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The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear.

Questions/purposes

We therefore examined whether the design changes between HF and posterior-stabilized (PS) tibial inserts would affect overall damage or damage on their articular surface, backside, and tibial post and whether flexion angle achieved related to damage.

Methods

We matched 20 retrieved HF inserts to 20 retrieved PS inserts from the same implant system on the basis of duration of implantation, body mass index, and age. Inserts were divided into 16 zones and a microscopic analysis of surface damage was carried out. Five inserts were scanned using micro-CT to further quantify instances of severe post notching. We determined overall damage with a scoring system.

Results

We found greater backside and post damage in the HF group but no difference in the articular surface or overall damage scores. Backside and post damage scores correlated to flexion angle in the HF group. There was no flexion/damage correlation in the PS group. Notch depths around the post in both groups ranged from 0.6 to 1.9 mm.

Conclusions

HF inserts are more susceptible to post damage, possibly as a result of higher contact stresses from greater flexion. The increased backside damage was unexpected because the two groups have the same tibial component, locking mechanism, and sterilization method.

Clinical Relevance

The introduction of a highly crosslinked HF insert will require close scrutiny as a result of the potential for post damage demonstrated in this series.

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Acknowledgments

We thank Lyndsay Somerville for her guidance in the area of statistical analysis.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, London Health Sciences Centre—University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Nicholas R. Paterson BScH, Steven J. MacDonald MD, FRCSC, Richard W. McCalden MD, MPhil(Edin), FRCSC & Douglas D. R. Naudie MD, FRCSC

  2. Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada

    Matthew G. Teeter BScH, PhD

  3. Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada

    Matthew G. Teeter BScH, PhD

Authors
  1. Nicholas R. Paterson BScH
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  2. Matthew G. Teeter BScH, PhD
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  3. Steven J. MacDonald MD, FRCSC
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  4. Richard W. McCalden MD, MPhil(Edin), FRCSC
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  5. Douglas D. R. Naudie MD, FRCSC
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Corresponding author

Correspondence to Douglas D. R. Naudie MD, FRCSC.

Additional information

The institution of one or more of the authors (NRP, RWM, SJM, DDRN) has received funding from DePuy Orthopaedics, Warsaw, IN, USA; Smith & Nephew, Memphis, TN, USA; and Stryker, Mahwah, NJ, USA.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at The London Health Sciences Centre, London, Ontario, Canada.

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Paterson, N.R., Teeter, M.G., MacDonald, S.J. et al. The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-stabilized Tibial Inserts. Clin Orthop Relat Res 471, 56–63 (2013). https://doi.org/10.1007/s11999-012-2387-3

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  • DOI: https://doi.org/10.1007/s11999-012-2387-3

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