Rapid Screening of Retrieved Knee Prosthesis Components by Confocal Raman Micro-Spectroscopy

Abstract

(1) Aim: To evaluate the failure reason and surface modifications of a retrieved knee prosthesis; (2) Methods: Rapid confocal Raman spectroscopy screening was applied on the surface of a retrieved knee prosthesis (both titanium and UHMWPE (Ultra-high-molecular-weight polyethylene) component) in order to determine predominate implant damage, along with the chemical composition of synovial fluid accumulated in the stem of the tibial component during the implantation period. Correlations between the medical records of the patient (clinical and radiographic information) and spectroscopic results are pointed out, the parameters being interpreted in the context of proper functioning and life span of knee prosthesis; (3) Results: The metallic tibial component does not show any modification during the implantation period, as demonstrated by the well preserved titanium component with signature of anatase phase detected in retrieved component, compared to unused piece. The spectral features of polymeric component (ultrahigh molecular weight polyethylene, UHMWPE) revealed structural modification in crystallinity and amorphous phase accompanied by insignificant level of oxidation (OI < 1). Scratching, pitting and persistent organic spots as a result of mechanical and chemical deterioration were noticed on the surface of retrieved insert. Acrylic cement deterioration was also noticed. Synovial fluid collected from the stem of the tibial component demonstrated a lipidomic profile; (4) Conclusions: Combining the clinical evidences with confocal Raman spectroscopy allowed a rapid screening with high sensitivity and nondestructive measurements in the case of failure in TKA (total knee arthroplasty). The third body wear and lipidomic profile of synovial fluid are cumulative factors of failure in this case, resulting in an osteolysis that finally leads to an aseptic loosening.

Restoring the Patient’s Pre-Arthritic Posterior Slope Is the Correct Target for Maximizing Internal Tibial Rotation When Implanting a PCL Retaining TKA with Calipered Kinematic Alignment

“…MA surgeons commonly use techniques such as increasing the posterior slope and PCL recession and release to increase knee flexion; however, they cause a loss of internal tibial rotation and risk tibial component failure [3,5]. A Calipered KA that sets the components patient-specific to restore the patient's individual pre-arthritic joint lines within ±0.5 mm has the biomechanical advantage of retaining the PCL and restoring native knee tibial compartment forces and laxities during passive flexion without ligament release [23][24][25][32][33][34].…”

Comparing Metabolic Preconditioning and Diabetes As Risk Factors in Knee Arthroplasty Complications

“…A study emphasized that the impact of associated diseases and post-surgical complications on the physical function of patients who underwent total hip replacement is more significant than the influence of BMI itself [11]. Recently, two classifications were considered based on several clinical trials, shedding light on rapidly progressive osteoarthritis [12][13][14].…”

“…Rapidly progressive osteoarthritis type 1 described by Lequesne [14] involves a reduction in joint space width of over 2 mm within a year. In contrast, rapidly progressive osteoarthritis type 2 is characterized by massive bone loss and severe injury such as osteolysis [12,13]. In clinical trials involving anti-nerve growth factor (NGF) treatments, these types of rapidly progressive osteoarthritis are generally observed (though not always) in joints with pre-existing osteoarthritis [15].…”