The Causes of Insert Backside Wear in Total Knee Arthroplasty

Wasielewski, Ray C.

doi:10.1097/00003086-200211000-00037

Cited by 62 publications

(34 citation statements)

References 73 publications

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“…Based on these observations we conclude that the effect of backside wear was low. This outcome is not surprising for the tibial inserts because the MG II design exhibits low conformity and to a large extent, backside wear in TKRs is strongly associated with high-conformity tibial inserts [38]. The mean wear rate of 38 mm 3 per year for the entire THR group was slightly less than the range of 40 to 83 mm 3 per year previously reported for historical PE of that generation, GUR 4150 gamma-sterilized in air [25,34].…”

Section: Discussionmentioning

confidence: 84%

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: 84%

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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“…A historical TKA implant system was examined, but this was a deliberate choice as it enabled us to independently examine surface roughness and sterilization methods as factors, without any confounding influences from comparing across manufacturers or models. Implant design has been found to influence backside wear [7]. The locking mechanism used in the examined implant is known to be weak.…”

Section: Discussionmentioning

confidence: 99%

“…Factors influencing backside wear have been identified, including component material (cobalt-chromium or titanium), locking mechanism design, and surface roughness [2][3][4][5][6][7][8][9][10]. Another major factor influencing polyethylene wear (at all interfaces) is the method of implant sterilization.…”

mentioning

confidence: 99%

Contribution of Surface Polishing and Sterilization Method to Backside Wear in Total Knee Arthroplasty

Teeter

Lanting

Shrestha

et al. 2015

The Journal of Arthroplasty

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“…Moreover micromotion up to 25 µwith a cyclic axial load [2] and at least of 100 µ with anteroposterior 82 Chir Organi Mov (2008) 92:79-83 and mediolateral loads, have been recorded on the undersurface of polyethylene between the tibial insert and baseplate in several modular fixed-bearing implants; this might create an undesirable second interface where a back-side wear will occur [2,16,18,19]. Finally, even distinguished fixed-bearings surgeons pronounce in favor of mobile-bearings as the best way to improve long-term wear performance in total knee replacements [14].…”

Section: Discussionmentioning

confidence: 99%

“…In the knee joint, the implant should gain mobility and stability with respect to the normal kinematics, avoiding peaks of stress on the polyethylene surface and constraint forces on the tibial component. In fact, flat-on-flat designs allow a wide mobility but the mechanical load increases, which causes higher contact stress; in contrast, implants with an intrinsic constraint transmit the complex multidirectional stresses acting on the knee joint mainly on the tibial baseplate, leading to its mechanical mobilization in the intermediate term [1,2]. A total knee replacement with a mobile bearing, maintaining the congruity of the surfaces and providing unconstrained mobility, should represent the proper compromise to reduce significantly the polyethylene wear [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Comparison among total knee arthroplasties with a mobile bearing: menisci versus rotating platform versus AP glide platform

et al. 2008

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A retrospective study was conducted on 60 patients (53 females, seven males with a mean age of 68 years and 5 months) who underwent a total knee replacement using a mobile bearing. The diagnosis was primary osteoarthritis in 57 cases and rheumatoid arthritis in three cases. None of the patients underwent a bilateral procedure, thus 60 implants (33 all cementless, three all cemented, 24 with only the tibial component cemented) were considered. Three different groups were identified: Group 1: first 20 total knee arthroplasties with menisci. Group 2: first 20 total knee arthroplasties with rotating platform. Group 3: first 20 total knee arthroplasties with AP glide platform. Clinical and radiological results at the final follow up, although different in time among the three groups, have shown no revision due to mechanical or septic reasons, and no signs of impending failure.

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The Causes of Insert Backside Wear in Total Knee Arthroplasty

Cited by 62 publications

References 73 publications

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

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

Contribution of Surface Polishing and Sterilization Method to Backside Wear in Total Knee Arthroplasty

Comparison among total knee arthroplasties with a mobile bearing: menisci versus rotating platform versus AP glide platform

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