Effect of joint laxity on polyethylene wear in total knee replacement

Kretzer, Jan Philippe; Jakubowitz, Eike; Sonntag, Robert; Hofmann, Kerstin; Heisel, Christian; Thomsen, M.

doi:10.1016/j.jbiomech.2009.12.016

Cited by 40 publications

(25 citation statements)

References 41 publications

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“…Restraint characteristics are defined by the restraint of the passive structures (ligaments, soft tissue, and capsule) which are based on in vitro laxity measurements [19–21]. In the first scenario, a stable TKR was defined with an absent anterior cruciate ligament and otherwise intact ligament structures [22]. In the second scenario, a ligamentously insufficient stabilized TKR (unstable TKR) was defined with an absent anterior cruciate ligament (ACL), insufficient posterior cruciate ligament (PCL), and medial collateral ligament (MCL).…”

Section: Methodsmentioning

confidence: 99%

Wear Behavior of an Unstable Knee: Stabilization via Implant Design?

Reinders

Sonntag

Kretzer

2014

BioMed Research International

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Background. Wear-related failures and instabilities are frequent failure mechanisms of total knee replacements. High-conforming designs may provide additional stability for the joint. This study analyzes the effects of a ligamentous insufficiency on the stability and the wear behavior of a high-conforming knee design. Methods. Two simulator wear tests were performed on a high-conforming total knee replacement design. In the first, a ligamentous-stable knee replacement with a sacrificed anterior cruciate ligament was simulated. In the second, a ligamentous-unstable knee with additionally insufficient posterior cruciate ligament and medial collateral ligament was simulated. Wear was determined gravimetrically and wear particles were analyzed. Implant kinematics was recorded during simulation. Results. Significantly higher wear rates (P ≤ 0.001) were observed for the unstable knee (14.58 ± 0.56 mg/106 cycles) compared to the stable knee (7.97 ± 0.87 mg/106 cycles). A higher number of wear particles with only small differences in wear particle characteristics were observed. Under unstable knee conditions, kinematics increased significantly for translations and rotations (P ≤ 0.01). This increase was mainly attributed to higher tibial posterior translation and internal rotations. Conclusion. Higher kinematics under unstable test conditions is a result of insufficient stabilization via implant design. Due to the higher kinematics, increased wear was observed in this study.

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Section: Methodsmentioning

confidence: 99%

Wear Behavior of an Unstable Knee: Stabilization via Implant Design?

Reinders

Sonntag

Kretzer

2014

BioMed Research International

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“…In-vitro wear simulation, implant kinematics and PE wear Force-controlled simulation according to ISO 14243-1:2009(E) was carried out on the AMTI knee simulator (Model KS2-6-1000, Advanced Mechanical Technology Inc., Watertown, MA, USA) [15] (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…The following test parameters were employed: a maximum load of 2600 N, a flexion angle of 0-58°, AP (anterior-posterior) force of −265 N to 110 N, and an IE (internal-external) rotational torque of −1 Nm to 6 Nm. As the laxity of ligaments influences the wear behaviour of TKA, asymmetric-nonlinear motion restraints were chosen for AP and IE to simulate the clinical situation of a sectioned anterior cruciate ligament and a retaining posterior cruciate ligament [15]. Simulation lasted a total of 5×10 6 cycles at a frequency of 1 Hz.…”

Section: Methodsmentioning

confidence: 99%

Wear in total knee arthroplasty—just a question of polyethylene?

Kretzer

Reinders

Sonntag

et al. 2013

International Orthopaedics (SICOT)

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Purpose Biological reactions against wear particles are a common cause for revision in total knee arthroplasty. To date, wear has mainly been attributed to polyethylene. However, the implants have large metallic surfaces that also could potentially lead to metal wear products (metal ions and debris). The aim of this study was to determine the local release of cobalt, chromium, molybdenum and titanium in total knee arthroplasty during a standard knee wear test. Methods Four moderately conforming fixed-bearing implants were subjected to physiological loadings and motions for 5×10 6 walking cycles in a knee wear simulator. Polyethylene wear was determined gravimetrically and the release of metallic wear products was measured using high resolutioninductively coupled plasma-mass spectrometry. Results A polyethylene wear rate of 7.28±0.27 mg/10 6 cycles was determined and the cumulative mass of released metals measured 1.63±0.28 mg for cobalt, 0.47±0.06 mg for chromium, 0.42±0.06 mg for molybdenum and 1.28±0.14 mg for titanium. Conclusion For other metallic implants such as metal-on-metal total hip arthroplasty, the metal wear products can interact with the immune system, potentially leading to immunotoxic effects. In this study about 12 % by weight of the wear products were metallic, and these particles and ions may become clinically relevant for patients sensitive to these materials in particular. Non-metallic materials (e.g. ceramics or suitable coatings) may be considered for an alternative treatment for those patients.

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“…A virtual soft tissue control system of the wear simulator was used to simulate the soft tissue stabilization [54]. Briefly, the soft tissue control system is a mathematical algorithm which calculates the restraint based on the current relative position in real time and reduces the acting force accordingly.…”

Section: Wear Testingmentioning

confidence: 99%

“…In our study, we used measured non-linear restraint characteristics of the ankle and implemented these characteristics into the virtual restraint model of the simulator [54]. Due to technical reasons, most simulator concepts use springs to simulate passive structures in wear simulation.…”

Section: Wear Testmentioning

confidence: 99%