant interface would add another level of understanding to the surgical factors, patient comorbidities, bone quality and implant characteristics. Thank you.
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