The influence of a calcium sulphate bone void filler on the third-body damage and polyethylene wear of total knee arthroplasty

Cowie, Raelene M.; Aiken, S. S.; Cooper, H. John; Jennings, Louise

doi:10.1302/2046-3758.82.bjr-2018-0146.r1

Cited by 6 publications

(19 citation statements)

References 31 publications

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“…Scratching the counterfaces with a diamond stylus allowed the geometry of the scratches to be more closely controlled. Previous studies have shown the lip height of scratches on retrieved hip and knee implants to be in the range of 0.01-4.1 µm [25,26] and experimental studies have shown larger scratch lip heights, up to 4 µm, to increase the wear of both hip [27] and knee implants [28]. To create a scratch of the same lip height in PEEK, a lower axial load was applied to the diamond stylus against the PEEK plates compared to CoCr due to the lower hardness of the PEEK polymer (Table A1) [18].…”

Section: Discussionmentioning

confidence: 99%

Third Body Wear of UHMWPE-on-PEEK-OPTIMA™

Cowie

Pallem

Briscoe³

et al. 2020

Materials

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PEEK-OPTIMA™ is being considered as an alternative to cobalt chrome (CoCr) in the femoral component of total knee replacements. To date, investigations of ultra-high molecular weight polyethylene (UHMWPE)-on-PEEK have shown an equivalent wear rate to conventional implant materials under standard conditions. In this study, the third body wear performance of UHMWPE-on-PEEK was directly compared to UHMWPE-on-CoCr in a series of pin-on-plate studies using two approaches for third body damage. Damage simulation with particles of bone cement showed a significant (p < 0.001), four-fold increase in the mean surface roughness of PEEK plates compared to CoCr. However, wear simulation against the damaged plates showed no significant difference in the wear of UHMWPE pins against the different materials (p = 0.59), and a polishing effect by the pin against the PEEK plates was observed. Scratching PEEK and CoCr counterfaces with a diamond stylus to create scratches representative of severe third body damage (4 µm lip height) resulted in a significantly higher (p = 0.01) wear of UHMWPE against CoCr compared to PEEK and again, against PEEK plates, polishing by the UHMWPE pin led to a reduction in scratch lip height. This study shows that in terms of its wear performance under third body wear/damage conditions, UHMWPE-on-PEEK differs from conventional knee replacement materials.

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Section: Discussionmentioning

confidence: 99%

Third Body Wear of UHMWPE-on-PEEK-OPTIMA™

Cowie

Pallem

Briscoe³

et al. 2020

Materials

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“… 52 , 53 Cone fracture 54 underneath the tibial insert is another failure mode seen in mobile designs but rarely found in fixed-bearing knees. Further investigation is required to understand whether novel biomaterials could reduce implant wear in TKA 55 or reduce the incidence of component breakage.…”

Section: Discussionmentioning

confidence: 99%

Effect of material selection on tibial post stresses in posterior-stabilized knee prosthesis

Huang

Hsu

et al. 2020

Bone & Joint Research

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Aims The material and design of knee components can have a considerable effect on the contact characteristics of the tibial post. This study aimed to analyze the stress distribution on the tibial post when using different grades of polyethylene for the tibial inserts. In addition, the contact properties of fixed-bearing and mobile-bearing inserts were evaluated. Methods Three different grades of polyethylene were compared in this study; conventional ultra high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (HXLPE), and vitamin E-stabilized polyethylene (VEPE). In addition, tibial baseplates with a fixed-bearing and a mobile-bearing insert were evaluated to understand differences in the contact properties. The inserts were implanted in neutral alignment and with a 10° internal malrotation. The contact stress, von Mises stress, and equivalent plastic strain (PEEQ) on the tibial posts were extracted for comparison. Results The stress and strain on the tibial post for the three polyethylenes greatly increased when the insert was placed in malrotation, showing a 38% to 56% increase in von Mises stress and a 335% to 434% increase in PEEQ. The VEPE insert had the lowest PEEQ among the three materials. The mobile-bearing design exhibited a lower increase in stress and strain around the tibial posts than the fixed-bearing design. Conclusion Using VEPE for the tibial component potentially eliminates the risk of material permanent deformation. The mobile-bearing insert can help to avoid a dramatic increase in plastic strain around the tibial post in cases of malrotation. The mobility allows the pressure to be distributed on the tibial post and demonstrated lower stresses with all three polyethylenes simulated. Cite this article: Bone Joint Res 2020;9(11):768–777.

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“…Pubic symphysis osteomyelitis is a rare complication following urological surgery (Kahokehr et al, 2020;Lavien et al, 2017;Nosé et al, 2020). Bony infection of the pubic symphysis following urological surgery typically presents with pain in the groin or paramidline over the pubis with tenderness with or without purulent drainage from previous incisions (Burns and Gregory, 1977;Del Busto et al, 1982;Gupta et al, 2015). Additionally, patients may have difficulty or pain with ambulation over the pubic symphysis (Devlieger et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, patients may have difficulty or pain with ambulation over the pubic symphysis (Devlieger et al, 2020). In acute cases of osteomyelitis, there may be elevated C-reactive protein (CRP), leukocytosis, and elevated erythrocyte sedimentation rate (ESR) (Del Busto et al, 1982;Gupta et al, 2015). However, in chronic osteomyelitis, there is a compromised local or systemic immune response, and inflammatory markers may not be elevated (Cierny et al, Cierny and DiPasquale, 2006;Panteli and Giannoudis, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Imaging, which involves radiographs and magnetic resonance imaging (MRI), may be utilized to further confirm the diagnosis of pubic symphysis osteomyelitis. However, in acute cases of osteomyelitis, standard radiographs may not demonstrate any abnormal findings (Del Busto et al, 1982). In these situations, MRI may be particularly useful; additionally, MRI can identify any urinary fistulas and guide urological surgical planning (Plateau et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Orthopedic management of pubic symphysis osteomyelitis: a case series

Shu

Elhessy

Conway

et al. 2021

J. Bone Joint Infect.

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Abstract. Objectives: The purpose of this case series is to describe the orthopedic management of pubic symphysis osteomyelitis with an emphasis on the key principles of treating bony infection. Furthermore, we sought to identify whether debridement of the pubic symphysis without subsequent internal fixation would result in pelvic instability. Methods: A retrospective chart review was performed to identify all cases of pubic symphysis osteomyelitis treated at both institutions from 2011 to 2020. Objective outcomes collected included infection recurrence, change in pubic symphysis diastasis, sacroiliac (SI) joint diastasis, and ambulatory status. Subjective outcome measures collected included the numeric pain rating scale (NPRS) and the 36-Item Short Form Survey (SF-36). Pubic symphysis diastasis was measured as the distance between the two superior tips of the pubis on a standard anterior–posterior (AP) view of the pelvis. SI joint diastasis was measured bilaterally as the joint space between the ileum and sacrum approximately at the level of the sacral promontory on the inlet view of the pelvis. A paired t test was utilized to compare the differences in outcome measures. An α value of 0.05 was utilized. Results: Six patients were identified, of which five were males and one was female (16.7 %), with a mean ± standard deviation (SD) follow-up of 19 ± 12 months (range 6–37 months). Mean ± SD age was 76.2 ± 9.6 years (range 61.0–88.0 years) and body mass index (BMI) was 28.0 ± 2.9 kg/m2 (range 23.0–30.8 kg/m2). When postoperative radiographs were compared to final follow-up radiographs, there were no significant differences in pubic symphysis diastasis (P = 0.221) or SI joint diastasis (right, P = 0.529 and left, P = 0.186). All patients were ambulatory without infection recurrence at final follow-up. Mean improvement for NPRS was 5.6 ± 3.4 (P = 0.020) and mean improvement for SF-36 physical functioning was 53.0 ± 36.8 (P = 0.032). Conclusion: This case series highlights our treatment strategy for pubic symphysis osteomyelitis of aggressive local debridement with local antibiotic therapy. Additionally, debridement of the pubic symphysis without subsequent internal fixation did not result in pelvic instability, as determined by pelvic radiographs and ability to fully weight bear postoperatively.

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The influence of a calcium sulphate bone void filler on the third-body damage and polyethylene wear of total knee arthroplasty

Cited by 6 publications

References 31 publications

Third Body Wear of UHMWPE-on-PEEK-OPTIMA™

Third Body Wear of UHMWPE-on-PEEK-OPTIMA™

Effect of material selection on tibial post stresses in posterior-stabilized knee prosthesis

Orthopedic management of pubic symphysis osteomyelitis: a case series

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