Polyethylene wear in knee arthroplasty

Goodman, Stuart B.; Lidgren, Lars

doi:10.3109/17453679209154804

Cited by 51 publications

(15 citation statements)

References 58 publications

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“…It might thus be explained by a higher volume of polyethylene particles in the joint (Goodman and Lidgren 1992). Such an association is also supported by similar phenomena observed when assessing wear and loosening of cups after hip arthroplasty (Wroblewski et al 2004, Wilkinson et al 2005).…”

Section: Discussionmentioning

confidence: 99%

Failure of total knee arthroplasty with or without patella resurfacing

Lygre¹,

Espehaug²,

Havelin³

et al. 2011

Acta Orthopaedica

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Background and purposePatella resurfacing during primary total knee arthroplasty (TKA) is disputed and new prosthesis designs have been introduced without documentation of their survival. We assessed the impact on prosthesis survival of patella resurfacing and of prosthesis brand, based on data from the Norwegian Arthroplasty Register.Patients and methods5 prosthesis brands in common use with and without patella resurfacing from 1994 through 2009 were included n = 11,887. The median follow-up times were 9 years for patella-resurfaced implants and 7 years for implants without patella resurfacing. For comparison of prosthesis brands, also brands in common use with only one of the two treatment options were included in the study population (n = 25,590). Cox regression analyses were performed with different reasons for revision as endpoints with adjustment for potential confounders.ResultsWe observed a reduced overall risk of revision for patella resurfaced (PR) TKAs, but the statistical significance was borderline (RR = 0.84, p = 0.05). At 15 years, 92% of PR and 91% of patella non resurfaced (NR) prostheses were still unrevised. However, PR implants had a lower risk of revision due to pain alone (RR = 0.1, p < 0.001), but a higher risk of revision due to loosening of the tibial component (RR = 1.4, p = 0.03) and due to a defective polyethylene insert (RR = 3.2, p < 0.001).At 10 years, the survival for the reference NR brand AGC Universal was 93%. The NR brands Genesis I, Duracon, and Tricon (RR = 1.4–1.7) performed statistically significantly worse than NR AGC Universal, while the NR prostheses e.motion, Profix, and AGC Anatomic (RR = 0.1–0.7), and the PR prostheses NexGen and AGC Universal (RR = 0.4–0.5) performed statistically significantly better. LCS, NexGen, LCS Complete (all NR), and Tricon, Genesis I, LCS, and Kinemax (all PR) showed no differences in this respect from the reference brand. A lower risk of revision (crude) was found for TKAs performed after 2000 as compared to those performed earlier (RR = 0.8, p = 0.001).InterpretationAlthough revision risk was similar for PR and NR TKAs, we found important differences in reasons for revision. Our results also indicate that survivorship of TKAs has improved.

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Section: Discussionmentioning

confidence: 99%

Failure of total knee arthroplasty with or without patella resurfacing

Lygre¹,

Espehaug²,

Havelin³

et al. 2011

Acta Orthopaedica

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“…Subtle changes in polyethylene properties through oxidative degradation, inferior designs for the articular surfaces, poor surgical technique, and a greater mechanical burden placed on implants by young, active patients often result in unacceptably high failure rates due to wear. [6][7][8][9][10][11][12][13][14] To improve wear performance, either the stresses need to be decreased or the wear resistance of the material needs to be increased. Research and development is proceeding on both fronts to better understand, for example, the structure of UHMWPE, 15,16 its potential for improvement, [17][18][19] and its mechanical response as a function of design.…”

Section: Introductionmentioning

confidence: 99%

Retrieval, experimental, and computational assessment of the performance of total knee replacements

Rawlinson

Furman

et al. 2006

J. Orthop. Res.

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Wear mechanisms in polyethylene components for total knee replacements are inherently mechanical; the local stresses or strains exceed some material limit. Retrieval analysis and knee simulators have provided the means to quantify the damage observed in vivo or in vitro. These results have been circumstantially linked to the material stresses obtained from computational simulations using finite element analysis, knee simulator tests, and computational simulations of two condylar knee designs. We hypothesize that if an equivalent loading environment is produced in the computational simulation, we can correlate the distribution of computed stresses with observed damage of simulator specimens and further relate design differences to in vivo performance from retrieval analyses. The finite element model agreed with the knee simulator kinematics and kinetics within 2-13%, and composite FEA contact areas matched 66-90% of the damage areas due to burnishing on the simulator specimens. Burnishing was the primary mode of damage for both the simulator and retrieval specimens corresponding with the relatively low magnitudes of contact stress observed. Both the computational and experimental techniques underpredicted the amount determined from retrieval analysis, but the differences between the two designs were consistent for all three methods. Combining these techniques strengthens the applicability of the computational simulation while highlighting the complementary approach of these methods for preclinical testing and assessing the link between material state and damage.

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“…One of the most significant factors that leads to revision in total joint arthroplasty is the damage to and failure of ultrahigh molecular weight polyethylene (UHMWPE). [1][2][3][4] Although many factors can affect the performance of UHMWPE in artificial joints, most investigators have adopted a purely mechanical force approach (e.g., estimation of stress distribution or trials to increase the strength of materials). [5][6][7][8][9][10] In addition, postirradiation oxidative degradation of UHMWPE is also receiving attention as a potential factor influencing the performance of UHMWPE.…”

Section: Introductionmentioning

confidence: 99%

Analysis of ultrahigh molecular weight polyethylene failure in artificial knee joints: Thermal effect on long-term performance

Young

Cheng²,

Lee

et al. 1999

J. Biomed. Mater. Res.

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The mechanism resulting in damage to and failure of ultrahigh molecular weight polyethylene (UHMWPE) tibial inserts was investigated on clinically retrieved components. The severity of the subsurface damage increased with the length of time that the component had been implanted. A theoretical analysis was developed to account for the generation of subsurface damage based on a heat transfer model. Friction generates surface heat during articulation of total knee systems. Due to the cooling effect of body fluid on the surface, the rise in temperature on the UHMWPE surface is lower than that below the surface. The peak temperature was estimated to occur on a plane positioned about 1 to 2 mm below the surface. This result was similar to the bulk temperature variation observed during in vivo and in vitro studies by other investigators. Although the difference in temperature on and below the surface is only a few degrees, the thermal effect becomes apparent after a long time and may be explained by the viscoelastic behavior of polymers: the temperature-time equivalence. It is therefore suggested that this thermal effect is another contributory factor to material damage, in addition to high stress and oxidative degradation (in appropriate cases). Therefore, any technological efforts aimed at improving the performance of artificial joint prostheses should minimize the thermal effects at the subsurface of the articular components.

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Polyethylene wear in knee arthroplasty

Cited by 51 publications

References 58 publications

Failure of total knee arthroplasty with or without patella resurfacing

Failure of total knee arthroplasty with or without patella resurfacing

Retrieval, experimental, and computational assessment of the performance of total knee replacements

Analysis of ultrahigh molecular weight polyethylene failure in artificial knee joints: Thermal effect on long-term performance

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