Wear and Osteolysis Around Total Knee Arthroplasty

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.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Polyethylene Wear Is Influenced by Manufacturing Technique in Modular TKA

Lombardi

Ellison

Berend

2008

“…We understand this precludes any conclusions regarding long-term differences in the weight, size, and shape of polyethylene wear particles in the TKAs with an OxZr femoral component and in those with a Co-Cr femoral component. Although polyethylene wear particles from failed knee prostheses yield important information, polyethylene wear particles in such failed TKA prostheses are generated in extreme conditions [2,23] and might be affected by unstable interface and third bodies; thus we believe such data from patients who are functioning well yield complementary data.…”

Section: Discussionmentioning

confidence: 99%

Weight of Polyethylene Wear Particles is Similar in TKAs with Oxidized Zirconium and Cobalt-chrome Prostheses

Kim

Huh

et al. 2010

Background The greater lubricity and resistance to scratching of oxidized zirconium femoral components are expected to result in less polyethylene wear than cobaltchrome femoral components. Questions/purposes We examined polyethylene wear particles in synovial fluid and compared the weight, size (equivalent circle diameter), and shape (aspect ratio) of polyethylene wear particles in knees with an oxidized zirconium femoral component with those in knees with a cobalt-chrome femoral component. Patients and Methods One hundred patients received an oxidized zirconium femoral component in one knee and a cobalt-chrome femoral component in the other. There were 73 women and 27 men with a mean age of 55.6 years (range, 44-60 years). The minimum followup was 5 years (mean, 5.5 years; range, 5-6 years). Polyethylene wear particles were analyzed using thermogravimetric methods and scanning electron microscopy. Results The weight of polyethylene wear particles produced at the bearing surface was 0.0223 ± 0.0054 g in 1 g synovial fluid in patients with an oxidized zirconium femoral component and 0.0228 ± 0.0062 g in patients with a cobalt-chrome femoral component. Size and shape of polyethylene wear particles were 0.59 ± 0.05 lm and 1.21 ± 0.24, respectively, in the patients with an oxidized zirconium femoral component and 0.52 ± 0.03 lm and 1.27 ± 0.31, respectively, in the patients with a cobaltchrome femoral component. Knee Society knee and function scores, radiographic results, and complication rate were similar between the knees with an oxidized zirconium and cobalt-chrome femoral component. Conclusions The weight, size, and shape of polyethylene wear particles were similar in the knees with an oxidized zirconium and a cobalt-chrome femoral component. We found the theoretical advantages of this surface did not provide the actual advantage. Level of Evidence Level I, therapeutic study. See the guidelines for Authors for a complete description of levels of evidence.

“…Tibial component polyethylene wear, with resultant particle-induced osteolysis, is one of the causes of late failure, component loosening, and reoperation after TKA [13,21,23]. The frequency of periprosthetic osteolysis after TKA has been reported to be 5% to 20% at followup of \ 5 to 15 years [1,6,15,16,21].…”

Section: Introductionmentioning

confidence: 99%

“…The frequency of periprosthetic osteolysis after TKA has been reported to be 5% to 20% at followup of \ 5 to 15 years [1,6,15,16,21]. The prevalence and severity of polyethylene wear after TKA are related to multiple factors, including implant design, patient age and activity level, and technical issues.…”

Section: Introductionmentioning

confidence: 99%

Is There a Benefit to Highly Crosslinked Polyethylene in Posterior-stabilized Total Knee Arthroplasty? A Randomized Trial

Lachiewicz

Soileau

2016

Background Polyethylene wear and osteolysis remain a concern with the use of modular, fixed-bearing total knee arthroplasty (TKA). A variety of highly crosslinked polyethylenes (XLPs) have been introduced to address this problem, but there are few data on the results and complications of this polyethylene in posterior-stabilized knee prostheses. Questions/purposes In a randomized prospective study design comparing standard polyethylene (SP) tibial inserts with XLP inserts, we asked the following questions: (1) Are there any differences in the clinical results (as measured by the classic Knee Society scoring system) and radiographic results (as measured by an evaluation for radiolucencies and osteolysis) between these groups? (2) What is the frequency of reoperation in these two groups? (3) Are there any specific complications related to XLP liners?Methods These are preliminary data from a single surgeon of a planned interim analysis of a prospective randomized study of one modular posterior-stabilized TKA. One hundred ninety-two patients (236 knees) were randomized to receive a SP compression-molded liner or a XLP (6.5 CGy electron beam-irradiated and remelted) polyethylene liner. There was no difference in the number of knees who were lost or refused followup (14 knees . There were no differences, with the numbers available, in the presence of effusion (two of 94 XLP and five of 99 SP) with 2 years minimum followup. There were no differences in the frequency of radiolucent lines (13 knees with SP and 15 with XLP) or of osteolysis (two knees with SP and none with XLP). There was no difference in frequency of reoperation between the two groups (three infections in 110 knees allocated to the XLP group and five (two infections, one femoral loosening, one instability, one fracture plating) in