Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 1860–1868 | Cite as

Knee Wear Measured in Retrievals: A Polished Tray Reduces Insert Wear

  • Daniel J. Berry
  • John H. Currier
  • Michael B. Mayor
  • John P. Collier
Symposium: Retrieval Studies



Polyethylene wear is often cited as the cause of failure of TKA. Rotating platform (RP) knees show notable surface damage on the rotating surface raising concerns about increased wear compared to fixed bearing inserts.


We therefore addressed the following questions: Is wear in RP inserts increased compared to that in fixed bearing inserts? Does the surface roughness of the tibial tray have a measurable impact on in vivo wear of modular knees? And does wear rate differ between posterior stabilized (PS) and cruciate retaining (CR) knees?


We compared wear in two series of retrieved knee devices: 94 RP mobile bearings with polished cobalt-chrome (CoCr) trays and 218 fixed bearings with both rough titanium (Ti) and polished CoCr trays. Minimum implantation time was 0.4 months (median, 36 months; range, 0.4–124 months) and 2 months (median, 72 months; range, 2–179 months) for the RP and fixed bearing series, respectively.


Wear rate was lower for RP inserts than for fixed bearing inserts. Backside wear rate was lower for fixed bearing inserts mated to polished CoCr trays than for inserts from rough Ti trays. Inserts against polished trays (RP or fixed bearing) showed no increase in wear rate increase over time. Wear rate of PS knees was similar to that of CR knees.


We found mobile bearing knees have reduced wear rate compared to fixed bearings, likely due to the polished CoCr tibial tray surface. Fixed bearing inserts in polished CoCr trays wear less than their counterparts in rough Ti trays, and the wear rate of inserts from polished CoCr trays does not appear to increase with time.



The authors thank the surgeons who have collaborated with our institutions by sending retrieved devices for analysis. We also thank DePuy Orthopaedics, Inc, for providing the design and manufacturing data for the implants studied in this investigation, without which this type of clinical retrieval analysis is not possible.


  1. 1.
    Atwood SA, Currier JH, Mayor MB, Collier JP, Van Citters DW, Kennedy FE. Clinical wear measurement on low contact stress rotating platform knee bearings. J Arthroplasty. 2008;23:431–440.PubMedCrossRefGoogle Scholar
  2. 2.
    Bartel DL, Rawlinson JJ, Burstein AH, Ranawat CS, Flynn WF. Stresses in polyethylene components of contemporary total knee replacements. Clin Orthop Relat Res. 1995;317:76–82.PubMedGoogle Scholar
  3. 3.
    Benjamin J, Szivek J, Dersam G, Persselin S, Johnson R. Linear and volumetric wear of tibial inserts in posterior cruciate-retaining knee arthroplasties. Clin Orthop Relat Res. 2001;392:131–138.PubMedCrossRefGoogle Scholar
  4. 4.
    Billi F, Sangiorgio SN, Aust S, Ebramzadeh E. Material and surface factors influencing backside fretting wear in total knee replacement tibial components. J Biomech. 2010;43:1310–1315.PubMedCrossRefGoogle Scholar
  5. 5.
    Bragdon CR, O’Connor DO, Lowenstein JD, Jasty M, Syniuta WD. The importance of multidirectional motion on the wear of polyethylene. Proc Inst Mech Eng H. 1996;210:157–165.PubMedGoogle Scholar
  6. 6.
    Buechel FF. Mobile-bearing knee arthroplasty: rotation is our salvation! J Arthroplasty. 2004;19:27–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Burroughs BR, Blanchet TA. Factors affecting the wear of irradiated UHMWPE. Tribol Trans. 2001;44:215–223.CrossRefGoogle Scholar
  8. 8.
    Callagan JJ, Liu SS. Posterior cruciate ligament-substituting total knee arthroplasty. In: Scott WN, ed. Surgery of the Knee. New York, NY: Elsevier; 2006:1531–1557.Google Scholar
  9. 9.
    Cheng CK, Huang CH, Liau JJ, Huang CH. The influence of surgical malalignment on the contact pressures of fixed and mobile bearing knee prostheses—a biomechanical study. Clin Biomech (Bristol, Avon). 2003;18:231–236.CrossRefGoogle Scholar
  10. 10.
    Collier MB, Engh CA, McAuley JP, Ginn SD, Engh GA. Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert—findings at five to ten years postoperatively. J Bone Joint Surg Am. 2005;87:2702–2708.PubMedCrossRefGoogle Scholar
  11. 11.
    Conditt MA, Stein JA, Noble PC. Factors affecting the severity of backside wear of modular tibial inserts. J Bone Joint Surg Am. 2004;86:305–311.PubMedGoogle Scholar
  12. 12.
    Conditt MA, Thompson MT, Usrey MM, Ismaily SK, Noble PC. Backside wear of polyethylene tibial inserts: mechanism and magnitude of material loss. J Bone Joint Surg Am. 2005;87:326–331.PubMedCrossRefGoogle Scholar
  13. 13.
    Crowninshield RD, Wimmer MA, Jacobs JJ, Rosenberg AG. Clinical performance of contemporary tibial polyethylene components. J Arthroplasty. 2006;21:754–761.PubMedCrossRefGoogle Scholar
  14. 14.
    Cuckler JM, Lemons J, Tamarapalli JR, Beck P. Polyethylene damage on the nonarticular surface of modular total knee prostheses. Clin Orthop Relat Res. 2003;410:248–253.PubMedCrossRefGoogle Scholar
  15. 15.
    Dennis DA, Komistek RD. Mobile-bearing total knee arthroplasty: design factors in minimizing wear. Clin Orthop Relat Res. 2006;452:70–77.PubMedCrossRefGoogle Scholar
  16. 16.
    D’Lima DD, Trice M, Urquhart AG, Colwell CW. Tibiofemoral conformity and kinematics of rotating-bearing knee prostheses. Clin Orthop Relat Res. 2001;386:235–242.PubMedCrossRefGoogle Scholar
  17. 17.
    Engh GA, Lounici S, Rao AR, Collier MB. In vivo deterioration of tibial baseplate locking mechanisms in contemporary modular total knee components. J Bone Joint Surg Am. 2001;83:1660–1665.PubMedGoogle Scholar
  18. 18.
    Engh GA, Zimmerman RL, Parks NL, Engh CA. Analysis of wear in retrieved mobile and fixed bearing knee inserts. J Arthroplasty. 2009;24:28–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Fisher J, McEwen H, Tipper J, Jennings L, Farrar R, Stone M, Ingham E. Wear-simulation analysis of rotating-platform mobile-bearing knees. Orthopedics. 2006;29:S36–S41.PubMedGoogle Scholar
  20. 20.
    Garcia RM, Kraay MJ, Messerschmitt PJ, Goldberg VM, Rimnac CM. Analysis of retrieved ultra-high-molecular-weight polyethylene tibial components from rotating-platform total knee arthroplasty. J Arthroplasty. 2009;24:131–138.PubMedCrossRefGoogle Scholar
  21. 21.
    Hood RW, Wright TM, Burstein AH. Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses. J Biomed Mater Res. 1983;17:829–842.PubMedCrossRefGoogle Scholar
  22. 22.
    Kelly NH, Fu RH, Wright TM, Padgett DE. Wear damage in mobile-bearing TKA is as severe as that in fixed-bearing TKA. Clin Orthop Relat Res. 2011;469:123–130.PubMedCrossRefGoogle Scholar
  23. 23.
    Kendrick BJ, Longino D, Pandit H, Svard U, Gill HS, Dodd CA, Murray DW, Price AJ. Polyethylene wear in Oxford unicompartmental knee replacement: a retrieval study of 47 bearings. J Bone Joint Surg Br. 2010;92:367–373.PubMedCrossRefGoogle Scholar
  24. 24.
    Kop AM, Swarts E. Quantification of polyethylene degradation in mobile bearing knees—a retrieval analysis of the anterior-posterior-glide (APG) and rotating platform (RP) low contact stress (LCS) knee. Acta Orthop. 2007;78:364–370.PubMedCrossRefGoogle Scholar
  25. 25.
    Landy MM, Walker PS. Wear of ultra-high-molecular-weight polyethylene components of 90 retrieved knee prostheses. J Arthroplasty. 1988;3:S73–S85.PubMedCrossRefGoogle Scholar
  26. 26.
    Li S, Scuderi G, Furman BA, Bhattacharyya S, Schmieg JJ, Insall JN. Assessment of backside wear from the analysis of 55 retrieved tibial inserts. Clin Orthop Relat Res. 2002;404:75–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Lonner JH, Siliski JM, Scott RD. Prodromes of failure in total knee arthroplasty. J Arthroplasty. 1999;14:488–492.PubMedCrossRefGoogle Scholar
  28. 28.
    Lu YC, Huang CH, Chang TK, Ho FY, Cheng CK, Huang CH. Wear-pattern analysis in retrieved tibial inserts of mobile-bearing and fixed-bearing total knee prostheses. J Bone Joint Surg Br. 2010;92:500–507.PubMedCrossRefGoogle Scholar
  29. 29.
    Muratoglu OK, Bragdon CR, O’Connor DO, Jasty M, Harris WH, Gul R, McGarry F. Unified wear model for highly crosslinked ultra-high molecular weight polyethylenes (UHMWPE). Biomaterials. 1999;20:1463–1470.PubMedCrossRefGoogle Scholar
  30. 30.
    Muratoglu OK, Ruberti J, Melotti S, Spiegelberg SH, Greenbaum ES, Harris WH. Optical analysis of surface changes on early retrievals of highly cross-linked and conventional polyethylene tibial inserts. J Arthroplasty. 2003;18:42–47.PubMedCrossRefGoogle Scholar
  31. 31.
    Parks NL, Engh GA, Topoleski LD, Emperado J. The Coventry Award. Modular tibial insert micromotion: a concern with contemporary knee implants. Clin Orthop Relat Res. 1998;356:10–15.PubMedCrossRefGoogle Scholar
  32. 32.
    Rao AR, Engh GA, Collier MB, Lounici S. Tibial interface wear in retrieved total knee components and correlations with modular insert motion. J Bone Joint Surg Am. 2002;84:1849–1855.PubMedGoogle Scholar
  33. 33.
    Schmalzried TP, Jasty M, Rosenberg A, Harris WH. Polyethylene wear debris and tissue-reactions in knee as compared to hip-replacement prostheses. J Appl Biomater. 1994;5:185–190.PubMedCrossRefGoogle Scholar
  34. 34.
    Scuderi GR, Clarke HD. Cemented posterior stabilized total knee arthroplasty. J Arthroplasty. 2004;19:17–21.PubMedCrossRefGoogle Scholar
  35. 35.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Surace MF, Berzins A, Urban RM, Jacobs JJ, Berger RA, Natarajan RN, Andriacchi TP, Galante JO. Coventry Award paper. Backsurface wear and deformation in polyethylene tibial inserts retrieved postmortem. Clin Orthop Relat Res. 2002;404:14–23.PubMedCrossRefGoogle Scholar
  37. 37.
    Wang A. A unified theory of wear for ultra-high molecular weight polyethylene in multi-directional sliding. Wear. 2001;248:38–47.CrossRefGoogle Scholar
  38. 38.
    Wasielewski RC, Parks N, Williams I, Surprenant H, Collier JP, Engh G. Tibial insert undersurface as a contributing source of polyethylene wear debris. Clin Orthop Relat Res. 1997;345:53–59.PubMedCrossRefGoogle Scholar
  39. 39.
    Wright TM, Rimnac CM, Stulberg SD, Mintz L, Tsao AK, Klein RW, McCrae C. Wear of polyethylene in total joint replacements: observations from retrieved PCA knee implants. Clin Orthop Relat Res. 1992;276:126–134.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Daniel J. Berry
    • 1
  • John H. Currier
    • 2
  • Michael B. Mayor
    • 2
  • John P. Collier
    • 2
  1. 1.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA
  2. 2.Dartmouth Biomedical Engineering Center, Thayer School of EngineeringDartmouth CollegeHanoverUSA

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