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Zhou Y, Harries D, Stoney JD. A Polished Cobalt-Chrome Baseplate is not Associated With a Lower Revision Rate Than Matt Titanium in a Single Total Knee Arthroplasty Implant System With Identical Baseplate Design. J Arthroplasty 2024; 39:896-903. [PMID: 37852451 DOI: 10.1016/j.arth.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Polished baseplates were introduced into total knee arthroplasty (TKA) systems to reduce the incidence of backside wear. In 2004, a fixed-bearing knee arthroplasty system underwent a change in baseplate material from matt titanium to polished cobalt-chrome (CoCr) with the intention to reduce backside wear. Other design aspects were left unchanged. The aim of this study was to compare these implants with each baseplate using data from the Australian Orthopaedic Association National Joint Replacement Registry. METHODS Primary TKA procedures performed between January 2010 and December 2021 for osteoarthritis, using a single design with cross-linked polyethylene inserts and matt titanium or polished CoCr baseplates, were analyzed. The primary outcome was all-cause revision, summarized using Kaplan-Meier estimates, with age- and sex-adjusted hazard ratios estimated from Cox proportional hazards models. In total, there were 2,091 procedures with matt titanium and 2,519 procedures with polished CoCr baseplates. RESULTS The 9-year cumulative percent revision was 2.5% (95% confidence interval [CI] 1.8 to 3.5%) and 4.2% (95% CI 3.1 to 5.6%) for the matt titanium and CoCr groups, respectively. Compared to matt titanium, the revision rate of CoCr baseplates was not significantly higher (hazard ratio 1.44; 95% CI 0.96 to 2.15; P = .076). CONCLUSIONS Polished CoCr baseplates in a single TKA system were not associated with reduced all-cause revision rates compared to matt titanium up to 11 years post-TKA. Our results suggest that the predicted reduction in wear particle debris production from polished CoCr baseplates may not correlate with reduced revision rates in vivo, but further evaluation is required.
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Affiliation(s)
- Yushy Zhou
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The University of Melbourne, Victoria, South Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - James D Stoney
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The University of Melbourne, Victoria, South Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia
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Ozer A. Computational wear of knee implant polyethylene insert surface under continuous dynamic loading and posterior tibial slope variation based on cadaver experiments with comparative verification. BMC Musculoskelet Disord 2022; 23:871. [PMID: 36123647 PMCID: PMC9484235 DOI: 10.1186/s12891-022-05828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background The effect of posterior tibial slope on the maximum contact pressure and wear volume of polyethylene (PE) insert were not given special attention. The effects of flexion angle, Anterior-Posterior (AP) Translation, and Tibial slope on the max contact pressure and wear of PE insert of TKR were investigated under loadings which were obtained in cadaver experiments by using Archard’s wear law. This study uses not only loads obtained from cadaver experiments but also dynamic flexion starting from 0 to 90 degrees. Method Wear on knee implant PE insert was investigated using a 2.5 size 3 dimensional (3D) cruciate sacrificing total knee replacement model and Finite Element Method (FEM) under loadings and AP Translation data ranging from 0 to 90 flexion angles validated by cadaver experiments. Two types of analyses were done to measure the wear effect on knee implant PE insert. The first set of analyses included the flexion angles dynamically changing with the knee rotating from 0 to 90 angles according to the femur axis and the transient analyses for loadings changing with a certain angle and duration. Results It is seen that the contact pressure on the PE insert decreases as the cycle increases for both Flexion and Flexion+AP Translation. It is clear that as the cycle increases, the wear obtained for both cases increases. The loadings acting on the PE insert cannot create sufficient pressure due to the AP Translation effect at low speeds and have an effect to reduce the wear, while the effect increases with the wear as the cycle increases, and the AP Translation now contributes to the wear at high speeds. It is seen that as the posterior tibial slope angle increases, the maximum contact pressure values slightly decrease for the same cycle. Conclusions This study indicated that AP Translation, which changes direction during flexion, had a significant effect on both contact pressure and wear. Unlike previous similar studies, it was seen that the amount of wear continues to increase as the cycle increases. This situation strengthens the argument that loading and AP Translation values that change with flexion shape the wear effects on PE Insert.
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Affiliation(s)
- Alaettin Ozer
- Department of Mechanical Engineering, Yozgat Bozok University, Yozgat, Turkey.
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3
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Bhalekar RM, Nargol ME, Shyam N, Nargol AVF, Wells SR, Collier R, Pabbruwe M, Joyce TJ, Langton DJ. Tibial tray debonding from the cement mantle is associated with deformation of the backside of polyethylene tibial inserts. Bone Joint J 2021; 103-B:1791-1801. [PMID: 34474593 DOI: 10.1302/0301-620x.103b.bjj-2020-2555.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs). METHODS At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays. RESULTS A total of 114 explanted fixed-bearing TKAs were examined. This included 76 used with contemporary PE inserts which were compared with 15 used with older generation PEs. The Attune and NexGen (central locking) trays were found to have significantly less cement cover than Triathlon and PFC trays (peripheral locking group) (p = 0.001). The median planicity values of the PE inserts used with central locking trays were significantly greater than of those with peripheral locking inserts (205 vs 85 microns; p < 0.001). Attune and NexGen inserts had a characteristic pattern of backside deformation, with the outer edges of the PE deviating inferiorly, leaving the PE margins as the primary areas of articulation. CONCLUSION Explanted TKAs with central locking mechanisms were significantly more likely to debond from the cement mantle. The PE inserts of these designs showed characteristic patterns of deformation, which appeared to relate to the manufacturing process and may be exacerbated in vivo. This pattern of deformation was associated with PE wear occurring at the outer edges of the articulation, potentially increasing the frictional torque generated at this interface. Cite this article: Bone Joint J 2021;103-B(12):1791-1801.
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Affiliation(s)
| | | | | | | | | | - Ryan Collier
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Moreica Pabbruwe
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
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Current Total Knee Designs: Does Baseplate Roughness or Locking Mechanism Design Affect Polyethylene Backside Wear? Clin Orthop Relat Res 2017; 475:2970-2980. [PMID: 28905208 PMCID: PMC5670066 DOI: 10.1007/s11999-017-5494-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 08/31/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial baseplate roughness and polyethylene-insert micromotion resulting from locking-mechanism loosening can lead to polyethylene backside wear in TKAs. However, many retrieval studies examining these variables have evaluated only older TKA implant designs. QUESTIONS We used implant-retrieval analysis to examine if there were differences in: (1) backside damage scores, (2) backside damage modes, and (3) backside linear wear rates in five TKA implant designs owing to differing baseplate surface roughness and locking mechanisms. Additionally, we examined if (4) patient demographics influence backside damage and wear. METHODS Five TKA implant models (four modern and one historical design) were selected with different tibial baseplate and/or locking mechanism designs. Six tibial inserts retrieved at the time of revision from each TKA model were matched for time in vivo, age of the patient at TKA revision, BMI, sex, revision number, and revision reason. Each insert backside was analyzed for: (1) visual total damage score and (2) individual visual damage modes, both by two observers and with an intraclass correlation coefficient of 0.66 (95% CI, 0.39-0.92), and (3) linear wear rate measured by micro-CT. Median primary outcomes were compared among the five designs. For our given sample size among five groups we could detect with 80% power a 10-point difference in damage score and an 0.11-mm per year difference in wear rate. RESULTS The polished tibial design with a partial peripheral capture locking mechanism and anterior constraint showed a lower total damage score compared with the nonpolished tibial design with only a complete peripheral-rim locking mechanism (median, 12.5; range, 9.5-18.0; 95% CI, 9.58-16.42 versus median, 22.3; range, 15.5-27.0; 95% CI, 17.5-26.5; p = 0.019). The polished baseplate with a tongue-in-groove locking mechanism showed more abrasions than the nonpolished baseplate with a peripheral-rim capture and antirotational island (median, 7.25; range, 0.5-8.0; 95% CI, 2.67-8.99 versus median, 0.75; range, 0-1.5; 95% CI, 0.20-1.47; p = 0.016)). Dimpling was a unique wear mode to the nonpolished baseplates with the peripheral-rim capture and antirotational island (median, 5.5; range, 2.0-9.0; 95% CI, 2.96-8.38) and the peripheral-rim capture alone (median, 9.0; range, 6.0-10.0; 95% CI, 7.29-10.38). Overall, the linear wear rate for polished designs was lower than for nonpolished designs (0.0102 ± 0.0044 mm/year versus 0.0224 ± 0.0119 mm/year; p < 0.001). Two of the polished baseplate designs, the partial peripheral capture with anterior constraint (median, 0.083 mm/year; range, 0.0037-0.0111 mm/year; 95% CI, 0.0050-0.0107 mm versus median, 0.0245 mm/year; range, 0.014-0.046 mm/year; 95% CI, 0.0130-0.0414 mm; p = 0.008) and the tongue-in-groove locking mechanism (median, 0.0085 mm/year; range, 0.005-0.015 mm/year; 95% CI, 0.0045-0.0138 mm; p = 0.032) showed lower polyethylene linear wear rates compared with the nonpolished baseplate design with only a peripheral-rim capture. CONCLUSIONS Total damage scores and linear wear rates were highest involving the nonpolished design with only a peripheral rim capture. There were no differences among the other TKA designs regarding damage and wear, but this finding should be considered in the setting of a relatively small sample size. CLINICAL RELEVANCE Our study showed that in the complex interplay between baseplate surface finish and locking mechanism design, a polished baseplate with a robust locking mechanism had the lowest backside damage and linear wear. However, improvements in locking mechanism design in nonpolished baseplates potentially may offset some advantages of a polished baseplate. Further retrieval analyses need to be done to confirm such findings, especially analyzing current crosslinked polyethylene. Additionally, we need mid- and long-term studies comparing TKA revisions attributable to wear and osteolysis among implants before understanding if such design differences are clinically relevant.
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Chalmers BP, Sculco PK, Fehring KA, Trousdale RT, Taunton MJ. A Novel Percentage-Based System for Determining Aseptic Loosening of Total Knee Arthroplasty Tibial Components. J Arthroplasty 2017; 32:2274-2278. [PMID: 28285901 DOI: 10.1016/j.arth.2017.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are limited data on evaluating the significance of radiolucent lines and aseptic loosening in total knee arthroplasty (TKA). We sought to compare the sensitivity, specificity, and reliability of the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System (KSRES) in detecting tibial component loosening compared to a novel percentage-based system (PBS). METHODS We retrospectively reviewed radiographs obtained from 48 patients within 6 months prior to revision TKA. The radiographs were randomized and four reviewers independently used the KSRES to categorize tibial implants as nonconcerning, clinical follow-up for progression, or loose as described by KSRES. For the PBS, the percent involvement of the tibial implant interface of any radiolucency at the bone-cement or cement-implant interface was determined. The higher percentage from either the anteroposterior or the lateral image was the final score. Components were categorized as nonconcerning (≤10%), clinical follow-up for progression (11%-24%), or loose (≥25%). We compared the sensitivity, specificity, and interobserver reliability using intraoperative assessment of implant fixation as the gold standard. RESULTS For the KSRES, the mean sensitivity for determining tibial loosening was 7.3% and mean specificity for determining a nonconcerning implant was 95.9%. The PBS significantly increased the sensitivity to 91.1% (P < .001) while maintaining a specificity of 87.9% (P = .2). Interobserver reliability significantly increased from a mean kappa of 0.26 to 0.75 (P < .001). CONCLUSION The KSRES significantly underestimates implant loosening. The proposed percentage-based system demonstrated excellent sensitivity, specificity, and interobserver reliability in determining tibial implant loosening in this patient population.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter K Sculco
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Keith A Fehring
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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6
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Łapaj Ł, Mróz A, Kokoszka P, Markuszewski J, Wendland J, Helak-Łapaj C, Kruczyński J. Peripheral snap-fit locking mechanisms and smooth surface finish of tibial trays reduce backside wear in fixed-bearing total knee arthroplasty. Acta Orthop 2017; 88:62-69. [PMID: 27781667 PMCID: PMC5251266 DOI: 10.1080/17453674.2016.1248202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Severe backside wear, observed in older generations of total knee replacements (TKRs), led to redesign of locking mechanisms to reduce micromotions between tibial tray and inlay. Since little is known about whether this effectively reduces backside wear in modern designs, we examined backside damage in retrievals of various contemporary fixed-bearing TKRs. Patients and methods - A consecutive series of 102 inlays with a peripheral (Stryker Triathlon, Stryker Scorpio, DePuy PFC Sigma, Aesculap Search Evolution) or dovetail locking mechanism (Zimmer NexGen, Smith and Nephew Genesis II) was examined. Articular and backside surface damage was evaluated using the semiquantitative Hood scale. Inlays were examined using scanning electron microscopy (SEM) to determine backside wear mechanisms. Results - Mean Hood scores for articular (A) and backside (B) surfaces were similar in most implants-Triathlon (A: 46, B: 22), Genesis II (A: 55, B: 24), Scorpio (A: 57, B: 24), PFC (A: 52, B: 20); Search (A: 56, B: 24)-except the NexGen knee (A: 57, B: 60), which had statistically significantly higher backside wear scores. SEM studies showed backside damage caused by abrasion related to micromotion in designs with dovetail locking mechanisms, especially in the unpolished NexGen trays. In implants with peripheral liner locking mechanism, there were no signs of micromotion or abrasion. Instead, "tray transfer" of polyethylene and flattening of machining was observed. Interpretation - Although this retrieval study may not represent well-functioning TKRs, we found that a smooth surface finish and a peripheral locking mechanism reduce backside wear in vivo, but further studies are required to determine whether this actually leads to reduced osteolysis and lower failure rates.
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Affiliation(s)
- Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | | | - Paweł Kokoszka
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Jacek Markuszewski
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Justyna Wendland
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Celina Helak-Łapaj
- Department of Bioinformatics and Computational Biology, Poznań University of Medical Sciences
- Clinical Eye Unit and Pediatric Ophtalmology Service, Heliodor Swiecicki University Hospital, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Kruczyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
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7
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Preston S, Petrera M, Kim C, Zywiel MG, Gandhi R. Towards an understanding of the painful total knee: what is the role of patient biology? Curr Rev Musculoskelet Med 2016; 9:388-395. [PMID: 27613710 DOI: 10.1007/s12178-016-9363-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) remains the treatment of choice for end-stage osteoarthritis of the knee. With an aging population, the demand for TKA continues to increase, placing a significant burden on a health care system that must function with limited resources. Although generally accepted as a successful procedure, 15-30 % of patients report persistent pain following TKA. Classically, pain generators have been divided into intra-articular and extra-articular causes. However, there remains a significant subset of patients for whom pain remains unexplained. Recent studies have questioned the role of biology (inflammation) in the persistence of pain following TKA. This article aims to serve as a review of previously identified causes of knee pain following TKA, as well as to explore the potential role of biology as a predictor of pain following knee replacement surgery.
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Affiliation(s)
- Stephen Preston
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Massimo Petrera
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Christopher Kim
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Michael G Zywiel
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.,Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Room 1E439, Toronto, Ontario M5T 2S8 Canada
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8
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Holleyman RJ, Scholes SC, Weir D, Jameson SS, Holland J, Joyce TJ, Deehan DJ. Changes in surface topography at the TKA backside articulation following in vivo service: a retrieval analysis. Knee Surg Sports Traumatol Arthrosc 2015; 23:3523-31. [PMID: 25100486 DOI: 10.1007/s00167-014-3197-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE With the advent of modular total knee arthroplasty (TKA) systems, backside wear at the articulation between the ultra-high-molecular-weight-polyethylene (UHMWPE) component undersurface and the tibial baseplate has received increasing attention as a source of clinically significant polyethylene wear debris. The aim of this study was to investigate the reciprocating interface at the TKA undersurface articulation using profilometry after in vivo service. Our null hypothesis was that there would be no discernible pattern or relationship between the metal tibial baseplate and UHMWPE surface profile. METHODS A nanoscale analysis of thirty retrieved fixed-bearing TKA explants was performed. Surface roughness (Sa) and skewness (Ssk) were measured on both the UHMWPE component undersurface and the tibial baseplate of explants using a non-contacting profilometer (1 nm resolution). Four pristine unimplanted components of two different designs (Stryker Kinemax and DePuy PFC) were examined for control purposes. RESULTS Mean explant baseplate surface roughness was 1.24 μm (0.04-3.01 μm). Mean explant UHMWPE undersurface roughness was 1.16 μm (0.23-2.44 μm). Each explant had an individual roughness pattern with unique baseplate and undersurface UHMWPE surface roughness that was different from, but closely related to, surface topography observed in control implants of the same manufacturer and design. Following in vivo service, UHMWPE undersurface showed changes towards a negative skewness, demonstrating that wear is occurring at the backside interface. CONCLUSION In vivo loading of the TKA prosthesis leads to measurable changes in surface profile at the backside articulation, which appear to be dependent on several factors including implant design and in vivo duration. These findings are consistent with wear occurring at this surface. Findings of this study would support the use of a polished tibial tray over an unpolished design in total knee arthroplasty with the goal of reducing PE wear by means of providing a smoother backside countersurface for the UHMWPE component.
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Affiliation(s)
- Richard J Holleyman
- Newcastle Upon Tyne Hospitals Trust, Royal Victoria Infirmary & Freeman Hospital, Newcastle upon Tyne, NE1 4LP, UK.
- Newcastle University, Newcastle upon Tyne, UK.
| | | | - David Weir
- Newcastle Upon Tyne Hospitals Trust, Royal Victoria Infirmary & Freeman Hospital, Newcastle upon Tyne, NE1 4LP, UK
| | | | - Jim Holland
- Newcastle Upon Tyne Hospitals Trust, Royal Victoria Infirmary & Freeman Hospital, Newcastle upon Tyne, NE1 4LP, UK
| | - Tom J Joyce
- Newcastle University, Newcastle upon Tyne, UK
| | - David J Deehan
- Newcastle Upon Tyne Hospitals Trust, Royal Victoria Infirmary & Freeman Hospital, Newcastle upon Tyne, NE1 4LP, UK
- Newcastle University, Newcastle upon Tyne, UK
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9
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Teeter MG, Lanting BA, Shrestha KR, Howard JL, Vasarhelyi EM. Contribution of Surface Polishing and Sterilization Method to Backside Wear in Total Knee Arthroplasty. J Arthroplasty 2015; 30:2320-2. [PMID: 26182981 DOI: 10.1016/j.arth.2015.06.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to compare the relative contributions of backside wear from polished and roughened tibial baseplates and different sterilization methods. Three groups of tibial inserts of the same design were matched: roughened gamma-air (RGA), polished gamma-air (PGA), and polished gas-plasma (PGP). Visual damage scoring and micro-CT deviation maps were used for evaluation. Total backside damage was higher (P=0.045) in RGA (13.8±3.4) compared to PGA (8.7±3.4) and PGP (8.2±4.8). Backside wear rates were greatest (P=0.02) in RGA (0.038 mm/year), followed by PGA (0.012 mm/year), and lowest in PGP (0.009 mm/year). Use of a roughened tibial baseplate had a greater effect on wear magnitude than sterilization method.
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Affiliation(s)
- Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kush R Shrestha
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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10
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Teeter MG, Parikh A, Taylor M, Sprague J, Naudie DD. Wear and creep behavior of total knee implants undergoing wear testing. J Arthroplasty 2015; 30:130-4. [PMID: 25175057 DOI: 10.1016/j.arth.2014.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/03/2014] [Accepted: 08/03/2014] [Indexed: 02/01/2023] Open
Abstract
We sought to determine what dimensional changes occurred from wear testing of a total knee implant, as well as any changes within the polyethylene subsurface. Three fixed bearing implants underwent wear simulator testing to 6.1 million cycles. Gravimetric analysis and micro-CT scans were performed pre-test, mid-test, and post-test. Wear volume and surface deviations were greater during 0-3.2 million cycles (91 ± 12mm(3)) than from 3.2 to 6.1 million cycles (52 ± 18mm(3)). Deviations (wear and creep) occurred across all surfaces of the tibial inserts, including the articular surface, backside surface, sides, and locking mechanism. No subsurface changes were found. The micro-CT results were a useful adjunct to gravimetric analysis, defining the dimensional changes that occurred with testing and ruling out subsurface fatigue.
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Affiliation(s)
- Matthew G Teeter
- Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Douglas D Naudie
- Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
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11
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Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, Ritter MA, Nunley RM. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013; 28:116-9. [PMID: 23954423 DOI: 10.1016/j.arth.2013.04.056] [Citation(s) in RCA: 284] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 04/11/2013] [Accepted: 04/28/2013] [Indexed: 02/01/2023] Open
Abstract
Revision knee data from six joint arthroplasty centers were compiled for 2010 and 2011 to determine mechanism of failure and time to failure. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%), and malalignment (6.6%). Mean time to failure was 5.9 years (range 10 days to 31 years). 35.3% of all revisions occurred less than 2 years after the index arthroplasty, 60.2% in the first 5 years. In contrast to previous reports, polyethylene wear is not a leading failure mechanism and rarely presents before 15 years. Implant performance is not a predominant factor of knee failure. Early failure mechanisms are primarily surgeon-dependent.
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Affiliation(s)
- William C Schroer
- St. Louis Joint Replacement Institute, SSM DePaul Health Center, St. Louis, Missouri
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12
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O'Brien S, Luo Y, Wu C, Petrak M, Bohm E, Brandt JM. Prediction of backside micromotion in total knee replacements by finite element simulation. Proc Inst Mech Eng H 2012; 226:235-45. [PMID: 22558838 DOI: 10.1177/0954411911435593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The micromotion at the interface between the polyethylene tibial insert and metal tibial tray [corrected] in modular total knee replacements [corrected] has been shown to contribute to wear particle-induced osteolysis and may [corrected] cause implant failure. Therefore, studying the design parameters that are involved in the backside wear process is an important task that may lead to improvement in new total knee replacements. In the present study, a finite element model was developed to predict the backside micromotion along the entire modular interface. Both the linear elastic constitutive model and non-linear J2-plasticity constitutive model were considered in the finite element model for polyethylene and were corroborated against published results obtained from displacement controlled knee simulator wear tests. The finite element simulation with the non-linear J2-plasticity constitutive model was able to predict backside micromotion [corrected] more accurately than the simulation with the linear elastic constitutive model. [corrected] The developed finite element model (including the non-linear J2-plasticity constitutive model) was then applied to assess the effects of the tibial tray locking mechanism design (dovetails versus fullperipheral [corrected] design) and different levels of interference fit on insert micromotion. The developed finite element model, implementing the non-linear J2-plasticity constitutive model, was shown to successfully predict clinical amounts of backside micromotion and could be used for the design and development of total knee replacements for the reduction of backside micromotion and polyethylene [corrected] wear.
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Affiliation(s)
- Sean O'Brien
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering University of Manitoba, Canada
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