Tibial Insert Undersurface as a Contributing Source of Polyethylene Wear Debris

Wasielewski, Ray C.; Parks, Nancy L.; Williams, Ian; Surprenant, Helene P.; Collier, John; Engh, Gerard A.

doi:10.1097/00003086-199712000-00009

Cited by 145 publications

(76 citation statements)

References 18 publications

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“…3 A dial indicator was used to measure retrieved insert thickness and thereby estimate total through-thickness wear in both the medial and lateral bearing areas, respectively. source of failure [2,4,9,12,13]. Many factors have been thought to affect tibial insert backside wear [2,4,9,12,13]; there are no reported studies that look specifically at topside tibial insert conformity in near isolation while eliminating most other variables.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, clinical performance of knee bearings is often based on visual assessment of bearing surfaces rather than actual material lost [7,8,10]. Rather than surface deformation features, it is the polyethylene debris from both the abrasive and adhesive wear on the backside surface of the tibial inserts that is implicated as a cause for wear debris osteolysis [11,13].…”

Section: Discussionmentioning

confidence: 99%

“…Modular implants, however, introduce a second bearing surface that is a potential site for particle generation. Relative motion between the polyethylene insert and the tibial base plate has been shown to be a source of wear and fine polyethylene particle generation that can lead to clinically significant osteolysis and implant loosening [2,4,9,12,13]. Retrieval studies have confirmed the presence of tibial insert polyethylene backside wear and shown a relationship to the tibial insert locking mechanism and implantation time [2,4,9,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Backside wear and subsequent osteolysis were relatively rare beneath the original flat inserts but became an issue and a possible source of polyethylene wear and debris after the more rotationally conforming inserts were introduced. Although it is known that modular tibial components introduce the possibility for backside wear resulting from relative motion between the polyethylene insert and the tibial baseplate [2,4,9,12,13], it is not known to what degree that variability in the conformity of the tibial polyethylene insert itself might have on the tibial insert backside wear.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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show abstract

“…Polyethylene wear in modular TKA occurs at the articular surface and backside of the insert. Although the articular surface of the polyethylene insert is the predominant source of wear debris, a growing number of reports have implicated backside wear as a major source of polyethylene wear [7,13,22,28,37].…”

Section: Introductionmentioning

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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Digital photogrammetry for quantitative wear analysis of retrieved TKA components

et al. 2006

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The use of new materials in knee arthroplasty demands a way in which to accurately quantify wear in retrieved components. Methods such as damage scoring, coordinate measurement, and in vivo wear analysis have been used in the past. The limitations in these methods illustrate a need for a different methodology that can accurately quantify wear, which is relatively easy to perform and uses a minimal amount of expensive equipment. Off-the-shelf digital photogrammetry represents a potentially quick and easy alternative to what is readily available. Eighty tibial inserts were visually examined for front and backside wear and digitally photographed in the presence of two calibrated reference fields. All images were segmented (via manual and automated algorithms) using Adobe Photoshop and National Institute of Health ImageJ. Finally, wear was determined using ImageJ and Rhinoceros software. The absolute accuracy of the method and repeatability/reproducibility by different observers were measured in order to determine the uncertainty of wear measurements. To determine if variation in wear measurements was due to implant design, 35 implants of the three most prevalent designs were subjected to retrieval analysis. The overall accuracy of area measurements was 97.8%. The error in automated segmentation was found to be significantly lower than that of manual segmentation. The photogrammetry method was found to be reasonably accurate and repeatable in measuring 2-D areas and applicable to determining wear. There was no significant variation in uncertainty detected among different implant designs. Photogrammetry has a broad range of applicability since it is size- and design-independent. A minimal amount of off-the-shelf equipment is needed for the procedure and no proprietary knowledge of the implant is needed.

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Tibial Insert Undersurface as a Contributing Source of Polyethylene Wear Debris

Cited by 145 publications

References 18 publications

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

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

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Digital photogrammetry for quantitative wear analysis of retrieved TKA components

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