{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:16:49Z","timestamp":1791825409011,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Radiostereometric analysis (RSA) is a highly accurate tool to detect implant migration and predict loosening following total knee arthroplasty (TKA). However, little is known about the predisposing risk factors for implant migration, nor which migration profile should be considered physiological (i.e., merely part of an implant-settling phase) and which should be considered pathological (i.e., having a high probability for implant loosening). By pooling individual participant data from long-term follow-up RSA studies, we aimed to identify predisposing risk factors for tibial component loosening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Individual data were collected for 630 patients from 11 RSA studies. The repeated measurements were analyzed with use of a linear mixed-effects model, determining the effect of age, sex, body mass index, diagnosis, preoperative and postoperative limb alignment, and prosthesis characteristics on tibial component migration over time, taking into account the clustering of patients within studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>High initial migration was found to result in early mechanical loosening in 18 cases (2.9%) and septic loosening in 2 cases (0.3%), whereas stabilization of high initial migration occurred in 17 cases (2.7%). Late loosening occurred in 13 cases (2.1%). All other 580 cases (92.1%) showed early stabilization and remained stable over time. Mixed-effects model analyses showed that for cemented prostheses, sex, diagnosis, and posterior cruciate ligament type had an effect on migration, but these differences were nonsignificant when analyzing migration from 3 months onwards. Uncemented prostheses aligned in varus showed more migration than neutrally and valgus-aligned TKAs (p = 0.031), and this difference increased over time (p &lt; 0.001). Significantly higher migration was observed following uncemented TKA without an osseointegration-promoting surface (p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>For cemented prostheses, increased migration during the first 3 postoperative months was observed for female patients, patients with rheumatoid arthritis, and patients who underwent a posterior-stabilized TKA. For uncemented prostheses, both postoperative varus alignment of the lower limb and the absence of an osseointegration-promoting surface significantly increased postoperative tibial component migration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.01454","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T23:22:00Z","timestamp":1619133720000},"page":"1115-1124","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":27,"title":["Risk Factors for Tibial Component Loosening"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6159-7689","authenticated-orcid":false,"given":"Koen T.","family":"van Hamersveld","sequence":"first","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1439-0989","authenticated-orcid":false,"given":"Perla J.","family":"Marang-van de Mheen","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-5401","authenticated-orcid":false,"given":"Roula","family":"Tsonaka","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-3408","authenticated-orcid":false,"given":"Kjell G.","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Surgical and Perioperative Sciences and Department of Orthopaedics, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5932-3128","authenticated-orcid":false,"given":"S\u00f6ren","family":"Toksvig-Larsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, H\u00e4ssleholm Hospital, H\u00e4ssleholm, Sweden"},{"name":"Department of Clinical Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1228-4162","authenticated-orcid":false,"given":"Rob G.H.H.","family":"Nelissen","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics (K.T.v.H. and R.G.H.H.N.) and Biomedical Data Sciences (P.J.M.-v.d.M. and R.T.), Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"issue":"4","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1080\/17453670510041574","article-title":"Guidelines for standardization of radiostereometry (RSA) of implants","volume":"76","author":"Valstar","year":"2005","journal-title":"Acta Orthop."},{"issue":"3","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1080\/17453674.2018.1443635","article-title":"RSA migration of total knee replacements","volume":"89","author":"Pijls","year":"2018","journal-title":"Acta Orthop."},{"issue":"3","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1302\/0301-620X.77B3.7744919","article-title":"Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses","volume":"77","author":"Ryd","year":"1995","journal-title":"J Bone Joint Surg Br."},{"issue":"Suppl 3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"62","DOI":"10.2106\/JBJS.K.00907","article-title":"RSA and registries: the quest for phased introduction of new implants","volume":"93","author":"Nelissen","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1097\/CORR.0000000000001209","article-title":"RSA-tested TKA implants on average have lower mean 10-year revision rates than non-RSA-tested designs","volume":"478","author":"Hasan","year":"2020","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1080\/17453674.2018.1562633","article-title":"Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties","volume":"90","author":"Laende","year":"2019","journal-title":"Acta Orthop."},{"issue":"12","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1302\/0301-620X.99B12.BJJ-2016-1118.R2","article-title":"Stable migration of peri-apatite-coated uncemented tibial components in a multicentre study","volume":"99-B","author":"Dunbar","year":"2017","journal-title":"Bone Joint J."},{"issue":"2","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1080\/17453674.2019.1566510","article-title":"Superior fixation and less periprosthetic stress-shielding of tibial components with a finned stem versus an I-beam block stem: a randomized RSA and DXA study with minimum 5 years\u2019 follow-up","volume":"90","author":"Stilling","year":"2019","journal-title":"Acta Orthop."},{"issue":"4","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1080\/17453674.2018.1464317","article-title":"Migration of all-polyethylene compared with metal-backed tibial components in cemented total knee arthroplasty","volume":"89","author":"Van Hamersveld","year":"2018","journal-title":"Acta Orthop."},{"issue":"6","key":"bib10-20250430","first-page":"2075","article-title":"Risk and treatment effect heterogeneity: re-analysis of individual participant data from 32 large clinical trials","volume":"45","author":"Kent","year":"2016","journal-title":"Int J Epidemiol."},{"key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"c221","DOI":"10.1136\/bmj.c221","article-title":"Meta-analysis of individual participant data: rationale, conduct, and reporting","volume":"340","author":"Riley","year":"2010","journal-title":"BMJ."},{"issue":"5","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1080\/17453674.2016.1205169","article-title":"Trabecular Metal tibial knee component still stable at 10 years","volume":"87","author":"Henricson","year":"2016","journal-title":"Acta Orthop."},{"issue":"4","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/17453674.2019.1605692","article-title":"Marker-based versus model-based radiostereometric analysis of total knee arthroplasty migration: a reanalysis with comparable mean outcomes despite distinct types of measurement error","volume":"90","author":"van Hamersveld","year":"2019","journal-title":"Acta Orthop."},{"issue":"4","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1080\/17453674.2018.1469223","article-title":"Peri-apatite coating decreases uncemented tibial component migration: long-term RSA results of a randomized controlled trial and limitations of short-term results","volume":"89","author":"Van Hamersveld","year":"2018","journal-title":"Acta Orthop."},{"key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1471-2288-12-35","article-title":"Alternative analyses for handling incomplete follow-up in the intention-to-treat analysis: the randomized controlled trial of balloon kyphoplasty versus non-surgical care for vertebral compression fracture (FREE)","volume":"12","author":"Ranstam","year":"2012","journal-title":"BMC Med Res Methodol."},{"issue":"6","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1080\/10543400903242795","article-title":"An overview of practical approaches for handling missing data in clinical trials","volume":"19","author":"DeSouza","year":"2009","journal-title":"J Biopharm Stat."},{"issue":"5","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"745","DOI":"10.2106\/00004623-198769050-00016","article-title":"Radiographic analysis of the axial alignment of the lower extremity","volume":"69","author":"Moreland","year":"1987","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1016\/j.arth.2017.02.032","article-title":"Low preoperative BMD is related to high migration of tibia components in uncemented TKA-92 patients in a combined DEXA and RSA study with 2-year follow-up","volume":"32","author":"Andersen","year":"2017","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1302\/0301-620X.87B4.15684","article-title":"Contact stress at the post-cam mechanism in posterior-stabilised total knee arthroplasty","volume":"87","author":"Nakayama","year":"2005","journal-title":"J Bone Joint Surg Br."},{"issue":"6","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1080\/17453674.2018.1518570","article-title":"Higher mid-term revision rates of posterior stabilized compared with cruciate retaining total knee arthroplasties: 133,841 cemented arthroplasties for osteoarthritis in the Netherlands in 2007-2016","volume":"89","author":"Spekenbrink-Spooren","year":"2018","journal-title":"Acta Orthop."},{"issue":"13","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.2106\/JBJS.18.00691","article-title":"The effect of coronal alignment on tibial component migration following total knee arthroplasty: a cohort study with long-term radiostereometric analysis results","volume":"101","author":"van Hamersveld","year":"2019","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1302\/0301-620X.97B10.36499","article-title":"Alignment and fixation in total knee arthroplasty: changing paradigms","volume":"97-B","author":"Oussedik","year":"2015","journal-title":"Bone Joint J."},{"issue":"12","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.2106\/JBJS.19.01010","article-title":"Cementless versus cemented tibial fixation in posterior stabilized total knee replacement: a randomized trial","volume":"102","author":"Nivbrant","year":"2020","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3109\/17453674.2012.665330","article-title":"The beneficial effect of hydroxyapatite lasts: a randomized radiostereometric trial comparing hydroxyapatite-coated, uncoated, and cemented tibial components for up to 16 years","volume":"83","author":"Pijls","year":"2012","journal-title":"Acta Orthop."},{"issue":"2","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3109\/17453674.2012.672092","article-title":"RSA prediction of high failure rate for the uncoated Interax TKA confirmed by meta-analysis","volume":"83","author":"Pijls","year":"2012","journal-title":"Acta Orthop."},{"key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/01.blo.0000224003.33260.74","article-title":"Uncemented HA-coated implant is the optimum fixation for TKA in the young patient","volume":"448","author":"Nilsson","year":"2006","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"864","DOI":"10.2106\/00004623-199274060-00007","article-title":"Osteolysis after total knee arthroplasty without cement","volume":"74","author":"Peters","year":"1992","journal-title":"J Bone Joint Surg Am."},{"key":"bib30-20250430","first-page":"173","article-title":"Screw osteolysis after cementless total knee replacement","volume":"321","author":"Lewis","year":"1995","journal-title":"Clin Orthop Relat Res."},{"issue":"19","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"e1411","DOI":"10.2106\/JBJS.L.01523","article-title":"Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study","volume":"95","author":"Nieuwenhuijse","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1302\/0301-620X.94B10.28858","article-title":"Differences in long-term fixation between mobile-bearing and fixed-bearing knee prostheses at ten to 12 years\u2019 follow-up: a single-blinded randomised controlled radiostereometric trial","volume":"94","author":"Pijls","year":"2012","journal-title":"J Bone Joint Surg Br."},{"issue":"11","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1302\/0301-620X.99B11.BJJ-2016-1347.R3","article-title":"Fixation and clinical outcome of uncemented peri-apatite-coated versus cemented total knee arthroplasty : five-year follow-up of a randomised controlled trial using radiostereometric analysis (RSA)","volume":"99-B","author":"van Hamersveld","year":"2017","journal-title":"Bone Joint J."},{"issue":"2","key":"bib34-20250430","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1080\/17453674.2018.1429108","article-title":"Migration and clinical outcome of mobile-bearing versus fixed-bearing single-radius total knee arthroplasty","volume":"89","author":"Van Hamersveld","year":"2018","journal-title":"Acta Orthop."},{"issue":"5","key":"bib35-20250430","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.knee.2014.05.012","article-title":"Similar early migration when comparing CR and PS in Triathlon\u2122 TKA: a prospective randomised RSA trial","volume":"21","author":"Molt","year":"2014","journal-title":"Knee."},{"issue":"12","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1302\/2046-3758.112.2000064","article-title":"Does a new knee design perform as well as the design it replaces?","volume":"1","author":"Molt","year":"2012","journal-title":"Bone Joint Res."},{"issue":"2","key":"bib37-20250430","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.knee.2013.10.008","article-title":"The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial","volume":"21","author":"Molt","year":"2014","journal-title":"Knee."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.01454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:46:40Z","timestamp":1787752000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.01454"}},"subtitle":["A Meta-Analysis of Long-Term Follow-up Radiostereometric Analysis Data"],"short-title":[],"issued":{"date-parts":[[2021,4,22]]},"references-count":35,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.01454","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,22]]}}}