Backside Wear in Modern Total Knee Designs

Abstract

Although modularity affords various options to the orthopedic surgeon, these benefits come at a price. The unintended bearing surface between the back surface of the tibial insert and the metallic tray results in micromotion leading to polyethylene wear debris. The objective of this study was to examine the backside wear of tibial inserts from three modern total knee designs with very different locking mechanisms: Insall-Burstein II® (IB II®), Optetrak®, and Advance®. A random sample of 71 inserts were obtained from our institution’s retrieval collection and examined to assess the extent of wear, depth of wear, and wear damage modes. Patient records were also obtained to determine patient age, body mass index, length of implantation, and reason for revision. Modes of wear damage (abrasion, burnishing, scratching, delamination, third body debris, surface deformation, and pitting) were then scored in each zone from 0 to 3 (0 = 0%, 1 = 0–10%, 2 = 10–50%, and 3 = >50%). The depth of wear was subjectively identified as removal of manufacturing identification markings stamped onto the inferior surface of the polyethylene. Both Advance® and IB II® polyethylene inserts showed significantly higher scores for backside wear than the Optetrak® inserts. All IB II® and Advance® implants showed evidence of backside wear, whereas 17% (5 out of 30) of the retrieved Optetrak® implants had no observable wear. There were no significant differences when comparing the depth of wear score between designs. The locking mechanism greatly affects the propensity for wear and should be considered when choosing a knee implant system.

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References

  1. 1.

    Pavone V, Youm T, Baldini T et al (2004) Bilateral cobalt alloy femoral component fracture: a case report. Am J Orthop 33:185–189

    PubMed  Article  Google Scholar 

  2. 2.

    Wright TM, Fukubayashi T, Burstein AH (1981) The effect of carbon fiber reinforcement on contact area, contact pressure, and time-dependent deformation in polyethylene tibial components. J Biomed Mater Res 15:719–730

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Connelly GM, Rimnac CM, Wright TM et al (1984) Fatigue crack propagation behavior of ultrahigh molecular weight polyethylene. J Orthop Res 2:119–125

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Wright TM, Rimnac CM, Faris PM et al (1988) Analysis of surface damage in retrieved carbon fiber-reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements. J Bone Joint Surg Am 70:1312–1319

    PubMed  CAS  Google Scholar 

  5. 5.

    Wright TM, Astion DJ, Bansal M et al (1988) Failure of carbon fiber-reinforced polyethylene total knee-replacement components. A report of two cases. J Bone Joint Surg Am 70:926–932

    PubMed  CAS  Google Scholar 

  6. 6.

    Bostrom MP, Bennett AP, Rimnac CM et al (1994) The natural history of ultra high molecular weight polyethylene. Clin Orthop Relat Res 309:20–28

    PubMed  Google Scholar 

  7. 7.

    Rimnac CM, Klein RW, Betts F et al (1994) Post-irradiation aging of ultra-high molecular weight polyethylene. J Bone Joint Surg Am 76:1052–1056

    PubMed  CAS  Google Scholar 

  8. 8.

    Li S, Chang JD, Barrena EG et al (1995) Nonconsolidated polyethylene particles and oxidation in Charnley acetabular cups. Clin Orthop Relat Res 319:54–63

    PubMed  Google Scholar 

  9. 9.

    Gomez-Barrena E, Li S, Furman BS et al (1998) Role of polyethylene oxidation and consolidation defects in cup performance. Clin Orthop Relat Res 352:105–117

    PubMed  Article  Google Scholar 

  10. 10.

    Rawlinson JJ, Furman BD, Li S et al (2006) Retrieval, experimental, and computational assessment of the performance of total knee replacements. J Orthop Res 24:1384–1394

    PubMed  Article  Google Scholar 

  11. 11.

    Wright TM, Bartel DL (1986) The problem of surface damage in polyethylene total knee components. Clin Orthop Relat Res 205:67–74

    PubMed  Google Scholar 

  12. 12.

    Bartel DL, Bicknell VL, Wright TM (1986) The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement. J Bone Joint Surg Am 68:1041–1051

    PubMed  CAS  Google Scholar 

  13. 13.

    Babis GC, Trousdale RT, Morrey BF (2002) The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg AM 84A:64–68

    Google Scholar 

  14. 14.

    Barrack RL (1994) Modularity of Prosthetic Implants. J Am Acad Orthop Surg 2:16–25

    PubMed  Google Scholar 

  15. 15.

    Engh GA, Koralewicz LM, Pereles TR (2000) Clinical results of modular polyethylene insert exchange with retention of total knee arthroplasty components. J Bone Joint Surg Am 82:516–523

    PubMed  CAS  Google Scholar 

  16. 16.

    Bert JM, Reuben J, Kelly F et al (1998) The incidence of modular tibial polyethylene insert exchange in total knee arthroplasty when polyethylene failure occurs. J Arthroplast 13:609–614

    Article  CAS  Google Scholar 

  17. 17.

    Cuckler JM, Lemons J, Tamarapalli JR et al (2003) Polyethylene damage on the nonarticular surface of modular total knee prostheses. Clin Orthop Relat Res 410:248–253

    PubMed  Article  Google Scholar 

  18. 18.

    Li S, Scuderi G, Furman BD et al (2002) Assessment of backside wear from the analysis of 55 retrieved tibial inserts. Clin Orthop Relat Res 404:75–82

    PubMed  Article  Google Scholar 

  19. 19.

    Wasielewski RC, Parks N, Williams I et al (1997) Tibial insert undersurface as a contributing source of polyethylene wear debris. Clin Orthop Relat Res 345:53–59

    PubMed  Article  Google Scholar 

  20. 20.

    Conditt MA, Ismaily SK, Alexander JW et al (2004) Backside wear of modular ultra-high molecular weight polyethylene tibial inserts. J Bone Joint Surg Am 86A:1031–1037

    Google Scholar 

  21. 21.

    Estupinan JA, Bartel DL, Wright TM (1998) Residual stresses in ultra-high molecular weight polyethylene loaded cyclically by a rigid moving indenter in nonconforming geometries. J Orthop Res 16:80–88

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Griffin FM, Scuderi GR, Gillis AM, Li S, Jimenez E, Smith T (1998) Osteolysis associated with cemented total knee arthroplasty. J Arthroplast 13:592–598

    Article  CAS  Google Scholar 

  23. 23.

    Rodriguez JA, Baez N, Rasquinha V et al (2001) Metal-backed and all-polyethylene tibial components in total knee replacement. Clin Orthop Relat Res 392:174–183

    PubMed  Article  Google Scholar 

  24. 24.

    Engh GA, Parks NL, Ammeen DJ (1994) Tibial osteolysis in cementless total knee arthroplasty. A review of 25 cases treated with and without tibial component revision. Clin Orthop Relat Res 309:33–43

    PubMed  Google Scholar 

  25. 25.

    Surace MF, Berzins A, Urban RM, Jacobs JJ, Berger RA, Natarajan RN, Andriacchi TP, Galante JO (2002) Coventry Award paper. Backsurface wear and deformation in polyethylene tibial. Clin Orthop Relat Res (404):14–23

  26. 26.

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

    CAS  Google Scholar 

  27. 27.

    Engh GA (1988) Failure of the polyethylene bearing surface of a total knee replacement within four years. A case report. J Bone Joint Surg Am 70:1093–1096

    PubMed  CAS  Google Scholar 

  28. 28.

    Burstein AH, Wright TM (1994) Fundamentals of orthopaedic biomechanics. Williams & Wilkins, Baltimore, pp 203–210

    Google Scholar 

  29. 29.

    Wang A, Polineni VK, Stark C et al (1998) Effect of femoral head surface roughness on the wear of ultrahigh molecular weight polyethylene acetabular cups. J Arthroplast 13:615–620

    Article  CAS  Google Scholar 

  30. 30.

    Rao AR, Engh GA, Collier MB et al (2002) Tibial interface wear in retrieved total knee components and correlations with modular insert motion. J Bone Joint Surg Am 84A:1849–1855

    Google Scholar 

  31. 31.

    Conditt MA, Stein JA, Noble PC (2004) Factors affecting the severity of backside wear of modular tibial inserts. J Bone Joint Surg Am 86A:305–311

    Google Scholar 

  32. 32.

    Font-Rodriguez DE, Scuderi GR, Insall JN (1997) Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res 345:79–86

    PubMed  Article  Google Scholar 

  33. 33.

    Stern SH, Insall JN (1992) Posterior stabilized prosthesis. Results after follow-up of nine to twelve years. J Bone Joint Surg Am 74A:980–986

    Google Scholar 

  34. 34.

    Hood RW, Wright TM, Burstein AH (1993) Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses. J Biomed Mater Res 17:829–842

    Article  Google Scholar 

  35. 35.

    Crowninshield RD, Wimmer MA, Jacobs JJ et al (2006) Clinical performance of contemporary tibial `polyethylene components. J Arthroplast 21:754–761

    Article  Google Scholar 

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Correspondence to Timothy M. Wright PhD.

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Jayabalan, P., Furman, B.D., Cottrell, J.M. et al. Backside Wear in Modern Total Knee Designs. HSS Jrnl 3, 30–34 (2007). https://doi.org/10.1007/s11420-006-9033-0

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Key words

  • polyethylene
  • wear
  • knee
  • backside
  • back surface
  • locking mechanism