Review Article: Osteolysis After Total Knee Arthroplasty

Gupta, Sanjay; Chu, Alice; Ranawat, Amar S.; Slamin, John; Ranawat, Chitranjan S.

doi:10.1016/j.arth.2007.05.041

Cited by 118 publications

(88 citation statements)

References 27 publications

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“…Given the high local stresses and the possibility of edge loading on tibial inserts, there is a question regarding whether highly crosslinked PE is necessary in TKRs, or if moderately crosslinked PE would be sufficient to mitigate wear and osteolysis. Our findings, in conjunction with the lower incidence of osteolysis in TKR compared with THR components [12], suggest a moderately crosslinked PE could be sufficient. This hypothesis could be investigated by applying the methods used herein on a cohort of contemporary implants made from crosslinked PEs.…”

Section: Discussionmentioning

confidence: 54%

“…This comparison entailed adjusting the wear rates to a patient age of 70 years to account for age dependence, and included only active patients. Given that wear particles from tibial wear tend to be larger than those from acetabular liners made from historical PE, approximately by a factor of three [33], the lower wear rate for knees suggests that the number of submicron particles generated from knee wear could be more than an order magnitude lower than for hips, consistent with the lower incidence of wear-induced osteolysis reported for knees [11,12].…”

Section: Discussionmentioning

confidence: 66%

“…Interestingly, the incidence of osteolysis appears lower in patients with a TKR than a THR [12]. We hypothesized that, for the same interval and in the absence of material fatigue, the TKR/THR wear volume ratio would be less than one.…”

Section: Discussionmentioning

confidence: 98%

“…This ratio is for active patients and excludes delaminated tibial liners. The lower TKR wear rate and assumed subsequent lower particle burden is in line with the lower incidence of osteolysis in TKRs compared with THRs [11,12]. Although we used components made from historical PE in this study, the approach we used to evaluate wear of tibial inserts also can be applied to contemporary retrieved tibial inserts.…”

Section: Discussionmentioning

confidence: 99%

“…Others have worked on more complex technologies to allow quantitative, volumetric wear measurements on PE inserts [9,19,35,36]. Because the incidence and extent of osteolysis after TKRs are less than that after THRs [12], we hypothesized that, for the same interval and in the absence of material fatigue (PE delamination), the TKR/THR wear volume ratio would be less than one.…”

Section: Introductionmentioning

confidence: 99%

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How Does Wear Rate Compare in Well-functioning Total Hip and Knee Replacements? A Postmortem Polyethylene Liner Study

Pourzal

Knowlton

Hall

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The longevity of total hip (THR) and knee replacements (TKR) that used historical bearing materials of gamma-in-air sterilized UHMWPE was affected more by osteolysis in THRs than in TKRs, although osteolysis remains a concern in TKRs. Therefore, the study of polyethylene wear is still of interest for the knee, particularly because few studies have investigated volumetric material loss in tibial knee inserts. For this study, a unique collection of autopsy-retrieved TKR and THR components that were well-functioning at the time of retrieval was used to compare volumetric wear differences between hip and knee polyethylene components made from identical material. Questions/purposes The following questions were addressed: (1) How much did the hip liners wear and what wear patterns did they exhibit? (2) How much did the knee inserts wear and what wear patterns did they exhibit? (3) What is the ratio between TKR and THR wear after controlling for implantation time and patient age? Methods We compared 23 THR components (HarrisGalante [HG] and HG II) and 20 TKR components (MillerGalante [MG II]) that were retrieved postmortem. The components were made from the same polyethylene formulation and with similar manufacturing and sterilization (gamma-in-air) processes. Twenty-one patients (12 males, nine females) had THRs and 16 (four males, 12 females) had TKRs. Patients who had TKRs had an older (p = 0.001) average age than patients who had THRs (age, 75 years; SD, 10, versus 66 years; SD, 12, respectively). Only wellfunctioning components were included in this study. Therefore, implants retrieved postmortem from physically active patients and implanted for at least 2 years were considered. In addition, only normally wearing TKR components were considered, ie, those with fatigue wear (delamination) were excluded. The wear volume of each component was measured using metrology. For the tibial inserts an autonomous mathematic reconstruction method was used for quantification. Results The acetabular liners of the THR group had a wear rate of 38 mm 3 per year (95% CI, 29-47 mm 3 /year). Excluding patients with low-activity, the wear rate was 47 mm 3 per year (95% CI, 37-56 mm 3 /year). The wear rate of normally wearing tibial inserts was 17 mm 3 per year (95% CI, À6 to 40 mm 3 /year). After controlling for the relevant confounding variable of age, we found a TKR/THR wear rate ratio of 0.5 (95% CI, 0.29-0.77) at 70 years of age with a slightly increasing difference with increasing age. Conclusions Excluding delamination, TKRs exhibited lower articular wear rates than THRs for historical polyethylene in these two unique cohorts of postmortem retrievals.

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Section: Discussionmentioning

confidence: 54%