The Coventry Award Paper: Factors Influencing Wear and Osteolysis in Press-Fit Condylar Modular Total Knee Replacements

Fehring, Thomas K.; Murphy, Jeffrey A.; Hayes, T.David; Roberts, Donna; Pomeroy, Donald L.; Griffin, William L.

doi:10.1097/01.blo.0000148853.37270.67

Cited by 89 publications

(56 citation statements)

References 30 publications

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“…All failures related to polyethylene wear, osteolysis and loosening occurred in cases performed between 1993 and 1996 with all but one in the 3 year period between 1994 and 1996, years in which the polyethylene used was still sterilized in air, as opposed to in an inert environment. Several studies have demonstrated a higher failure rate related to polyethylene wear and osteolysis for this device during the time interval of the failures in this study [11]. There were no failures in the cases with polyethylene that was sterilized in an inert environment although these were the cases at the end of the study (1997,1998) with less followup.…”

Section: Discussionmentioning

confidence: 61%

“…The authors hoped to answer whether knee arthroplasties with modular tibial trays resulted in survivorship comparable to those performed without modularity in the younger patient population at long-term followup, but testing the hypothesis is difficult because there are no comparable series with similar lengths of followup in young patients with OA, and because many of the components in this series were performed during a time interval where there is now concern regarding the polyethylene processing utilized [11]. However, these and other knee arthroplasty studies of younger patients with OA should provide a benchmark for cases of similar cohorts with newer designs and materials to evaluate any improvement in survivorship with these more recent technologies.…”

Section: Discussionmentioning

confidence: 99%

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Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Odland

Callaghan

Liu

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Odland

Callaghan

Liu

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…All the inserts in this study were gamma-in-air sterilized, a known gateway to oxidation and fatigue failure [3]. The study by Fehring et al [6] did not consider the advent of the more conforming polyethylene inserts.…”

Section: Discussionmentioning

confidence: 97%

“…In a study by Fehring et al [6], five variables were identified as possible attributers to polyethylene wear: (1) shelf life; (2) polyethylene finishing method (wood tumbling or not); (3) polyethylene sheet vendor; (4) patient sex; and (5) patient age. All the inserts in this study were gamma-in-air sterilized, a known gateway to oxidation and fatigue failure [3].…”

Section: Discussionmentioning

confidence: 99%

Does Increased Topside Conformity in Modular Total Knee Arthroplasty Lead to Increased Backside Wear?

Schwarzkopf

Scott

Carlson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Modular metal-backed tibia components allow surgeons intraoperative flexibility. Although it is known that modular tibia components introduce the possibility for backside wear resulting from relative motion between the polyethylene insert and the tibial baseplate, it is not known to what degree variability in the conformity of the tibial polyethylene liner itself might contribute to backside wear. Questions/purposes The purpose of this study was to determine whether a flat, cruciate-retaining tibial polyethylene bearing generates less backside wear than a more conforming (curved) tibial polyethylene bearing in an analysis of specimens explanted during revision surgery. MethodsThe study included 70 total knee inserts explanted at revision surgery, all implanted and explanted by the same surgeon. Two different cruciate-retaining insert options in an otherwise similar knee system were used: one with a curvedon-flat (17) articular geometry and one with a highly conforming curved-on-curved design (53); both groups were sequential cohorts. The composite backside wear depth for the insert as well as the volume of backside wear was measured and compared between groups. Results The median linear backside-normalized wear for the posterior lipped inserts was 0.0063 mm/year (range, 0-0.085 mm/year), which was lower than for the curved inserts at 0.05 mm/year (range, 0.00003-0.14 mm/year) (p \ 0.001). The median calculated volumetric backsideOne of the authors (RS) has received consulting fees from Smith & Nephew (Memphis, TN, USA) (less than USD 10,000). One of the authors (RDS) has received consulting fees from DePuy (Warsaw, IN, USA) (less than USD 10,000) and royalties from DePuy (greater than USD 1,000,000). One or more of the authors (EMC, JHS) has received institutional funding from DePuy, ConforMIS (Bedford, MA, USA), and Biomet (Warsaw, IN, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was conducted at the New England Baptist Hospital, Boston, MA USA. The biomechanical material analysis was conducted at the Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. Conclusions In this retrieval study, more conforming tibial inserts demonstrated more backside-normalized wear than the flatter designs. This suggests that in this modular total knee arthroplasty design, higher articular conformity to address the issues of high bear...

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“…The sterilization process has also improved since Bohl et al demonstrated gamma irradiation in an oxygen environment resulted in poor wear characteristics [3]. Other studies have likewise demonstrated sterilization techniques that minimize free oxygen radicals using either ethylene oxide gas or gamma irradiation in an inert environment enhance wear resistance [5][6][7]16].…”

Section: Discussionmentioning

confidence: 99%

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Lombardi

Ellison

Berend

2008

Clinical Orthopaedics &Amp; Related Research

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Polyethylene insert backside surface wear is implicated in osteolysis and failure of total knee arthroplasty. Manufacturing and sterilization methods reduce articular-sided wear. We questioned whether manufacturing technique influences the severity of backside wear. We examined 39 explanted tibial bearings in a blinded fashion using visual, stereomicroscopic, and scanning electron microscopic techniques. We examined 26 direct compression molded components and 13 nondirect compression molded components and applied a new backside wear severity score. The score characterized the magnitude of the various modes of wear with severity ranging from 0 (no wear) to 27 (severe wear). Time in vivo, tibial baseplate material, and manufacturing technique were used as variables for comparison. Backside wear was related to polyethylene manufacturing process with direct compression molded implants having a wear score of 2.3 and nondirect compression molded a score of 5.7. Time in vivo influenced backside wear, although direct compression molded predicted decreased backside wear independent of time in vivo. The data suggest manufacturing technique influences backside wear in total knee arthroplasty polyethylene inserts.

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The Coventry Award Paper: Factors Influencing Wear and Osteolysis in Press-Fit Condylar Modular Total Knee Replacements

Cited by 89 publications

References 30 publications

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Does Increased Topside Conformity in Modular Total Knee Arthroplasty Lead to Increased Backside Wear?

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

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