Implant Retrieval Analysis for Total Joint Arthroplasty: A Review

Joint replacement is one of the most successful complex surgical procedures, in large part due to innovations in implant materials and designs. Understanding how implants perform in vivo and why some fail has been crucial to continuous improvement. Analysis of implants retrieved at revision surgery can determine mechanisms driving both performance and failure and suggest necessary changes to address problems. Retrieval analysis can also serve as the earliest warning that an implant system has failed to meet expectations and that a regulatory recall may be the prudent decision. In this review, we provide a history of how retrieval analysis has been leveraged to provide mechanistic answers to design and material problems, to advance implant design and practice, and to provide warnings of early failures. We describe methods to conduct failure analysis of revised implants from subjective observations to quantitative techniques that span engineering, imaging, and pathology. We then present ways in which retrieval analysis has advanced biomaterials and design improvements using the development of polyethylene-based materials and the discovery of implant tribocorrosion and subsequent mitigation strategies as examples. We also discuss how retrieval analysis was combined with finite element modeling in the evolution of four generations of knee implant design. Finally, we discuss how retrieval analysis can continue to be a valuable resource for joint replacement surgery and implant manufacturing.