The influence of design, materials and kinematics on the in vitro wear of total knee replacements

McEwen, H.M.J.; Barnett, P.I.; Bell, Carol; Farrar, R.; Auger, D D; Stone, Martin; Fisher, John

doi:10.1016/j.jbiomech.2004.02.015

Cited by 285 publications

(244 citation statements)

References 17 publications

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“…Elevated crosslinked polyethylenes reduce wear rates in TKA simulator studies [8,19,21], but this benefit must be balanced with the mechanical changes that accompany the increased crosslinking, specifically reduced fracture toughness and reduced resistance to fatigue crack propagation [3,6,10].…”

Section: Discussionmentioning

confidence: 99%

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

Dolan

Kelly

Nguyen

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The tibial post in posterior-stabilized total knees is a potential source of polyethylene wear debris, but the relationship between the shape and location of the tibial post in relation to the tibiofemoral bearing surfaces and the subsequent wear damage patterns remains unknown. Questions/purposes We used observations made on retrieved implant components from three contemporary posterior-stabilized knee designs to examine how differences in tibial post design affected wear damage on the post. Methods We examined 113 retrieved Zimmer NexGen 1 , 103 Exactech Optetrak 1 , and 58 Smith and Nephew Genesis 1 II posterior-stabilized inserts using a subjective scale to grade post damage.Results All 274 inserts demonstrated wear damage. Total wear scores and scores for wear damage on the anterior post differed among designs: Optetrak 1 20 ± 4 and 5 ± 1, NexGen 1 13 ± 4 and 3 ± 1, and Genesis 1 II 8 ± 3 and 1 ± 1, respectively. The Optetrak 1 had predominantly anterior wear damage, the NexGen 1 had more global wear damage, and the Genesis 1 II had predominantly posterior wear damage. Tibial post wear damage and anterior post wear damage were primarily determined by implant design and to a lesser extent by length of implantation and revision diagnosis. Conclusions Although tibial post wear damage is multifactorial, the primary determinant of wear damage, and specifically anterior wear damage, is implant design. Clinical Relevance The constraint provided by the posterior-stabilized post-cam contact in modern knee arthroplasties is reflected in the wear damage patterns that occur during in vivo use. Unintended constraint such as anterior impingement should be addressed through design modifications for future posterior-stabilized knee arthroplasties.

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Section: Discussionmentioning

confidence: 99%

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

Dolan

Kelly

Nguyen

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Over 1 billion cycles of testing have been completed and published in the last decade in both pin-on-plate and knee simulator studies, providing a robust platform for standardized comparison of both materials and designs. Knee simulator studies were undertaken on the Prosim knee simulator (Simulation Solutions, Manchester, UK) [4,11,12,22]. Two sets of tests were carried out: (1) comparison of fixed-bearing PFC sigma knee to the PFC sigma rotating platform knee (DePuy International) and (2) comparison of sigma fixed-bearing knee with low conforming fixed-bearing knee, where the curved tibial insert was replaced by a flat polymer insert.…”

Section: Methodsmentioning

confidence: 99%

“…The irradiation level was between 2.5 and 4 MRad, indicating moderate levels of cross-linking, which was available for both types of knee design. Tests were carried out using the ISO loading profile 2.6 KN with a medial offset load and flexion extension waveform of 0°to 58°r epresenting standard gait [22]. For high kinematic conditions displacement was controlled with internal external rotation set at ± 5°as in the natural knee and anterior posterior displacement set at 0 to 10 mm [22].…”

Section: Methodsmentioning

confidence: 99%

“…It is important to differentiate the delamination wear mechanisms, which produce fatigue failure [6,19], from the surface wear mechanisms, which produce submicron-and nanometer-sized wear particles and result in long-term osteolysis [16,17,24]. Surface wear leading to the potential of osteolysis is considered the longer-term risk factor, particularly since increased kinematics with more active patients substantially increases wear rates and the total wear volume in fixed-bearing knees [4,22].…”

Section: Introductionmentioning

confidence: 99%

“…Medium levels of cross-linking of 5 to 7.5 MRad are now more commonly used in the knee. Medium cross-linking (5 MRad) reduces surface wear by approximately 30% compared to gammairradiated in barrier pack polyethylene in the knee [22]. Given there is a limitation to the level of cross-linking that can be applied in the knee, it is important to consider other tribological design factors that may be used to reduce polyethylene surface wear.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees

Fisher

Jennings

Galvin

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Knee arthroplasties in young and active patients place a substantial increase in the lifetime tribological demand and potential for wear-induced osteolysis. Polyethylene materials have advanced in recent years, reducing the potential for oxidative degradation and delamination failure. It is timely to consider tribological design variables and their potential to reduce surface wear and the long-term risk of osteolysis. The influence of reduced cross shear in rotating platform mobile-bearing knee designs and reduced surface wear area in low conforming fixed-bearing knees has been investigated. A reduction in cross shear substantially reduced wear in both multidirectional pin-on-plate studies and in rotating platform mobile-bearing designs in knee simulator studies. A reduction in bearing surface contact area substantially reduced surface wear in multidirectional pin-on-plate simulations and in low conforming fixed-bearing knee designs in knee simulator studies. This offers potential for a paradigm shift in knee design predicated by enhanced mechanical properties of new polymer materials. We describe two distinct low-wearing tribological design solutions: (1) a rotating platform design solution with reduced cross shear provides reduced wear with conformity and intrinsic stability; and (2) a low conformity fixed bearing with reduced surface area, provides reduced wear, but has less intrinsic stability and requires good soft tissue function.

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Experimental Wear Studies of Total Joint Replacements

Brockett¹,

Fisher²

2013

Biotribology

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The influence of design, materials and kinematics on the in vitro wear of total knee replacements

Cited by 285 publications

References 17 publications

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees

Experimental Wear Studies of Total Joint Replacements

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