Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Ackerl, M.
Impact of Titanium nitride coating in TKA on the clinical outcome in allergic patients
Humanmedizin; [ Diplomarbeit/Master Thesis (UNI) ] Graz Medical University; 2018. pp.86.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leitner Lukas
- Sadoghi Patrick
- Altmetrics:
- Abstract:
- Background: Up to 20% of patients receiving total knee arthroplasty (TKA) complain about some degree of sustained knee pain. The impact of allergy reaction on the metal components is still controversial in this context. To address this difficulty in allergic patients titanium nitride coating (TNC), considered to have superior biocompatible properties, is available for some knee systems. Clinical impact of the theoretic concept of TNC in longtime follow-up is still discussed controversially and therefore the focus of our study was on clinical outcome with special interest on allergies and related chronic complaints. Material and Methods: In this retrospective observational study, the clinically approved low contact stress system (LCS) TKA with conventional cobalt-chromium-molybdenum alloy was compared to the advanced coated system (ACS) TKA, using the TNC-system. Allergic status and clinical scores, including Tegner activity scale, WOMAC-score, Knee Society Score Pain/Function (KSS), and the visual analogue scale (VAS) were measured before and 10 years after surgery. Additionally, specific information about subjective sensitivity to weather changes, as well as swelling and redness of the treated knee was included after surgery. Results: 260 patients (age: 65.95 ± 10.97) receiving LCS and 484 patients (age: 65.87 ± 8.35) receiving ACS were included, of which 19% had a documented allergy. The main follow-up was 11.92 ± 3.05 years. Rate of meteorosensitivity was significantly higher in allergic patients with ACS (ACS: 76.5%, LCS: 18.5%; p<0.001), which was also found for the total sample size. Postoperative clinical scores after 10 years revealed statistically significantly better results for overall population of LCS concerning VAS-score without clinical relevance (ACS: 1.95 ± 2.01, LCS: 1.42 ± 1.83; p=0.003). Among allergics VAS (ACS: 2.72 ± 2.51, LCS: 1.79 ± 1.88; p=0.031) and KSS function (ACS: 59.96 ± 23.5, LCS: 75.32 ± 21.94; p=0.003) showed significantly better results in the LCS group without clinical relevance either. Tegner activity scale (ACS: 2.78 ± 1.21, LCS: 2.18 ± 1.47; p<0.001) and KSS Pain (ACS: 83.21 ± 15.69, LCS: 70.82 ± 21.87; p<0.001) revealed better results for the ACS overall population, without reaching clinical relevance. KSS Pain among allergics was statistically superior in the ACS population (ACS: 78.82 ± 17.75, LCS: 69.23 ± 19.15; p=0.017) without clinical relevance. No significant differences were found for WOMAC-score, KSS Function (overall) and Tegner activity scale (allergics) between the two systems 10 years after operation. All statistically significant differences reached no value of clinical relevance comparing the two different knee systems. Discussion: The data revealed no clinically relevant difference in the outcome of ACS compared to LCS 10 years after operation for the overall group and allergic patients. Sensitivity to weather changes, an indicator for chronic local inflammatory reaction, was statistically found in correlation with ACS implants more often, but the difference is not considered to be clinically significant either. According to our findings, the concept of TNC reducing local reactivity could not be approved in longtime follow-up in the clinical setting.