Can a gait-dependent model predict wear on retrieved total knee arthroplasty components?

A retrospective longitudinal study was conducted to compare directly volumetric wear of retrieved polyethylene inserts to predicted volumetric wear modelled from individual gait mechanics of total knee arthroplasty (TKA) patients.

In total, 11 retrieved polyethylene tibial inserts were matched with gait analysis testing performed on those patients. Volumetric wear on the articular surfaces was measured using a laser coordinate measure machine and autonomous reconstruction. Knee kinematics and kinetics from individual gait trials drove computational models to calculate medial and lateral tibiofemoral contact paths and forces. Sliding distance along the contact path, normal forces and implantation time were used as inputs to Archard's equation of wear to predict volumetric wear from gait mechanics. Measured and modelled wear were compared for each component.

Volumetric wear rates on eight non-delaminated components measured 15.9 mm³/year (standard error (SE) ± 7.7) on the total part, 11.4 mm³/year (SE ± 6.4) on the medial side and 4.4 (SE ± 2.6) mm³/year on the lateral side. Volumetric wear rates modelled from patient gait mechanics predicted 16.4 mm³/year (SE 2.4) on the total part, 11.7 mm³/year (SE 2.1) on the medial side and 4.7 mm³/year (SE 0.4) on the lateral side. Measured and modelled wear volumes correlated significantly on the total part (p = 0.017) and the medial side (p = 0.012) but not on the lateral side (p = 0.154).

In the absence of delamination, patient-specific knee mechanics during gait directly affect wear of the tibial component in TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):129-137.