Original article
Wear in retrieved condylar knee arthroplasties: A comparison of wear in different designs of 280 retrieved condylar knee prostheses

https://doi.org/10.1016/S0883-5403(97)90024-3Get rights and content

Abstract

The plastic components of 280 retrieved unicondylar and total knee arthroplasties were studied. Wear was visually scored using a relative ranked data method. Although wear on the components was highly variable, several conclusions could be drawn regarding the nature and causes. Wear was associated more with the medial than the lateral condyle. Delamination was the most severe type of wear and occurred in short (< 5 years)-, medium (5–10 years)-, and long (> 10 years)-term retrievals. In the short term, delamination wear was associated with hot pressing of the tibial plastic or with fracture of the tibial baseplate. For a single design, a significant difference in the amount of delamination on hot-pressed and non-hot-pressed tibial components was observed. In medium- and long-term retrieved specimens of the designs with moderately high conformity, delamination wear was associated with restriction of rotational movement of the femoral component or with abrupt changes in the radius of the tibial component. In flatter, less conforming designs, wear was associated with laxity, such that the polyethylene delaminated toward the edges of the tibial component. Wear attributed to cement abrasion or entrapment occurred on the more conforming designs. Delamination was associated with the presence of fusion defects in the polyethylene but could also occur in the absence of such defects. That delamination was the principal wear type and that this is caused by a fatigue mechanism mean that the incidence of failure could accelerate considerably over follow-up periods beyond 10 years. Designs of moderate conformity without abrupt changes in radii may prolong the duration of plastic tibial components before serious delamination occurs.

References (33)

  • RM Rose et al.

    On the pressure dependance of the wear of UHMWPE

    Wear

    (1983)
  • JC Thatcher et al.

    Inherent laxity in total knee prostheses

    J Arthroplasty

    (1987)
  • MM Landy et al.

    Wear of ultra high molecular weight polyethylene components of 90 retrieved knee prostheses

    J Arthroplasty

    (1988)
  • DL Bartel et al.

    The effect of conformity, thickness, and material on stresses in ultra high molecular weight components for total joint replacement

    J Bone Joint Surg

    (1986)
  • RW Hood et al.

    Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses

    J Biomed Mater Res

    (1983)
  • RM Rose et al.

    A prognosis for ultra high molecular weight polyethylene

    Biomaterials

    (1990)
  • S Sathasivam et al.

    Optimisation of bearing geometry of total knees

    J Biomech

    (1993)
  • PS Walker et al.

    The deformation and wear of plastic components in artificial knee joints

    Eng Med

    (1981)
  • JP Collier et al.

    Analysis of the failure of 122 polyethylene inserts from uncemented tibial knee components

    Clin Orthop

    (1991)
  • PL Bartel et al.

    The effect of conformity, thickness and material stresses in metal backed plastic implants

    J Biomech Eng

    (1985)
  • TP Andriacchi et al.

    The influence of total knee replacement design and stair climbing

    J Bone Joint Surg

    (1982)
  • GW Blunn et al.

    The dominance of cyclic sliding in producing wear in total knee replacements

    Clin Orthop

    (1991)
  • SM Jones et al.

    Polyethylene wear in uncemented knee replacements

    J Bone Joint Surg

    (1992)
  • RD Bloebaum et al.

    Investigation of early surface delamination observed in retrieved heat pressed tibial inserts

    Clin Orthop

    (1991)
  • TM Wright et al.

    Analysis of surface damage in retrieved carbon-fibre reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements

    J Bone Joint Surg

    (1988)
  • W Rostoker et al.

    Contact pressure dependence of wear rates of UHMWPE

    J Biomed Mater Res

    (1979)
  • Cited by (188)

    • Design Optimization and Manufacturing of Bio-fixed tibial implants using 3D printing technology

      2021, Journal of the Mechanical Behavior of Biomedical Materials
    • Total Knee Arthroplasty Kinematics

      2019, Journal of Arthroplasty
      Citation Excerpt :

      Several authors have demonstrated this phenomenon using fluoroscopy [100,130–134] (Video 3). Studies suggest that edge-loading the insert during FCLO may accelerate wear [98,102,135,136]. In a knee joint simulator, in the absence of FCLO, MB TKAs exhibited a lower PE wear rate than FB TKAs [137].

    View all citing articles on Scopus

    Supported by the Devices Procurement Division, UK Department of Health; the Swedish Medical Resources Council (Project 9509); and the Wishbone Appeal of the British Orthopaedic Association (grant to A.B.J.).

    View full text