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Woiczinski M, Schröder C, Paulus A, Kistler M, Jansson V, Müller PE, Weber P. Varus or valgus positioning of the tibial component of a unicompartmental fixed-bearing knee arthroplasty does not increase wear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3016-3021. [PMID: 31690992 DOI: 10.1007/s00167-019-05761-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Higher revision rates were shown in varus- or valgus-positioned tibias in unicompartmental knee arthroplasty (UKA), but more than 15% of UKA prostheses are implanted with more than 5° of varus or valgus. This study aimed to analyze the wear rate in UKA when implanting the tibial component in either varus or valgus position versus a neutral placement at 90° to the tibial anatomical axis. The study hypothesized that a 5° varus or valgus positioning of the tibial plateau will generate less wear compared to a neutral alignment. METHODS Wear was experimentally analyzed on a medial anatomical fixed-bearing unicompartmental knee prosthesis (Univation, Aesculap, Germany) in vitro with a customized, four-station, servohydraulic knee wear simulator, reproducing the walking cycle. The forces, loading and range of motion were applied as specified in the ISO 14243-1:2002, 5 million cycles were analyzed. The tibial components of the medial prostheses were inserted in a neutral position, with 5° varus, and 5° valgus (n = 3, each group). RESULTS The wear rate decreased significantly with a 5° varus positioning (6.30 ± 1.38 mg/million cycles) and a 5° valgus positioning (4.96 ± 2.47 mg/million cycles) compared to the neutral position (12.16 ± 1.26 mg/million cycles) (p < 0.01 for the varus and the valgus position). The wear area on the inlay was slightly reduced in the varus and valgus group. CONCLUSION A varus or valgus "malpositioning" up to 5° will not lead to an increased wear. Wear was even less because of the reduced articulating contact area between the inlay and the femur. A slight varus positioning of the tibial component (parallel to the anatomical joint line) positioning can be advocated from a point of wear. LEVEL OF EVIDENCE Experimental study.
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Affiliation(s)
- Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Paulus
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Manuel Kistler
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Patrick Weber
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany. .,ECOM-Excellent Center of Medicine, Arabellastr, 17, 81925, Munich, Germany.
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Aleixo F, O’Callaghan SA, Ducla Soares L, Nunes P, Prieto R. AragoJ: A free, open‐source software to aid single camera photogrammetry studies. Methods Ecol Evol 2020. [DOI: 10.1111/2041-210x.13376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Luís Ducla Soares
- Instituto de Telecomunicações Instituto Universitário de Lisboa (ISCTE‐IUL) Lisbon Portugal
| | - Paulo Nunes
- Instituto de Telecomunicações Instituto Universitário de Lisboa (ISCTE‐IUL) Lisbon Portugal
| | - Rui Prieto
- MARE—Marine and Environmental Sciences Centre Lisbon Portugal
- OKEANOS and IMAR Centre at the University of the Azores Ponta Delgada Portugal
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3
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Łapaj Ł, Mróz A, Kokoszka P, Markuszewski J, Wendland J, Helak-Łapaj C, Kruczyński J. Peripheral snap-fit locking mechanisms and smooth surface finish of tibial trays reduce backside wear in fixed-bearing total knee arthroplasty. Acta Orthop 2017; 88:62-69. [PMID: 27781667 PMCID: PMC5251266 DOI: 10.1080/17453674.2016.1248202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Severe backside wear, observed in older generations of total knee replacements (TKRs), led to redesign of locking mechanisms to reduce micromotions between tibial tray and inlay. Since little is known about whether this effectively reduces backside wear in modern designs, we examined backside damage in retrievals of various contemporary fixed-bearing TKRs. Patients and methods - A consecutive series of 102 inlays with a peripheral (Stryker Triathlon, Stryker Scorpio, DePuy PFC Sigma, Aesculap Search Evolution) or dovetail locking mechanism (Zimmer NexGen, Smith and Nephew Genesis II) was examined. Articular and backside surface damage was evaluated using the semiquantitative Hood scale. Inlays were examined using scanning electron microscopy (SEM) to determine backside wear mechanisms. Results - Mean Hood scores for articular (A) and backside (B) surfaces were similar in most implants-Triathlon (A: 46, B: 22), Genesis II (A: 55, B: 24), Scorpio (A: 57, B: 24), PFC (A: 52, B: 20); Search (A: 56, B: 24)-except the NexGen knee (A: 57, B: 60), which had statistically significantly higher backside wear scores. SEM studies showed backside damage caused by abrasion related to micromotion in designs with dovetail locking mechanisms, especially in the unpolished NexGen trays. In implants with peripheral liner locking mechanism, there were no signs of micromotion or abrasion. Instead, "tray transfer" of polyethylene and flattening of machining was observed. Interpretation - Although this retrieval study may not represent well-functioning TKRs, we found that a smooth surface finish and a peripheral locking mechanism reduce backside wear in vivo, but further studies are required to determine whether this actually leads to reduced osteolysis and lower failure rates.
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Affiliation(s)
- Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | | | - Paweł Kokoszka
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Jacek Markuszewski
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Justyna Wendland
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Celina Helak-Łapaj
- Department of Bioinformatics and Computational Biology, Poznań University of Medical Sciences
- Clinical Eye Unit and Pediatric Ophtalmology Service, Heliodor Swiecicki University Hospital, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Kruczyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
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4
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Arnholt CM, MacDonald DW, Malkani AL, Klein GR, Rimnac CM, Kurtz SM, Kocagoz SB, Gilbert JL. Corrosion Damage and Wear Mechanisms in Long-Term Retrieved CoCr Femoral Components for Total Knee Arthroplasty. J Arthroplasty 2016; 31:2900-2906. [PMID: 27426028 PMCID: PMC5107165 DOI: 10.1016/j.arth.2016.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Metal debris and ion release has raised concerns in joint arthroplasty. The purpose of this study was to characterize the sources of metallic ions and particulate debris released from long-term (in vivo >15 years) total knee arthroplasty femoral components. METHODS A total of 52 CoCr femoral condyles were identified as having been implanted for more than 15 years. The femoral components were examined for incidence of 5 types of damage (metal-on-metal wear due to historical polyethylene insert failure, mechanically assisted crevice corrosion at taper interfaces, cement interface corrosion, third-body abrasive wear, and inflammatory cell-induced corrosion [ICIC]). Third-body abrasive wear was evaluated using the Hood method for polyethylene components and a similar method quantifying surface damage of the femoral condyle was used. The total area damaged by ICIC was quantified using digital photogrammetry. RESULTS Surface damage associated with corrosion and/or CoCr debris release was identified in 51 (98%) CoCr femoral components. Five types of damage were identified: 98% of femoral components exhibited third-body abrasive wear (mostly observed as scratching, n = 51/52), 29% of femoral components exhibited ICIC damage (n = 15/52), 41% exhibited cement interface damage (n = 11/27), 17% exhibited metal-on-metal wear after wear-through of the polyethylene insert (n = 9/52), and 50% of the modular femoral components exhibited mechanically assisted crevice corrosion taper damage (n = 2/4). The total ICIC-damaged area was an average of 0.11 ± 0.12 mm2 (range: 0.01-0.46 mm2). CONCLUSION Although implant damage in total knee arthroplasty is typically reported with regard to the polyethylene insert, the results of this study demonstrate that abrasive and corrosive damage occurs on the CoCr femoral condyle in vivo.
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Affiliation(s)
- Christina M. Arnholt
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Daniel W. MacDonald
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | | | - Gregg R. Klein
- Hartzband Center for Hip and Knee Replacement, 10 Forest Avenue, Paramus, NJ 07652
| | - Clare M. Rimnac
- Center for the Evaluation of Implant Performance, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104,Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104
| | | | - Sevi B. Kocagoz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104
| | - Jeremy L. Gilbert
- Syracuse Biomaterials Institute and Biomedical and Chemical Engineering, Syracuse University, 303C Bowne Hall, Syracuse, NY 13244
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Roy ME, Whiteside LA, Tilden DS, Noel OF. Reduced UHMWPE wear using magnesia-stabilized zirconia instead of CoCr femoral components in a knee simulator. J Arthroplasty 2015; 30:468-74. [PMID: 25316377 DOI: 10.1016/j.arth.2014.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/10/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Magnesia-stabilized zirconia (Mg-PSZ) is stable and maintains a scratch-resistant surface in hip replacement, but is untested in knees. We assessed whether using Mg-PSZ instead of cobalt-chromium (CoCr) femoral components resulted in less tibial insert wear, and evaluated changes in topography and roughness of the femoral components. Inserts bearing against CoCr or Mg-PSZ were tested using standard (9 Mc) and aggressive (6 Mc) waveforms. Femoral component surface topography and roughness were evaluated before and after testing by optical profilometry. When bearing against Mg-PSZ, UHMWPE wear rate decreased by 73% (standard) and by 59% (aggressive conditions). After 15 Mc, CoCr components featured deep scratches, and roughness increased five-fold, while Mg-PSZ components were unchanged. Mg-PSZ femoral components may be indicated for high-demand patients and those with metal sensitivity.
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Affiliation(s)
- Marcel E Roy
- Missouri Bone and Joint Research Foundation, St. Louis, Missouri
| | - Leo A Whiteside
- Missouri Bone and Joint Research Foundation, St. Louis, Missouri; Signal Medical Corp., St. Louis, Missouri
| | - David S Tilden
- Missouri Bone and Joint Research Foundation, St. Louis, Missouri; InSightec, Dallas, Texas
| | - Oscar F Noel
- Missouri Bone and Joint Research Foundation, St. Louis, Missouri; Des Peres Hospital, St. Louis, Missouri
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6
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Tierney EG, Duffy GP, Cryan SA, Curtin CM, O'Brien FJ. Non-viral gene-activated matrices: next generation constructs for bone repair. Organogenesis 2013; 9:22-8. [PMID: 23538777 DOI: 10.4161/org.24329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the context of producing enhanced therapeutics for regenerative medicine, our laboratory develops gene-activated matrices (GAMs) using non-viral gene therapy (GT) in combination with collagen-based scaffolds engineered specifically for tissue repair. Non-viral vectors have been referred to as a minority pursuit in GT but considering the concerns associated with viral vectors and as transient gene expression is such a key consideration, further research is clearly warranted for tissue engineering (TE) applications. Mesenchymal stem cells (MSCs) are well regarded for their capability in bone regeneration but as primary cells, they are difficult to transfect. We have recently optimised the non-viral vector, polyethyleneimine (PEI), to achieve high transfection efficiencies in MSCs. Subsequently, a series of PEI-based GAMs were developed using collagen, collagen-glycosaminoglycan and collagen-nanohydroxyapatite (collagen-nHa) scaffolds whereby transgene expression was detected up to 21 d with the collagen-nHa scaffold providing the most prolonged expression. Moreover, all PEI-based GAMs contained a low plasmid DNA dose of 2 µg which is far below doses often required in previous GAMs. Having successfully developed these GAMs, the ephrinB2 gene has recently been incorporated to produce a novel therapeutic GAM for bone repair. Herein, we discuss our recent investigations in the development and application of non-viral GAMs.
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Affiliation(s)
- Erica G Tierney
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
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7
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Kurtz SM, Ciccarelli L, Harper ML, Siskey R, Shorez J, Chan FW. Comparison of in vivo and simulator-retrieved metal-on-metal cervical disc replacements. Int J Spine Surg 2012; 6:145-56. [PMID: 25694884 PMCID: PMC4300870 DOI: 10.1016/j.ijsp.2012.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Cervical disc arthroplasty is regarded as a promising treatment for myelopathy and radiculopathy as an alternative to cervical spine fusion. On the basis of 2-year clinical data for the PRESTIGE® Cervical Disc (Medtronic, Memphis, Tennessee), the Food and Drug Administration recommended conditional approval in September 2006 and final approval in July 2007; however, relatively little is known about its wear and damage modes in vivo. The main objective was to analyze the tribological findings of the PRESTIGE® Cervical Disc. This study characterized the in vivo wear patterns of retrieved cervical discs and tested the hypothesis that the total disc replacements exhibited similar surface morphology and wear patterns in vitro as in vivo. Methods Ten explanted total disc replacements (PRESTIGE®, PRESTIGE® I, and PRESTIGE® II) from 10 patients retrieved after a mean of 1.8 years (range, 0.3–4.1 years) were analyzed. Wear testing included coupled lateral bending ( ±4.7°) and axial rotation ( ±3.8°) with a 49 N axial load for 5 million cycles followed by 10 million cycles of flexion-extension ( ±9.7°) with 148 N. Implant surfaces were characterized by the use of white-light interferometry, scanning electron microscopy, and energy dispersive spectroscopy. Results The explants generally exhibited a slightly discolored, elliptic wear region of varying dimension centered in the bearing center, with the long axis oriented in the medial-lateral direction. Abrasive wear was the dominant in vivo wear mechanism, with microscopic scratches generally oriented in the medial-lateral direction. Wear testing resulted in severe abrasive wear in a curvilinear fashion oriented primarily in the medial-lateral direction. All retrievals showed evidence of an abrasive wear mechanism. Conclusions This study documented important similarity between the wear mechanisms of components tested in vitro and explanted PRESTIGE® Cervical Discs; however, the severity of wear was much greater during the in vitro test compared with the retrievals.
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Affiliation(s)
- Steven M. Kurtz
- Exponent, Inc., Philadelphia, PA
- Drexel University, Philadelphia, PA
- Corresponding author: Steven M. Kurtz, PhD., Exponent, Inc., 3401 Market St, Ste 300, Philadelphia, PA 19104; Tel: 215-594-8800; Fax: 215-594-8899. E-mail address:
| | | | | | - Ryan Siskey
- Exponent, Inc., Philadelphia, PA
- Drexel University, Philadelphia, PA
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Knowlton CB, Wimmer MA. An autonomous mathematical reconstruction to effectively measure volume loss on retrieved polyethylene tibial inserts. J Biomed Mater Res B Appl Biomater 2012; 101:449-57. [PMID: 22915471 DOI: 10.1002/jbm.b.32782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/21/2012] [Accepted: 07/07/2012] [Indexed: 11/07/2022]
Abstract
Wear of the polyethylene tibial component is a major factor in the success of total knee replacements. However, sampling resolution and the challenges of estimating original surfaces with relatively complex articulating geometries have limited the accuracy of volumetric measurements of wear on surgically retrieved inserts. A mathematical model analyzed volume error due to sampling resolution and found that 100 × 100 μm(2) point spacing reduced error below 1 mm(3). Small volumes of material were progressively removed from the topside of three unworn tibial inserts, after which each component was weighed and digitized with a laser coordinate measuring machine. Six inserts worn in knee simulator tests and nine surgically retrieved inserts visually scored for damage were also digitized. For these tests, the original surface of an insert was mathematically reconstructed from unworn regions of the same component, and volume loss and its spatial distribution were calculated. Volume loss estimated by autonomous reconstruction correlated strongly to mass removed manually (R(2) = 0.954, slope = 1.02 ± 0.04), mass lost during simulator testing (R(2) = 0.935, slope = 1.01 ± 0.07) and visual damage scores separated by size (R(2)large = 0.9824, R(2)small = 0.9728). These results suggest that an autonomous mathematical reconstruction can be used to effectively measure volume loss in retrieved tibial inserts.
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Affiliation(s)
- Christopher B Knowlton
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Ballesteros R, Bonsfills N, Chacón M, García-Lázaro J, Gómez-Barrena E. Histomorphometry of the ligaments using a generic-purpose image processing software, a new strategy for semi-automatized measurements. J Digit Imaging 2011; 25:527-36. [PMID: 22143412 DOI: 10.1007/s10278-011-9440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Gold chloride technique can be combined with Adobe Photoshop® software to yield a quantitative assessment of the different areas in heterogeneous structures as are ligament. A semi-automatized method based on the sum of two- and three-dimensional morphological criteria upon colorimetric criteria allows the identification and measurement of the area occupied by a structure of interest. It also allows the quantification of color intensity to differentiate structures with similar staining avidity, like vessels and nerves. This computer-assisted, semiquantitative procedure for computerized morphometry is relatively simple to perform. The accuracy, efficiency, and reproducibility of this method based on a commercially available imaging program were considered adequate when tested on the anterior cruciate ligament of the cat. Image normalization by trained observers using a commercially available software package designed for photography, applied to a sample randomly chosen, has provided the means of making reproducible measurements of heterogeneous structures.
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Affiliation(s)
- Rafael Ballesteros
- Department of Orthopedics, Universitary Hospital of Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain.
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Akbari A, Roy ME, Whiteside LA, Katerberg BJ, Schnettgoecke DJ. Minimal backside surface changes observed in retrieved acetabular liners. J Arthroplasty 2011; 26:686-92. [PMID: 20875939 DOI: 10.1016/j.arth.2010.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 07/18/2010] [Indexed: 02/01/2023] Open
Abstract
Modular polyethylene liners offer versatility in total hip arthroplasty, but the locking mechanism may allow micromotion and backside wear. We evaluated the backside surface of 56 retrieved acetabular liners (mean 5.54 years in vivo, range 0.003-13.1 years) to determine whether damage correlated with liner age in vivo, patient factors associated with higher activity, and polyethylene quality. Half of the liners exhibited minimal damage, half exhibited no damage and none exhibited severe damage. Backside damage significantly correlated only to liner age in vivo. Ten of the 28 liners revised for osteolysis exhibited no backside damage, but the osteolytic cysts were peripheral and did not originate from screw holes. The results suggest that modular polyethylene liners in a porous titanium-coated shell with screw holes can be designed such that clinically significant backside wear is minimal.
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Affiliation(s)
- Abtin Akbari
- Missouri Bone and Joint Research Foundation, St. Louis, MO 63131, USA
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11
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Medel FJ, Kurtz SM, Sharkey PF, Austin MS, Klein GR, Cohen AR, Patel H, Goldberg VM, Kraay MJ, Rimnac CM. Post damage in contemporary posterior-stabilized tibial inserts: influence of implant design and clinical relevance. J Arthroplasty 2011; 26:606-14. [PMID: 21575793 DOI: 10.1016/j.arth.2010.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 05/17/2010] [Indexed: 02/01/2023] Open
Abstract
The mechanisms of damage at the polyethylene post in 3 contemporary tibial insert designs were evaluated and compared with a historical standard (Insall-Burstein II; Zimmer, Warsaw, Ind). One hundred five gamma sterilized posterior-stabilized tibial inserts were revised after an average of 4.7 years (0.05-13.6 years). Retrievals were classified according to their designs: Insall-Burstein II (n = 28); PFC (Johnson & Johnson, Raynham, Mass; n = 30); NexGen (Zimmer; n = 32); and Scorpio (Stryker Orthopaedics, Mahwah, NJ; n = 15). Reasons for revision and patient details were available. Surface damage scoring and photogrammetry were performed on all the retrieved tibial inserts. Oxidation analysis was carried out for traceable historical, gamma air-sterilized and conventional, gamma inert-sterilized tibial inserts (n = 61) with the use of infrared spectroscopy. The posts for all 3 contemporary designs exhibited damage similar to the historical controls. Articular, post, and backside damage scores significantly increased with implantation time. Post damage was insensitive to design and patient factors but was exacerbated by oxidation. An association between damage at the post and articular surface was also confirmed. Logistic models suggested an interaction between post damage, backside surface damage, and implant loosening.
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Affiliation(s)
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- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, 3401 Market Street. Suite 300, Philadelphia, PA 19104, USA
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12
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Azzam MG, Roy ME, Whiteside LA. Second-generation locking mechanisms and ethylene oxide sterilization reduce tibial insert backside damage in total knee arthroplasty. J Arthroplasty 2011; 26:523-30. [PMID: 20541356 DOI: 10.1016/j.arth.2010.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/20/2010] [Indexed: 02/01/2023] Open
Abstract
This study evaluated the effects of polyethylene quality and locking mechanism on damage to the nonarticulating (backside) surface of retrieved tibial inserts in total knee arthroplasty. Inserts with peripheral capture (PC) locking mechanisms and ethylene oxide (EtO)-sterilized polyethylene were hypothesized to prevent major backside damage. A total of 156 inserts were sorted by locking mechanism and sterilization method and analyzed by damage scoring methods. Ninety-seven specimens exhibited burnishing. Significant positive linear correlations were observed between damage score and age in vivo for all combinations, but damage occurred at a significantly lower rate for second-generation PC implants with EtO sterilization. Most specimens in this group were undamaged (46/72), with others exhibiting only burnishing. Sex, body mass index, and weight did not influence backside damage.
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Affiliation(s)
- Michael G Azzam
- School of Medicine, Saint Louis University, St Louis, Missouri, USA
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Harman M, Cristofolini L, Erani P, Stea S, Viceconti M. A pictographic atlas for classifying damage modes on polyethylene bearings. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:1137-1146. [PMID: 21461698 DOI: 10.1007/s10856-011-4303-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 03/21/2011] [Indexed: 05/30/2023]
Abstract
Evaluation of medical devices retrieved after in vivo service provides unique evidence related to the physiological environment in which the biomaterials performed. This study implements a training procedure for evaluating polyethylene bearings of joint prostheses obtained after pre-clinical tests or explanted after in vivo function. A total of 161 damage regions on 45 bearings were evaluated by four observers. An illustrated Damage Mode Atlas was developed as a reference guide, inclusive of both photographs and concise written descriptions of 16 specific damage modes that are typical for polyethylene bearings. Utilizing the Damage Mode Atlas to train new researchers improved the damage pattern analysis, including more accurate identification of damage modes and improved inter-rater reliability. This Damage Mode Atlas is a useful supplementary tool for conducting Stage II non-destructive analysis of explanted polyethylene bearings used for joint replacement, in accordance with international guidelines for evaluating explanted medical devices.
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Affiliation(s)
- Melinda Harman
- Medical Technology Lab, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
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Kuru O, Sahin B, Kaplan S. Alternative approach to evaluating lumbar lordosis on direct roentgenograms: Projection area per length squared. Anat Sci Int 2008; 83:83-8. [DOI: 10.1111/j.1447-073x.2007.00210.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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