Prediction of Wear in Crosslinked Polyethylene Unicompartmental Knee Arthroplasty

Effect of vitamin E-enhanced highly cross-linked polyethylene on wear rate and particle debris in anatomic total shoulder arthroplasty: a biomechanical comparison to ultrahigh-molecular-weight polyethylene

BACKGROUND

Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce cross-linking, but reducing the resulting free radicals with melting or heat annealing can compromise the component's mechanical properties. Vitamin E has been introduced as an adjuvant to thermal treatments. Anatomic shoulder arthroplasty models with a ceramic head component have demonstrated that vitamin E-enhanced polyethylene show improved wear compared with highly cross-linked polyethylene (HXLPE). This study aimed to assess the biomechanical wear properties and particle size characteristics of a novel vitamin E-enhanced highly cross-linked polyethylene (VEXPE) glenoid compared to a conventional ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid against a cobalt chromium molybdenum (CoCrMo) head component.

METHODS

Biomechanical wear testing was performed to compare the VEXPE glenoid to UHMWPE glenoid with regard to pristine polyethylene wear and abrasive endurance against a polished CoCrMo alloy humeral head in an anatomic shoulder wear-simulation model. Cumulative mass loss (milligrams) was recorded, and wear rate calculated (milligrams per megacycle [Mc]). Under pristine wear conditions, particle analysis was performed, and functional biologic activity (FBA) was calculated to estimate particle debris osteolytic potential. In addition, 95% confidence intervals for all testing conditions were calculated.

RESULTS

The average pristine wear rate was statistically significantly lower for the VEXPE glenoid compared with the HXLPE glenoid (0.81 ± 0.64 mg/Mc vs. 7.00 ± 0.45 mg/Mc) (P < .05). Under abrasive wear conditions, the VEXPE glenoid had a statistically significant lower average wear rate compared with the UHMWPE glenoid comparator device (18.93 ± 5.80 mg/Mc vs. 40.47 ± 2.63 mg/Mc) (P < .05). The VEXPE glenoid demonstrated a statistically significant improvement in FBA compared with the HXLPE glenoid (0.21 ± 0.21 vs. 1.54 ± 0.49 (P < .05).

CONCLUSIONS

A new anatomic glenoid component with VEXPE demonstrated significantly improved pristine and abrasive wear properties with lower osteolytic particle debris potential compared with a conventional UHMWPE glenoid component. Vitamin E-enhanced polyethylene shows early promise in shoulder arthroplasty components. Long-term clinical and radiographic investigation needs to be performed to verify if these biomechanical wear properties translate to diminished long-term wear, osteolysis, and loosening.

Computational Wear Prediction of TKR with Flatback Deformity during Gait

Loss of lumbar lordosis in flatback patients leads to changes in the walking mechanism like knee flexion. Such variations in flatback patients are predicted to alter the characteristics of total knee replacement (TKR) contact, so their TKR will show different wear characteristics with a normal gait. However, the relevant study is limited to predicting the wear depth of TKR for normal gait mechanisms or collecting and analyzing kinematic data on flatback gait mechanisms. The objective of this study was to compare wear in TKR of flatback patients with people without flatback syndrome. The main difference between the normal gait mechanism and the flat back gait mechanism is the knee flexion remain section and the tendency to change the vertical force acting on the knee. Thus, in this paper, A finite element-based computational wear simulation for the gait cycle using kinematic data for normal gait and flat gait were performed, and substituting the derived contact pressure and slip distance into the Archard formula, a proven wear model, wear depth was predicted. The FE analysis results show that the wear volume in flatback patients is greater. The results obtained can provide guidance on the TKR design to minimize wear on the knee implant for flatback patients.

Optimal Conformity Design of Tibial Insert Component Based on ISO Standard Wear Test Using Finite Element Analysis and Surrogate Model

Total knee replacement is a standard surgical treatment used to treat osteoarthritis in the knee. The implant is complicated, requiring expensive designs and testing as well as a surgical intervention. This research proposes a technique concerning the optimal conformity design of the symmetric polyethylene tibial insert component for fixed-bearing total knee arthroplasty. The Latin Hypercube Sampling (LHS) design of the experiment was used to create 30 cases of the varied tibial insert conformity that influenced the total knee replacement wear volume. The combination of finite element analysis and a surrogate model was performed to predict wear volume according to the standard of ISO-14243:2014 wear test and to determine the optimal conformity. In the first step, the results could predict wear volume between 5.50 to 72.92 mm3/106 cycle. The Kriging method of a surrogate model has then created the increased design based on the efficient global optimization (EGO) method with improving data 10 design points. The result revealed that the optimum design of tibial insert conformity in a coronal and sagittal plane was 0.70 and 0.59, respectively, with a minimizing wear volume of 3.07 mm3/106 cycle. The verification results revealed that the area surface scrape and wear volume are similar to those predicted by the experiment. The wear behavior on the tibial insert surface was asymmetry of both sides. From this study it can be concluded that the optimal conformity design of the tibial insert component can be by using a finite element and surrogate model combined with the design of conformity to the minimized wear volume.

Computational wear prediction of insert conformity and material on mobile-bearing unicompartmental knee arthroplasty

Objectives

Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty with isolated medial or lateral compartment osteoarthritis. However, polyethylene wear can significantly reduce the lifespan of UKA. Different bearing designs and materials for UKA have been developed to change the rate of polyethylene wear. Therefore, the objective of this study is to investigate the effect of insert conformity and material on the predicted wear in mobile-bearing UKA using a previously developed computational wear method.

Methods

Two different designs were tested with the same femoral component under identical kinematic input: anatomy mimetic design (AMD) and conforming design inserts with different conformity levels. The insert materials were standard or crosslinked ultra-high-molecular-weight polyethylene (UHMWPE). We evaluated the contact pressure, contact area, wear rate, wear depth, and volumetric wear under gait cycle loading conditions.

Results

Conforming design inserts had the lower contact pressure and larger contact area. However, they also had the higher wear rate and volumetric wear. The improved wear performance was found with AMD inserts. In addition, the computationally predicted volumetric wear of crosslinked UHMWPE inserts was less than half that of standard UHMWPE inserts.

Conclusion

Our results showed that increasing conformity may not be the sole predictor of wear performance; highly crosslinked mobile-bearing polyethylene inserts can also provide improvement in wear performance. These results provide improvements in design and materials to reduce wear in mobile-bearing UKA.

Cite this article: Bone Joint Res 2019;8:563–569.

Optimal Design of Patient-Specific Total Knee Arthroplasty for Improvement in Wear Performance

Life expectancy is on the rise and, concurrently, the demand for total knee arthroplasty (TKA), which lasts a lifetime, is increasing. To meet this demand, improved TKA designs have been introduced. Recent advances in radiography and manufacturing techniques have enabled the production of patient-specific TKA. Nevertheless, concerns regarding the wear performance, which limit the lifespan of TKA, remain to be addressed. This study aims at reducing the wear in patient-specific TKA using design optimization and parametric three-dimensional (3D) finite-element (FE) modelling. The femoral component design was implemented in a patient-specific manner, whereas the tibial insert conformity remained to be determined by design variables. The gait cycle loading condition was applied, and the optimized model was validated by the results obtained from the experimental wear tests. The wear predictions were iterated for five million gait cycles using the computational model with force-controlled input. Similar patterns for internal/external rotation and anterior/posterior translation were observed in both initial and optimal models. The wear rates for initial and optimal models were recorded as 23.2 mm³/million cycles and 16.7 mm³/million cycles, respectively. Moreover, the experimental wear rate in the optimal design was 17.8 mm³/million cycles, which validated our optimization procedure. This study suggests that tibial insert conformity is an important factor in influencing the wear performance of patient-specific TKA, and it is capable of providing improved clinical results through enhanced design selections. This finding can boost the future development of patient-specific TKA, and it can be extended to other joint-replacement designs. However, further research is required to explore the potential clinical benefits of the improved wear performance demonstrated in this study.

Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis

Objectives

Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patients. To satisfy this requirement, new patient-specific prosthetic designs have been introduced. The patient-specific UKA is designed on the basis of data from preoperative medical images. In general, knee implant design with increased conformity has been developed to provide lower contact stress and reduced wear on the tibial insert compared with flat knee designs. The different tibiofemoral conformity may provide designers the opportunity to address both wear and kinematic design goals simultaneously. The aim of this study was to evaluate wear prediction with respect to tibiofemoral conformity design in patient-specific UKA under gait loading conditions by using a previously validated computational wear method.

Methods

Three designs with different conformities were developed with the same femoral component: a flat design normally used in fixed-bearing UKA, a tibia plateau anatomy mimetic (AM) design, and an increased conforming design. We investigated the kinematics, contact stress, contact area, wear rate, and volumetric wear of the three different tibial insert designs.

Results

Conforming increased design showed a lower contact stress and increased contact area. In addition, increased conformity resulted in a reduction of the wear rate and volumetric wear. However, the increased conformity design showed limited kinematics.

Conclusion

Our results indicated that increased conformity provided improvements in wear but resulted in limited kinematics. Therefore, increased conformity should be avoided in fixed-bearing patient-specific UKA design. We recommend a flat or plateau AM tibial insert design in patient-specific UKA.

Cite this article: Y-G. Koh, K-M. Park, H-Y. Lee, K-T. Kang. Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis. Bone Joint Res 2019;8:156–164. DOI: 10.1302/2046-3758.83.BJR-2018-0193.R1.

Prediction of Wear on Tibial Inserts Made of UHMWPE, PEEK, and CFR-PEEK in Total Knee Arthroplasty Using Finite-Element Analysis

The wear of tibial inserts in total knee arthroplasty (TKA) remains a major limitation of longevity. However, wear tests are expensive and time-consuming. Computational wear prediction using a finite-element (FE) model followed by validation through comparison with experimental data is effective for assessing new prosthetic designs or materials prior to functional testing and surgical implementation. In this study, the kinematics, volumetric wear, and wear depth of tibial inserts made of different materials (ultrahigh-molecular weight polyethylene (UHMWPE), polyetheretherketone (PEEK), and carbon fiber-reinforced PEEK (CFR–PEEK)) in TKA were evaluated by employing FE models and analysis. The differences among the materials were evaluated using adaptive wear modeling to predict the wear depth, volumetric wear, and kinematics under a gait loading condition. The volumetric wear and wear depth of the CFR–PEEK decreased by 87.4% and 61.3%, respectively, compared with those of the UHMWPE, whereas the PEEK exhibited increased volumetric wear and wear depth. These results suggest that CFR–PEEK is a good alternative to UHMWPE as a promising and suitable material for tibial inserts used in TKA. However, orthopedic research should be performed to evaluate the threshold conditions and appropriate applications for the newly developed and introduced biomaterial.

Wear predictions for UHMWPE material with various surface properties used on the femoral component in total knee arthroplasty: a computational simulation study

The wear of ultrahigh-molecular weight polyethylene (UHMWPE) tibial inserts in total knee arthroplasty (TKA) remains a major limitation that hinders the longevity of clinically successful devices. Surface properties significantly affect the overall performance of TKA, and surface modification with mechanically and chemically stable materials is an effective method for overcoming the wear of TKA. However, wear tests are not cost-efficient or time-efficient; thus, the effects of geometric, loading, and alignment perturbations are often evaluated via parametric studies. Computational wear prediction using a finite element (FE) model followed by validation through comparison with experimental data is effective for assessing new prosthetic designs or surface change methods prior to functional testing and surgical implementation. The aim of this study was to evaluate the weight loss, wear depth, and kinematics for different surface properties, including nanostructured diamond (NSD), diamond-like carbon (DLC), titanium-nitride (TiN), and oxidized zirconium (OxZr) on femoral components in TKA using FE analysis under gait-cycle loading conditions. Weight loss and wear depth were lowest with OxZr followed by TiN, NSD, and DLC. However, the DLC femoral component did not show any improvement in wear rate compared to an uncoated cobalt-chromium (Co-Cr) femoral component. Not all surface changes applied in this study did lead to improvement in wear performance. However, this study demonstrates the potential of OxZr and TiN for reducing UHMWPE wear and offers new insights into the effects of wear on TKA.