What factors drive polyethylene wear in total knee arthroplasty?

2021 ◽  
Vol 103-B (11) ◽  
pp. 1695-1701
Author(s):  
John H. Currier ◽  
Barbara H. Currier ◽  
Matthew P. Abdel ◽  
Daniel J. Berry ◽  
Alexander J. Titus ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Wear Rate ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Wear Performance ◽  
Thickness Change ◽  
Wear Rates ◽  
Tibial Insert ◽  
Total Knee

Aims Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. Methods An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate. Results Five patient-specific variables and seven implant-specific variables were evaluated for significant association with lower insert wear rate. Six were significant when controlling for other factors: greater patient age, female sex, shorter duration in vivo, polished tray, highly cross-linked PE (HXLPE), and constrained knee design. Conclusion This study confirmed that knee wear rate increased with duration in vivo. Older patients and females had significantly lower wear rates. Polished modular tibial tray surfaces, HXLPE, and constrained TKA designs were device design factors associated with significantly reduced wear rate. Cite this article: Bone Joint J 2021;103-B(11):1695–1701.

scholarly journals Optimal Design of Patient-Specific Total Knee Arthroplasty for Improvement in Wear Performance

2019 ◽  
Vol 8 (11) ◽  
pp. 2023 ◽  
Author(s):  
Yong-Gon Koh ◽  
Kyung-Hwan Jung ◽  
Hyoung-Taek Hong ◽  
Kang-Min Kim ◽  
Kyoung-Tak Kang
Keyword(s):  
Total Knee Arthroplasty ◽  
Optimal Design ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Patient Specific ◽  
Fe Modelling ◽  
Wear Performance ◽  
Wear Rates ◽  
Tibial Insert ◽  
Total Knee

Life expectancy is on the rise and, concurrently, the demand for total knee arthroplasty (TKA), which lasts a lifetime, is increasing. To meet this demand, improved TKA designs have been introduced. Recent advances in radiography and manufacturing techniques have enabled the production of patient-specific TKA. Nevertheless, concerns regarding the wear performance, which limit the lifespan of TKA, remain to be addressed. This study aims at reducing the wear in patient-specific TKA using design optimization and parametric three-dimensional (3D) finite-element (FE) modelling. The femoral component design was implemented in a patient-specific manner, whereas the tibial insert conformity remained to be determined by design variables. The gait cycle loading condition was applied, and the optimized model was validated by the results obtained from the experimental wear tests. The wear predictions were iterated for five million gait cycles using the computational model with force-controlled input. Similar patterns for internal/external rotation and anterior/posterior translation were observed in both initial and optimal models. The wear rates for initial and optimal models were recorded as 23.2 mm3/million cycles and 16.7 mm3/million cycles, respectively. Moreover, the experimental wear rate in the optimal design was 17.8 mm3/million cycles, which validated our optimization procedure. This study suggests that tibial insert conformity is an important factor in influencing the wear performance of patient-specific TKA, and it is capable of providing improved clinical results through enhanced design selections. This finding can boost the future development of patient-specific TKA, and it can be extended to other joint-replacement designs. However, further research is required to explore the potential clinical benefits of the improved wear performance demonstrated in this study.

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

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 129-137
Author(s):  
Christopher B. Knowlton ◽  
Hannah J. Lundberg ◽  
Markus A. Wimmer ◽  
Joshua J. Jacobs
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Lateral Side ◽  
Volumetric Wear ◽  
Wear Rates ◽  
Medial Side ◽  
Knee Mechanics ◽  
Gait Mechanics ◽  
Total Knee

Aims 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. Methods 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. Results 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). Conclusion 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.

scholarly journals Wear Assessment of Tibial Inserts Made of Highly Cross-Linked Polyethylene Supplemented with Dodecyl Gallate in the Total Knee Arthroplasty

Polymers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1847
Author(s):  
Min Zhang ◽  
Jia-Yu Wang ◽  
Jian Su ◽  
Jian-Jun Wang ◽  
Shi-Tong Yan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Wear Rate ◽  
Knee Arthroplasty ◽  
Calf Serum ◽  
Oxidation Stability ◽  
Wear Particles ◽  
Implant Fixation ◽  
Dodecyl Gallate ◽  
Tibial Insert ◽  
Total Knee

Background: the wear of tibial insert is still one of primary factors leading to failure of total knee arthroplasty (TKA). Dodecyl gallate (DG) has shown improvements in the oxidation stability of highly cross-linked polyethylene (HXLPE). This study aimed to assess the application of HXLPE supplemented with DG (HXLPE-DG) on the tibial insert in TKA concerning the wear resistance and the potential impact on implant fixation; Methods: tibial inserts made of HXLPE-DG were subjected to a 3 million loading-cycle wear test following ISO 14243-1:2009. The loss of mass and wear rate of the tibial inserts were calculated. The quantity, size,- and shape of wear particles were recorded; Results: the test specimens lost an average mass of 16.00 mg ± 0.94 mg, and were on an average wear rate of 3.92 mg/million cycles ± 0.19 mg/million cycles. The content of wear particles in the calf serum medium was 3.94 × 108 particles/mL ± 3.93 × 107 particles/mL, 96.66% ± 0.77% of the particles had an equivalent circular diameter less than 0.5 μm. The aspect ratio of wear particles was 1.40 (min: 1.01; max: 6.42). Conclusions: HXLPE-DG displayed advantages over the commonly used materials for tibial inserts and presented the potential of application in TKA.

scholarly journals Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study

2021 ◽  
Vol 11 (5) ◽  
pp. 2423
Author(s):  
Periklis Tzanetis ◽  
Marco A. Marra ◽  
René Fluit ◽  
Bart Koopman ◽  
Nico Verdonschot
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Compressive Force ◽  
Patient Specific ◽  
Trochlear Groove ◽  
Secondary Effects ◽  
Reference Case ◽  
Tibial Insert ◽  
Total Knee ◽  
Thickness Variations

The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints.

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

2020 ◽  
Author(s):  
Stephen Thomas ◽  
Ankur Patel ◽  
Corey Patrick ◽  
Gary Delhougne
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Cost ◽  
Readmission Rate ◽  
Hospital Costs ◽  
Patient Specific ◽  
P Value ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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