Why incongruous knee replacements do not fail early

Rapid failure of knee prostheses does not usually occur, despite the non-conforming nature of the articulation between femoral and tibial components and the associated large contact pressures. This theoretical study examines the likelihood of fatigue fracture of a layered elastic model loaded by a sliding cylindrical indenter. Cracks (line-defects) were assumed to have nucleated within the layer. The stress intensity factors (SIFs) associated with these cracks were calculated. The values obtained for the SIFs are quite low, with a corresponding low likelihood of crack-growth. When taken in conjunction with the experimentally derived fatigue laws of previous investigators, they suggest that short line-cracks should not grow. It seems that early failures have not simply been due to large shear stresses which occur beneath the prosthesis surface. Other factors, such as the degradation of material through heat-pressing, sterilisation or oxidation, or the deleterious effect of fusion defects, may be required to drive the cracks to delamination.