Comparison of in vivo polyethylene wear particles between mobile- and fixed-bearing TKA in the same patients



Polyethylene wear particle generation is one of the most important factors that affects the mid- to long-term results of total knee arthroplasties (TKA). Mobile-bearing total knee prostheses were developed to reduce polyethylene wear generation. However, whether mobile-bearing prostheses actually generate fewer polyethylene wear particles than fixed-bearing prostheses remains controversial. The aim of this study was to compare, within individual patients, the in vivo polyethylene wear particles created by a newly introduced mobile-bearing prosthesis in one knee and a conventional fixed-bearing prosthesis in other knee.


Eighteen patients receiving bilateral TKAs to treat osteoarthritis were included. The synovial fluid was obtained from 36 knees at an average of 3.5 years after the operation. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined using a scanning electron microscope and an image analyser.


The size and shape of the polyethylene wear particles from the mobile-bearing prostheses were similar to those from the conventional fixed-bearing prostheses. Although the number of wear particles from the mobile-bearing prosthesis (1.63 × 107 counts/knee) appeared smaller than that from the fixed-bearing prosthesis (2.16 × 107 counts/knee), the difference was not statistically significant.


The current in vivo study shows that no statistically significant differences were found between the polyethylene wear particles generated by a newly introduced mobile-bearing PS prosthesis and a conventional fixed-bearing PS prosthesis during the early clinical stage after implantation.

Level of evidence

Therapeutic study, Level III.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C (1984) Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg 66A:228–241

    Article  Google Scholar 

  2. 2.

    Benevenia J, Lee FY, Buechel F, Parsons JR (1998) Pathologic supracondylar fracture due to osteolytic pseudotumor of knee following cementless total knee replacement. J Biomed Mater Res 43:473–477

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Bland JM, Altman DG (1990) A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comput Biol Med 20:337–340

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    DeHeer DH, Engels JA, DeVries AS, Knapp RH, Beebe JD (2001) In situ complement activation by polyethylene wear debris. J Biomed Mater Res 54:12–19

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Delport HP, Sloten JV, Bellemans J (2010) Comparative gravimetric wear analysis in mobile versus fixed-bearing posterior stabilized total knee prostheses. Acta Orthop Belg 76:367–373

    PubMed  Google Scholar 

  6. 6.

    Engh GA, Dwyer KA, Hanes CK (1992) Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prosthesis. J Bone Joint Surg 74B:9–17

    Google Scholar 

  7. 7.

    Ewald F (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  8. 8.

    Fisher J, Jennings LM, Galvin AL, Jin ZM, Stone MH, Ingham E (2010) 2009 Knee Society Presidential Guest Lecture: polyethylene wear in total knees. Clin Orthop Relat Res 468:12–18

    Article  PubMed  Google Scholar 

  9. 9.

    Grupp TM, Kaddick C, Schwiesau J, Maas A, Stulberg SD (2009) Fixed and mobile bearing total knee arthroplasty–influence on wear generation, corresponding wear areas, knee kinematics and particle composition. Clin Biomech (Bristol, Avon) 24:210–217

    CAS  Article  Google Scholar 

  10. 10.

    Hinarejos P, Piñol I, Torres A, Prats E, Gil-Gómez G, Puig-Verdie L (2013) Highly crosslinked polyethylene does not reduce the wear in total knee arthroplasty: in vivo study of particles in synovial fluid. J Arthroplasty 28:1333–1337

    Article  PubMed  Google Scholar 

  11. 11.

    Insall J, Dorr L, Scott R, Scott W (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  12. 12.

    Iwakiri K, Minoda Y, Kobayashi A, Sugama R, Iwaki H, Inori F, Hashimoto Y, Ohashi H, Ohta Y, Fukunaga K, Takaoka K (2009) In vivo comparison of wear particles between highly crosslinked polyethylene and conventional polyethylene in the same design of total knee arthroplasties. J Biomed Mater Res B Appl Biomate 91:799–804

    Article  Google Scholar 

  13. 13.

    Kadoya Y, Revell PA, al-Saffar N, Kobayashi A, Scott G, Freeman MA (1996) Bone formation and bone resorption in failed total joint arthroplasties: histomorphometric analysis with histochemical and immunohistochemical technique. J Orthop Res 14:473–482

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Kadoya Y, Revell PA, Kobayashi A, al-Saffar N, Scott G, Freeman MA (1997) Wear particulate species and bone loss in failed total joint arthroplasties. Clin Orthop Relat Res 340:118–129

    Article  Google Scholar 

  15. 15.

    Kim YH, Sohn KS, Kim JS (2005) Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am 87:1470–1475

    Article  PubMed  Google Scholar 

  16. 16.

    Kurita M, Tomita T, Yamazaki T, Fujii M, Futai K, Shimizu N, Yoshikawa H, Sugamoto K (2012) In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 36:2465–2471

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Laskin RS, Davis J (2005) Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases. Knee 12:163–167

    Article  PubMed  Google Scholar 

  18. 18.

    McEwen HM, Fisher J, Goldsmith AA, Auger DD, Hardaker C, Stone MH (2001) Wear of fixed bearing and rotating platform mobile bearing knees subjected to high levels of internal and external tibial rotation. J Mater Sci Mater Med 12:1049–1052

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Takaoka K (2004) Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties. J Biomed Mater Res 71B:1–6

    CAS  Article  Google Scholar 

  20. 20.

    Minoda Y, Kobayashi A, Iwaki H, Iwakiri K, Inori F, Sugama R, Ikebuchi M, Kadoya Y, Takaoka K (2009) In vivo analysis of polyethylene wear particles after total knee arthroplasty: the influence of improved materials and designs. J Bone Joint Surg 91A(Suppl 6):67–73

    Article  Google Scholar 

  21. 21.

    Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Yamano Y, Takaoka K (2003) Polyethylene wear particles in synovial fluid after total knee arthroplasty. Clin Orthop Relat Res 410:165–172

    Article  Google Scholar 

  22. 22.

    Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Takaoka K (2005) Polyethylene wear particle generation in vivo in an alumina medial pivot total knee prosthesis. Biomaterials 26:6034–6040

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Minoda Y, Hata K, Iwaki H, Ikebuchi M, Hashimoto Y, Inori F, Nakamura H (2014) No difference in in vivo polyethylene wear particles between oxidized zirconium and cobalt–chromium femoral component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:680–686

    Article  PubMed  Google Scholar 

  24. 24.

    Mueller-Rath R, Kleffner B, Andereya S, Mumme T, Wirtz DC (2007) Measures for reducing ultra-high-molecular-weight polyethylene wear in total knee replacement: a simulator study. Biomed Tech (Berl) 52:295–300

    CAS  Article  Google Scholar 

  25. 25.

    Piñol I, Torres A, Gil G, Prats E, Puig-Verdier L, Hinarejos P (2014) Polyethylene particles in joint fluid and osteolysis in revision total knee arthroplasty. Knee 21:402–405

    Article  PubMed  Google Scholar 

  26. 26.

    Shiramizu K, Vizesi F, Bruce W, Herrmann S, Walsh WR (2009) Tibiofemoral contact areas and pressures in six high flexion knees. Int Orthop 33:403–406

    Article  PubMed  Google Scholar 

  27. 27.

    Utzschneider S, Harrasser N, Schroeder C, Mazoochian F, Jansson V (2009) Wear of contemporary total knee replacements–a knee simulator study of six current designs. Clin Biomech (Bristol, Avon) 24:583–588

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Yukihide Minoda.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Minoda, Y., Hata, K., Ikebuchi, M. et al. Comparison of in vivo polyethylene wear particles between mobile- and fixed-bearing TKA in the same patients. Knee Surg Sports Traumatol Arthrosc 25, 2887–2893 (2017).

Download citation


  • Total knee arthroplasty
  • Polyethylene wear particle
  • Mobile-bearing prosthesis
  • Fixed-bearing prosthesis