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Surface Damage Versus Tibial Polyethylene Insert Conformity: A Retrieval Study

  • Symposium: Retrieval Studies
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Surface damage of the tibial polyethylene insert in TKA is thought to diminish with increasing conformity, based on computed lower contact stresses. Added constraint from higher conformity may, however, result in greater forces in vivo.

Questions/purposes

We therefore determined whether increased conformity was associated with increased surface pitting, delamination, creep, and polishing in a group of retrieved tibial inserts.

Methods

We compared 38 inserts with a dished articular surface (conforming group) with 31 inserts that were unconstrained and nonconforming in the sagittal plane (less conforming group). The two groups had identical polyethylene composition and processing history. The articulating surfaces were scored for pitting, delamination, deformation/creep, and polishing. Evidence of edge loading and the presence of embedded bone cement were also recorded.

Results

The conforming inserts were associated with higher delamination and pitting scores but lower polishing scores, even after adjusting for the effects of sex, age, insert thickness, and implantation duration. Long implantation duration and male sex were also associated with increased delamination, pitting, and polishing, whereas long shelf life was associated only with increased delamination. The conforming group also had approximately a fourfold greater prevalence of edge loading and approximately a threefold greater prevalence of embedded bone cement. The latter was associated with higher scores and proportions of delamination and pitting.

Conclusions

These findings suggest more conformity may increase surface fatigue damage in TKA. Higher constraint-induced stresses during secondary motions and more possibility for edge loading and bone cement capture on a dished surface may account for these results.

Clinical Relevance

The selection of materials with high fatigue resistance may be particularly important for high-conformity/constraint tibial inserts. In addition, awareness of the benefits and trade-offs with conformity may allow better matching of TKA design to patient.

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Acknowledgments

The authors thank Thorsten Schwenke and Vivek Shekhawat who as two of the three independent observers performed the visual examination and scoring of the tibial articular components. We also thank Dr Sanjib Basu, Division of Statistics, Northern Illinois University, DeKalb, IL, USA, for providing statistical consultation and Dr Anne Mündermann for helpful editorial input. This manuscript is dedicated to Dr. Aivars Berzins, our friend and colleague who initiated this study but, sadly, was unable to complete it before his sudden death.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL, 60612, USA

    Markus A. Wimmer PhD, Michel P. Laurent PhD, Jeannie D. Haman PhD, Joshua J. Jacobs MD & Jorge O. Galante MD

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  1. Markus A. Wimmer PhD
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  2. Michel P. Laurent PhD
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  3. Jeannie D. Haman PhD
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  4. Joshua J. Jacobs MD
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  5. Jorge O. Galante MD
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Corresponding author

Correspondence to Joshua J. Jacobs MD.

Additional information

One or more of the authors (JJJ) have received funding from the NIH (NIH Grant AR39310) and the Crown Family Chair. One or more of the authors has or may receive payments or benefits, in any 1 year, an amount in excess of $10,000 (JJJ) or $1,000,0000 (JOG) from a commercial entity related to this work (Zimmer, Inc, Warsaw, IN, USA). The institution of the authors has received, in any 1 year, funding from Zimmer, Inc.

Each author certifies that his or her institution has 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.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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Wimmer, M.A., Laurent, M.P., Haman, J.D. et al. Surface Damage Versus Tibial Polyethylene Insert Conformity: A Retrieval Study. Clin Orthop Relat Res 470, 1814–1825 (2012). https://doi.org/10.1007/s11999-012-2274-y

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