Abstract
Purpose
With the advent of modular total knee arthroplasty (TKA) systems, backside wear at the articulation between the ultra-high-molecular-weight-polyethylene (UHMWPE) component undersurface and the tibial baseplate has received increasing attention as a source of clinically significant polyethylene wear debris. The aim of this study was to investigate the reciprocating interface at the TKA undersurface articulation using profilometry after in vivo service. Our null hypothesis was that there would be no discernible pattern or relationship between the metal tibial baseplate and UHMWPE surface profile.
Methods
A nanoscale analysis of thirty retrieved fixed-bearing TKA explants was performed. Surface roughness (Sa) and skewness (Ssk) were measured on both the UHMWPE component undersurface and the tibial baseplate of explants using a non-contacting profilometer (1 nm resolution). Four pristine unimplanted components of two different designs (Stryker Kinemax and DePuy PFC) were examined for control purposes.
Results
Mean explant baseplate surface roughness was 1.24 μm (0.04–3.01 μm). Mean explant UHMWPE undersurface roughness was 1.16 μm (0.23–2.44 μm). Each explant had an individual roughness pattern with unique baseplate and undersurface UHMWPE surface roughness that was different from, but closely related to, surface topography observed in control implants of the same manufacturer and design. Following in vivo service, UHMWPE undersurface showed changes towards a negative skewness, demonstrating that wear is occurring at the backside interface.
Conclusion
In vivo loading of the TKA prosthesis leads to measurable changes in surface profile at the backside articulation, which appear to be dependent on several factors including implant design and in vivo duration. These findings are consistent with wear occurring at this surface. Findings of this study would support the use of a polished tibial tray over an unpolished design in total knee arthroplasty with the goal of reducing PE wear by means of providing a smoother backside countersurface for the UHMWPE component.
Similar content being viewed by others
References
Abdel MP, Gesell MW, Hoedt CW, Meyers KN, Wright TM, Haas SB (2014) Polished trays reduce backside wear independent of post location in posterior-stabilized TKAs. Clin Orthop Relat Res 472:2477–2482
Azzam MG, Roy ME, Whiteside LA (2011) Second-generation locking mechanisms and ethylene oxide sterilization reduce tibial insert backside damage in total knee arthroplasty. J Arthroplasty 26:523–530
Berry DJ, Currier JH, Mayor MB, Collier JP (2012) Knee wear measured in retrievals: a polished tray reduces insert wear. Clin Orthop Relat Res 470:1860–1868
Billi F, Sangiorgio SN, Aust S, Ebramzadeh E (2010) Material and surface factors influencing backside fretting wear in total knee replacement tibial components. J Biomech 43:1310–1315
Brandt J-M, Guenther L, O’Brien S, Vecherya A, Turgeon TR, Bohm ER (2013) Performance assessment of femoral knee components made from cobalt–chromium alloy and oxidized zirconium. Knee 20:388–396
Brandt J-M, MacDonald SJ, Bourne RB, Medley JB (2012) Retrieval analysis of modular total knee replacements: factors influencing backside surface damage. Knee 19:306–315
Brandt J-M, Medley JB, MacDonald SJ, Bourne RB (2011) Delamination wear on two retrieved polyethylene inserts after gamma sterilization in nitrogen. Knee 18:125–129
Collier MB, Engh CA, McAuley JP, Ginn SD, Engh GA (2005) 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 87:2702–2708
Conditt MA, Stein JA, Noble PC (2004) Factors affecting the severity of backside wear of modular tibial inserts. J Bone Joint Surg Am 86-A:305–311
Conditt MA, Thompson MT, Usrey MM, Ismaily SK, Noble PC (2005) Backside wear of polyethylene tibial inserts: mechanism and magnitude of material loss. J Bone Joint Surg Am 87:326–331
Dowson D, Taheri S, Wallbridge NC (1987) The role of counterface imperfections in the wear of polyethylene. Wear 119:277–293
Fisher J, Firkins P, Reeves EA, Hailey JL, Isaac GH (1995) The influence of scratches to metallic counterfaces on the wear of ultra-high molecular weight polyethylene. Proc Inst Mech Eng H 209:263–264
Heyse TJ, Elpers ME, Nawabi DH, Wright TM, Haas SB (2014) Oxidized zirconium versus cobalt-chromium in TKA: profilometry of retrieved femoral components. Clin Orthop Relat Res 472:277–283
Hood RW, Wright TM, Burstein AH (1983) Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses. J Biomed Mater Res 17:829–842
Jayabalan P, Furman BD, Cottrell JM, Wright TM (2007) Backside wear in modern total knee designs. HSS J 3:30–34
Joyce TJ, Grigg H, Langton DJ, Nargol AVF (2011) Quantification of self-polishing in vivo from explanted metal-on-metal total hip replacements. Tribol Int 44:513–516
Joyce TJ, Langton DJ, Jameson SS, Nargol AVF (2009) Tribological analysis of failed resurfacing hip prostheses and comparison with clinical data. Proc Inst Mech Eng J J Eng Tribol 223:317–323
Li S, Scuderi G, Furman BD, Bhattacharyya S, Schmieg JJ, Insall JN (2002) Assessment of backside wear from the analysis of 55 retrieved tibial inserts. Clin Orthop Relat Res 404:75–82
Lombardi AV Jr, Ellison BS, Berend KR (2008) Polyethylene wear is influenced by manufacturing technique in modular TKA. Clin Orthop Relat Res 466:2798–2805
Peters PC, Engh GA, Dwyer KA, Vinh TN (1992) Osteolysis after total knee arthroplasty without cement. J Bone Joint Surg Am 74:864–876
Petheram TG, Bone M, Joyce TJ, Serrano-Pedraza I, Reed MR, Partington PF (2013) Surface finish of the Exeter trauma stem: a cause for concern? Bone Joint J 95-B:173–176
Rao AR, Engh GA, Collier MB, Lounici S (2002) Tibial interface wear in retrieved total knee components and correlations with modular insert motion. J Bone Joint Surg Am 84-A:1849–1855
Scholes SC, Kennard E, Gangadharan R, Weir D, Holland J, Deehan D, Joyce TJ (2013) Topographical analysis of the femoral components of ex vivo total knee replacements. J Mater Sci Mater Med 24:547–554
Wasielewski RC, Parks N, Williams I, Surprenant H, Collier JP, Engh G (1997) Tibial insert undersurface as a contributing source of polyethylene wear debris. Clin Orthop Relat Res 345:53–59
Acknowledgments
We acknowledge Golara Jalalpour for her assistance in preparing images.
Conflict of interest
Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Holleyman, R.J., Scholes, S.C., Weir, D. et al. Changes in surface topography at the TKA backside articulation following in vivo service: a retrieval analysis. Knee Surg Sports Traumatol Arthrosc 23, 3523–3531 (2015). https://doi.org/10.1007/s00167-014-3197-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3197-9