{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:56Z","timestamp":1753893296413,"version":"3.41.2"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Total knee arthroplasty (TKA) is now frequently performed and is highly successful. However, patient satisfaction after TKA is often difficult to achieve. Because of the presence of metallic prosthetic knee joints, there is a lack of imaging tools that can accurately assess the patient's postoperative prosthetic position, soft tissue impingement, and periprosthetic bone density after TKA. We conducted a clinical trial of the world's first totally modular polyetheretherketone (PEEK) TKA and determined the bone density values in the stress concentration area around the prosthesis based on postoperative computed tomography data to reconstruct a three-dimensional model of the PEEK prosthetic knee joint after implantation. Based on the model, the overhang of the prosthesis was measured at various locations on the prosthesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients who underwent PEEK-based TKA were postoperatively assessed with radiography and computed tomography (CT). Hounsfield units (HUs) for the different components of the quantitative CT assessment were measured separately.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten patients (nine female and one male) aged 59\u201374 (mean 66.9, median 67) years were included. The HU values were as follows: PEEK prosthesis mean 182.95, standard deviation (SD) 4.90, coefficient of variation (CV) 2.68; polyethylene mean \u221289.41, SD 4.14, CV \u22124.63; lateral femoral osteochondral mean 192.19, SD 55.05, CV 28.64; lateral tibial osteochondral mean 122.94, SD 62.14, CV 42.86; medial femoral osteophyte mean 180.76, SD 43.48, CV 24.05; and medial tibial osteophyte mean 282.59, SD 69.28, CV 24.52. Analysis of the data at 1, 3, and 6 months showed that the mean PE (<jats:italic>p<\/jats:italic> = 0.598) and PEEK (<jats:italic>p<\/jats:italic> = 0.916) measurements did not change with the time of measurement. There was a decrease in bone mineral density in the lateral tibia at 3 months (<jats:italic>p<\/jats:italic> = 0.044). Otherwise, there was no significant change in bone density in other regions (<jats:italic>p<\/jats:italic> = 0.124\u20130.803). There was no overhang in all femoral prostheses, whereas there were two cases of overhang in tibial prostheses. Overhang measurements do not differ significantly across time points. The overhang measurements were not significantly different at all time points (<jats:italic>p<\/jats:italic> = 0.186\u20130.967).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PEEK knee joint prosthesis has excellent CT compatibility. The change in periprosthetic bone volume during the follow-up period can be determined using the HU value after CT scan, while the prosthesis position can be assessed. This assessment may potentially guide future improvements in knee prosthesis alignment techniques and artificial knee prosthesis designs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.809699","type":"journal-article","created":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T04:41:37Z","timestamp":1644813697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Zhengyu","family":"Cai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhua","family":"Qu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaochao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiguo","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liangjun","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teng","family":"Long","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuying","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Yue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"You","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Knee replacement","volume":"392","author":"Price","year":"2018","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/S0140-6736(19)31281-4","article-title":"The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial","volume":"394","author":"Beard","year":"2019","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2758","DOI":"10.3389\/fimmu.2019.02758","article-title":"Diagnosis of metal hypersensitivity in total knee arthroplasty: a case report","volume":"10","author":"Schoon","year":"2019","journal-title":"Front Immunol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1111\/cod.13590","article-title":"Allergic contact dermatitis due to titanium in a total knee replacement","volume":"83","author":"Dear","year":"2020","journal-title":"Contact Dermatitis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.anai.2020.02.012","article-title":"Metal hypersensitivity in total joint arthroplasties","volume":"124","author":"Penumarty","year":"2020","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1034\/j.1398-9995.2001.00086.x","article-title":"Epidemiology of contact allergy in adults","volume":"56","author":"Schafer","year":"2001","journal-title":"Allergy."},{"key":"B7","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s00132-009-1414-x","article-title":"Implant allergy register\u2013a first report","volume":"38","author":"Eben","year":"2009","journal-title":"Orthopade."},{"key":"B8","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s00132-007-1189-x","article-title":"Alternative materials and solutions in total knee arthroplasty for patients with metal allergy","volume":"37","author":"Bader","year":"2008","journal-title":"Orthopade."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e023","DOI":"10.5435\/JAAOSGlobal-D-19-00023","article-title":"Exploring the incidence, implications, and relevance of metal allergy to orthopaedic surgeons","volume":"3","author":"Haddad","year":"2019","journal-title":"J Am Acad Orthop Surg Glob Res Rev."},{"key":"B10","first-page":"125","article-title":"New insights on metal allergy in total joint arthroplasty","volume":"34","author":"Toro","year":"2020","journal-title":"J Biol Regul Homeost Agents"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1007\/s11999-016-4801-8","article-title":"Does a PEEK femoral TKA implant preserve intact femoral surface strains compared with CoCr? A preliminary laboratory study","volume":"474","author":"Rankin","year":"2016","journal-title":"Clin Orthop Relat Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.msec.2019.02.082","article-title":"Total knee arthroplasty application of polyetheretherketone and carbon-fiber-reinforced polyetheretherketone: a review","volume":"100","author":"Koh","year":"2019","journal-title":"Mater Sci Eng C Mater Biol Appl."},{"key":"B13","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.arth.2016.07.027","article-title":"Medial tibial stress shielding: a limitation of cobalt chromium tibial baseplates","volume":"32","author":"Martin","year":"2017","journal-title":"J Arthroplasty."},{"key":"B14","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00167-008-0649-0","article-title":"Does stress shielding occur with the use of long-stem prosthesis in total knee arthroplasty?","volume":"17","author":"Sathappan","year":"2009","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1016\/j.biomaterials.2007.12.001","article-title":"The in vitro response of human osteoblasts to polyetheretherketone (PEEK) substrates compared to commercially pure titanium","volume":"29","author":"Sagomonyants","year":"2008","journal-title":"Biomaterials."},{"key":"B16","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/0142-9612(95)93256-D","article-title":"Attachment and proliferation of osteoblasts and fibroblasts on biomaterials for orthopaedic use","volume":"16","author":"Hunter","year":"1995","journal-title":"Biomaterials."},{"key":"B17","doi-asserted-by":"publisher","first-page":"725","DOI":"10.18240\/ijo.2020.05.05","article-title":"Biocompatibility of polyetheretherketone for the treatment of orbital bone defects","volume":"13","author":"Gu","year":"2020","journal-title":"Int J Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.spinee.2015.04.011","article-title":"Polyetheretherketone (PEEK) intervertebral cage as a cause of chronic systemic allergy: a case report","volume":"15","author":"Maldonado-Naranjo","year":"2015","journal-title":"Spine J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2394","DOI":"10.1007\/s11999-016-4976-z","article-title":"The biologic response to polyetheretherketone (PEEK) wear particles in total joint replacement: a systematic review","volume":"474","author":"Stratton-Powell","year":"2016","journal-title":"Clin Orthop Relat Res."},{"key":"B20","unstructured":"2021"},{"key":"B21","doi-asserted-by":"publisher","first-page":"E204","DOI":"10.1111\/aor.13101","article-title":"Feasibility and safety of a cemented PEEK-on-PE knee replacement in a goat model: a preliminary study","volume":"42","author":"Du","year":"2018","journal-title":"Artif Organs."},{"key":"B22","doi-asserted-by":"publisher","first-page":"055027","DOI":"10.1088\/1748-605X\/ab998a","article-title":"Preclinical evaluation of a mini-arthroplasty implant based on polyetheretherketone and Ti6AI4V for treatment of a focal osteochondral defect in the femoral head of the hip","volume":"15","author":"Zhang","year":"2020","journal-title":"Biomed Mater."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1007\/s00167-016-4330-8","article-title":"Popliteus impingement after TKA may occur with well-sized prostheses","volume":"25","author":"Bonnin","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"8194670","DOI":"10.1155\/2018\/8194670","article-title":"Feasibility of magnetic resonance imaging monitoring of postoperative total knee arthroplasty without metal artifacts: a preliminary study of a novel implant model","volume":"2018","author":"Meng","year":"2018","journal-title":"Biomed Res Int."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.2106\/JBJS.H.00434","article-title":"Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences","volume":"92","author":"Mahoney","year":"2010","journal-title":"J Bone Joint Surg Am."},{"key":"B26","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.jor.2021.02.002","article-title":"The prevalence of posterolateral tibial baseplate overhang: an anatomical CT study","volume":"23","author":"Yokhana","year":"2021","journal-title":"J Orthop."},{"key":"B27","doi-asserted-by":"publisher","first-page":"3689","DOI":"10.1002\/jbm.a.35480","article-title":"Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review","volume":"103","author":"Abdullah","year":"2015","journal-title":"J Biomed Mater Res A."},{"key":"B28","doi-asserted-by":"crossref","DOI":"10.1016\/B978-1-4377-4463-7.10006-5","volume-title":"Chemical and Radiation Stability of PEEK","author":"Kurtz","year":"2012"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1016\/j.arth.2014.07.012","article-title":"Doctor, what does my knee arthroplasty weigh?","volume":"29","author":"Gibon","year":"2014","journal-title":"J Arthroplasty."},{"key":"B30","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/S0883-5403(98)90003-1","article-title":"Can a total knee replacement prosthesis be made entirely of polymers?","volume":"13","author":"Moore","year":"1998","journal-title":"J Arthroplasty."},{"key":"B31","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1002\/jbm.a.30351","article-title":"Performance of polyoxymethylene plastic (POM) as a component of a tissue engineering bioreactor","volume":"75","author":"Penick","year":"2005","journal-title":"J Biomed Mater Res A."},{"key":"B32","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s10544-021-00559-y","article-title":"Vacuum plasma sprayed porous titanium coating on polyetheretherketone for ACDF improves the osteogenic ability: an in vitro and in vivo study","volume":"23","author":"Liu","year":"2021","journal-title":"Biomed Microdevices."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2384","DOI":"10.1007\/s11999-016-4989-7","article-title":"The biotribology of PEEK-on-HXLPE bearings is comparable to traditional bearings on a multidirectional pin-on-disk tester","volume":"474","author":"Baykal","year":"2016","journal-title":"Clin Orthop Relat Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2314","DOI":"10.1007\/s00167-013-2443-x","article-title":"Mediolateral oversizing influences pain, function, and flexion after TKA","volume":"21","author":"Bonnin","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/j.arth.2009.07.009","article-title":"Femoral notch stenosis caused by soft tissue impingement in semi or open-box posterior-stabilized total knee arthroplasty","volume":"25","author":"Bonutti","year":"2010","journal-title":"J Arthroplasty."},{"key":"B36","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s00402-017-2850-4","article-title":"Posterolateral overhang affects patient quality of life after total knee arthroplasty","volume":"138","author":"Simsek","year":"2018","journal-title":"Arch Orthop Trauma Surg."},{"key":"B37","first-page":"659","article-title":"Tibial component in total knee replacement: the effect of overhang and sizing on outcome","volume":"83","author":"Foubert","year":"2017","journal-title":"Acta Orthop Belg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2532","DOI":"10.1007\/s00167-015-3512-0","article-title":"Oversizing the tibial component in TKAs: incidence, consequences and risk factors","volume":"24","author":"Bonnin","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"B39","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s13018-021-02250-7","article-title":"Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty","volume":"16","author":"Liu","year":"2021","journal-title":"J Orthop Surg Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1002\/jbmr.4436","article-title":"Alteration of bone density, microarchitecture, and strength in patients with Camurati-Engelmann disease: assessed by HR-pQCT","volume":"37","author":"Li","year":"2021","journal-title":"J Bone Miner Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1007\/s00402-020-03698-8","article-title":"Infection and periprosthetic fracture are the leading causes of failure after aseptic revision total knee arthroplasty","volume":"141","author":"Meyer","year":"2021","journal-title":"Arch Orthop Trauma Surg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1016\/j.joca.2017.07.014","article-title":"Quantitative regional and sub-regional analysis of femoral and tibial subchondral bone mineral density (sBMD) using computed tomography (CT): comparison of non-osteoarthritic (OA) and severe OA knees","volume":"25","author":"Omoumi","year":"2017","journal-title":"Osteoarthritis Cartilage."},{"key":"B43","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1109\/TMI.2015.2426684","article-title":"Quantitative evaluation of knee subchondral bone mineral density using cone beam computed tomography","volume":"34","author":"Turunen","year":"2015","journal-title":"IEEE Trans Med Imaging."},{"key":"B44","doi-asserted-by":"publisher","first-page":"30330","DOI":"10.1039\/C8RA04661A","article-title":"Characteristics of wear particles and wear behavior of retrieved PEEK-on-HXLPE total knee implants: a preliminary study","volume":"8","author":"Meng","year":"2018","journal-title":"RSC Adv."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.809699\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T04:41:43Z","timestamp":1644813703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.809699\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,14]]},"references-count":44,"alternative-id":["10.3389\/fsurg.2022.809699"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.809699","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2022,2,14]]},"article-number":"809699"}}