Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Tibial component wear in total knee replacement

H U Cameron1

  • 1Department of Surgery, University of Toronto, Ontario, Canada.

Clinical Orthopaedics and Related Research
|December 1, 1994
PubMed
Summary

Polyethylene wear in total knee replacement is common, often starting at the posteromedial tibial plateau. Minimizing wear may be possible by preventing initial polyethylene cold flow, potentially through cruciate-retaining designs.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Examining pain before and after primary total knee replacement (TKR): A retrospective chart review.

International journal of orthopaedic and trauma nursing·2019
Same author

What would you do?: challenges in hip surgery.

The Journal of bone and joint surgery. British volume·2012
Same author

Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes.

The Journal of bone and joint surgery. British volume·2012
Same author

What's New In Hip Surgery?

Canadian family physician Medecin de famille canadien·2011
Same author

Tennis elbow.

Canadian family physician Medecin de famille canadien·2011
Same author

Recent advances in artificial hip-joint replacement.

Canadian family physician Medecin de famille canadien·2011

Area of Science:

  • Biomedical Engineering
  • Orthopedic Surgery
  • Materials Science

Background:

  • Polyethylene wear is a significant challenge in total knee replacement (TKR) longevity.
  • Understanding wear patterns is crucial for improving implant design and patient outcomes.
  • Previous studies have identified various wear mechanisms, but a clear understanding of the primary pattern and its initiation is still developing.

Purpose of the Study:

  • To identify and characterize the predominant wear patterns in revised tibial components from total knee replacements.
  • To elucidate the initial mechanisms driving polyethylene wear in TKR.
  • To explore design factors that may influence or mitigate polyethylene wear.

Main Methods:

  • Analysis of a large cohort of revised tibial components to categorize wear patterns.
  • Microscopic and macroscopic examination of wear surfaces to identify deformation and material loss.
  • Correlation of wear patterns with implant design features, such as the presence or absence of a cruciate gap.

Main Results:

  • Three distinct wear patterns were observed: symmetrical central, symmetrical posterior (both rare), and asymmetric posteromedial wear (common).
  • Asymmetric posteromedial wear initiates with cold flow of polyethylene, leading to fixation of the horizontal axis of rotation.
  • This process traps the vertical axis, causing tibial external rotation, maltracking, and accelerated wear, generating debris that contributes to synovitis and osteolysis. Thinner polyethylene components exhibited more pronounced wear.
  • Absence of a cruciate gap appeared to inhibit initial cold flow, thereby reducing wear.

Conclusions:

  • Asymmetric posteromedial wear is the most prevalent pattern in TKR, driven by polyethylene cold flow and subsequent mechanical complications.
  • Implant design, particularly the presence of a cruciate gap, plays a critical role in wear initiation and progression.
  • Strategies to prevent initial cold flow, such as cruciate-retaining designs, may be effective in minimizing polyethylene wear and improving TKR survivorship.

Related Experiment Videos