Wear in total knee arthroplasty—just a question of polyethylene?

Abstract

Purpose Biological reactions against wear particles are a common cause for revision in total knee arthroplasty. To date, wear has mainly been attributed to polyethylene. However, the implants have large metallic surfaces that also could potentially lead to metal wear products (metal ions and debris). The aim of this study was to determine the local release of cobalt, chromium, molybdenum and titanium in total knee arthroplasty during a standard knee wear test. Methods Four moderately conforming fixed-bearing implants were subjected to physiological loadings and motions for 5×10 6 walking cycles in a knee wear simulator. Polyethylene wear was determined gravimetrically and the release of metallic wear products was measured using high resolutioninductively coupled plasma-mass spectrometry. Results A polyethylene wear rate of 7.28±0.27 mg/10 6 cycles was determined and the cumulative mass of released metals measured 1.63±0.28 mg for cobalt, 0.47±0.06 mg for chromium, 0.42±0.06 mg for molybdenum and 1.28±0.14 mg for titanium. Conclusion For other metallic implants such as metal-on-metal total hip arthroplasty, the metal wear products can interact with the immune system, potentially leading to immunotoxic effects. In this study about 12 % by weight of the wear products were metallic, and these particles and ions may become clinically relevant for patients sensitive to these materials in particular. Non-metallic materials (e.g. ceramics or suitable coatings) may be considered for an alternative treatment for those patients.

Chemometric evaluation of concentrations of trace elements in intervertebral disc tissue in patient with degenerative disc disease

“…Implants can produce a cell response, not only in close proximity, but may also may trigger a systemic response with the immune component. Although the influence of the implants are evaluated in local tissue or in blood [26], that is currently in use, to the best of the knowledge of the authors of the current study, there is no information confirming distant tissue TE alternation in such cases.…”

Wear in human knees

“…Wear products in artificial joints may induce biological reactions [106][107][108], such as irritation and the local accumulation of macrophages and osteoclasts [109]. Some work reported that particles in the size range of 0.1-1 mm were the most biological active [107].…”

Knee arthroplasty today

“…Innocenti [14] gives an excellent understanding on how to diagnose and treat patients with such a condition reporting encouraging results when an appropriate diagnostic protocol is applied and an appropriate allergic implant is positioned, and Kretzner [15] remind us that hypersensitivity may start from the positioned implant releasing metal ions from wear of the substrate determining local response and thus. similarly to P.E debris, to loosening of the implant.…”