Mid-term clinical and radiological results do not differ between fixed- and mobile-bearing total knee arthroplasty using titanium-nitride-coated posterior-stabilized prostheses: a prospective randomized controlled trial

Abstract

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Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

“…There are several limitations to this study, most importantly, the low number of examined components with a relatively short in vivo service time. It is very difficult to collect such retrievals because TiN coated implants are not routinely used in large groups of patients (Breugem et al, ; Buechel Sr et al, ; Buechel Sr et al, ; Park et al, ; Thienpont, ; Van Hove et al, ). This is reflected by lack of registry data and a small body of literature regarding Ti(Nb)N coated arthroplasties, and retrieval studies focused on such implants also involved small sample numbers (Bone & Naylor, ; Fabry et al, ; Harman et al, ; Khatkar et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ; Malviya et al, ; Raimondi & Pietrabissa, ).…”

“…Coating wear and presence of defects could also negatively affect tribological properties of the implants, potentially accelerating polyethylene wear and osteolysis (Wang, Polineni, Stark, & Dumbleton, ). Nonetheless, data from studies published so far did not demonstrate increased failure rates for TiN coated TKRs, and a study by Fabry et al suggested that TiN coated femoral components are more scratch resistant than oxidized zirconia films and conventional CoCrMo components which could minimize topside wear (Breugem et al, ; Fabry et al, ; Park et al, ; Thienpont, ; Van Hove et al, ). In the present study, femoral components of TKRs and UNIs had lower damage scores and fewer microscopic signs of wear than tibial components, suggesting that application of TiN coatings may potentially minimize topside wear in total and partial knee replacements, but has a limited effect on wear of the tibial mobile bearings.…”

“…Although TiN coatings have been used in arthroplasty for many decades, there is very little data available regarding their performance in knee replacements (Bone & Naylor, ; Breugem et al, ; Buechel Sr et al, ; Buechel Sr et al, ; Fabry et al, ; Haider et al, ; Harman et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ; Lappalainen & Santavirta, ; Malviya et al, ; Mohammed et al, ; Österle et al, ; Park et al, ; Park et al, ; Raimondi & Pietrabissa, ; Reich et al, ; Saxler et al, ; Serro et al, ; Sonntag, Reinders, & Kretzer, ; Subramanian, Muraleedharan, Ananthakumar, & Jayachandran, ; Weisenburger et al, ). Clinical studies indicated comparable mid‐term outcomes of Ti(Nb)N coated and conventional knee arthroplasties (Breugem et al, ; Mohammed et al, ; Park et al, ; Park et al, ; Van Hove et al, ). Since some studies demonstrated that implants with Ti(Nb)N and similar coatings have decreased allergenic potential in comparison to CoCrMo implants, they are an attractive alternative in metal sensitive patients (Lachiewicz et al, ; Reich et al, ; Thienpont, ; Thomsen et al, ).…”

“…Titanium nitride (TiN) and titanium niobium nitride (TiNbN) coatings have been used in arthroplasty since the 1980s because of their hardness and good tribological properties (Bone & Naylor, ; Breugem, Linnartz, Sierevelt, Bruijn, & Driessen, ; Buechel, Pappas, & Helbig, ; Buechel Sr, Buechel Jr, Helbig, D'Alessio, & Pappas, ; Buechel Sr, Buechel Jr, & Pappas Jr, ; Fabry, Zietz, Baumann, Ehall, & Bader, ; Harman, Banks, & Hodge, ; Hirschmann, Helfrich, & Friederich, ; Łapaj, Markuszewski, Wendland, Mróz, & Wierusz‐Kozłowska, ; Łapaj, Wendland, Markuszewski, Mróz, & Wiśsniewski, ; Mohammed, Metcalfe, & Woodnutt, ; Pappas, Makris, & Buechel, ; Park, Kang, Bae, & Song, ; Park, Kim, & In, ; Raimondi & Pietrabissa, ; Saxler, Temmen, & Bontemps, ). Their application is relatively inexpensive and can be easily performed in implants already used clinically without any major modifications of their design (Reich et al, ).…”

“…In such applications, the integrity and durability of the coating are of paramount importance, but despite a long history of clinical use, only a small number of studies regarding TiN coated total knee replacements (TKRs) are available (Breugem et al, ; Buechel et al, ; Fabry et al, ; Haider, Weisenburger, Croson, Namavar, & Garvin, ; Malikian, Maruthainar, Stammers, Wilding, & Blunn, ; Mohammed et al, ; Pappas et al, ; Park et al, ; Park et al, ; Saxler et al, ; Thienpont, ; Van Hove, Brohet, van Royen, & Nolte, ). Most of these papers demonstrated clinical results comparable to those of conventional TKRs, but very little is known about the durability of TiN coatings in vivo (Breugem et al, ; Fabry et al, ; Mohammed et al, ; Park et al, ; Saxler et al, ; Thienpont, ; Van Hove et al, ). The only retrieval analysis conducted so far used semiquantitative damage scoring and optical microscopy examination.…”