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Related Experiment Videos

Surface damage versus tibial polyethylene insert conformity: a retrieval study.

Markus A Wimmer1, Michel P Laurent, Jeannie D Haman

  • 1Department of Orthopedic Surgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA.

Clinical Orthopaedics and Related Research
|March 8, 2012
PubMed
Summary

Higher conformity in total knee arthroplasty (TKA) inserts may increase surface fatigue damage, including pitting and delamination. This suggests careful material selection and design matching for TKA patients is crucial.

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Area of Science:

  • Biomaterials Science
  • Orthopedic Surgery
  • Wear Analysis

Background:

  • Surface damage in total knee arthroplasty (TKA) is often assumed to decrease with increased polyethylene insert conformity.
  • However, higher conformity may lead to increased in vivo forces and potential for greater damage.

Purpose of the Study:

  • To investigate the association between increased conformity of tibial inserts and surface damage, specifically pitting, delamination, creep, and polishing.
  • To compare damage patterns between conforming (dished) and less conforming (nonconforming) tibial inserts.

Main Methods:

  • Retrieved tibial inserts (38 conforming, 31 less conforming) with identical polyethylene composition were analyzed.
  • Articulating surfaces were scored for pitting, delamination, deformation/creep, and polishing.

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  • Evidence of edge loading and embedded bone cement were also recorded.

    • Main Results:

    • Conforming inserts showed higher delamination and pitting scores, but lower polishing scores, independent of patient and implant factors.
    • Conforming inserts had a higher prevalence of edge loading and embedded bone cement, which correlated with increased delamination and pitting.
    • Longer implantation duration and male sex were associated with increased delamination, pitting, and polishing.

    Conclusions:

    • Increased conformity in TKA tibial inserts may promote surface fatigue damage, contrary to previous assumptions.
    • Higher constraint-induced stresses, edge loading, and bone cement capture on conforming surfaces likely contribute to this damage.
    • Selecting materials with high fatigue resistance and considering design trade-offs are important for high-conformity TKA inserts to optimize patient outcomes.