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Current Total Knee Designs: Does Baseplate Roughness or Locking Mechanism Design Affect Polyethylene Backside Wear?
Zachary W Sisko1,2, Matthew G Teeter3, Brent A Lanting3
1Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre and the Schulich School of Medicine & Dentistry at Western University, University Hospital, London, ON, Canada. Zachary.Sisko@ahn.org.
Clinical Orthopaedics and Related Research
|September 15, 2017
Summary
A polished tibial baseplate with a robust locking mechanism in total knee arthroplasty (TKA) designs showed the lowest backside damage and linear wear. Nonpolished designs with only peripheral rim capture had the highest damage and wear rates.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Implant retrieval analysis
Background:
- Tibial baseplate roughness and micromotion can cause polyethylene backside wear in total knee arthroplasty (TKA).
- Previous retrieval studies often focused on older TKA designs, limiting insights into modern implants.
Purpose of the Study:
- To compare backside damage scores, modes, and linear wear rates across five TKA designs with varying baseplate roughness and locking mechanisms.
- To investigate the influence of patient demographics on backside damage and wear.
Main Methods:
- Implant-retrieval analysis of six tibial inserts from each of five TKA models (four modern, one historical).
- Matching inserts based on time in vivo, patient age, BMI, sex, revision number, and reason.
- Assessing backside damage via visual scoring and modes, and measuring linear wear rate using micro-CT.
Main Results:
- Polished tibial designs exhibited significantly lower total damage scores and linear wear rates compared to nonpolished designs.
- Specific polished designs (partial peripheral capture with anterior constraint, tongue-in-groove) showed lower wear rates.
- Dimpling was identified as a unique wear mode in certain nonpolished baseplate designs.
Conclusions:
- Nonpolished designs with only peripheral rim capture demonstrated the highest total damage scores and linear wear rates.
- A polished baseplate combined with a robust locking mechanism appears to minimize backside damage and wear.
- Further research on current crosslinked polyethylene and long-term clinical relevance is warranted.
