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

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.

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What factors drive polyethylene wear in total knee arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.103b11.bjj-2020-2334.r1 ◽

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.

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Polyethylene Wear Particles in Synovial Fluid After Total Knee Arthroplasty

Clinical Orthopaedics and Related Research ◽

10.1097/01.blo.0000063122.39522.c2 ◽

2003 ◽

Vol 410 ◽

pp. 165-172 ◽

Cited By ~ 46

Author(s):

Yukihide Minoda ◽

Akio Kobayashi ◽

Hiroyoshi Iwaki ◽

Masatsugu Miyaguchi ◽

Yoshinori Kadoya ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Synovial Fluid ◽

Knee Arthroplasty ◽

Polyethylene Wear ◽

Wear Particles ◽

Total Knee

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Isolated tibial insert exchange in revision total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-1954.r2 ◽

2021 ◽

Vol 103-B (6) ◽

pp. 1103-1110

Author(s):

Matthew W. Tetreault ◽

Jeremy T. Hines ◽

Daniel J. Berry ◽

Mark W. Pagnano ◽

Robert T. Trousdale ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Polyethylene Wear ◽

Revision Total Knee Arthroplasty ◽

Common Reason ◽

Original Diagnosis ◽

Tibial Insert ◽

Total Knee ◽

Component Loosening ◽

Revision Tka

Aims This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). Methods From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. Results Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. Conclusion After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103–1110.

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