Cushion form bearings for total knee joint replacement. Part 2: Wear and durability

Cushion knee prostheses have been designed and constructed to produce larger initial contact areas and thicker theoretical film thicknesses than a conventional UHMWPE (ultra-high molecular weight polyethylene) joint. The compliant bearing had a flat tibial component which imposed fewer biomechanical constraints and allowed greater range of movement. Wear tests were performed in a knee joint simulator and creep tests were carried out in a servo-hydraulic apparatus. Various failure modes of cushion joints that require further study were identified. However, the results showed that adequate durability was achieved from a 20 MPa polyurethane material in joint simulating tests carried out over 0.5, 1.0 and 5.0 million cycles. Most importantly, during these tests, no detectable wear debris was generated. It is believed that this is the first time that the full potential of cushion bearings has been demonstrated in a joint simulator over periods corresponding to about five years of service in vivo.