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Haider H, Weisenburger J, Siskey R, Deans C, Hartman C, Kildow B, Konigsberg B, Garvin K. Do articular surfaces of dual mobility hips have more wear and friction? An in vitro investigation. J Arthroplasty 2023:S0883-5403(23)00390-X. [PMID: 37105329 DOI: 10.1016/j.arth.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Larger head-to-neck ratio of dual mobility (DM) hip arthroplasties provide greater range of motion/less risk of dislocation, but raise concerns for high wear and friction. We measured in vitro, the wear rates of contemporary DM hips with highly-crosslinked Ultra High Molecular Weight Polyethylene (UHWMPE), where it came from, and their frictional torques. METHODS Hip simulators were used to compare the wear of DM to fixed-bearing (FB) designs of two different implants. Each of eight different configurations underwent millions of simulated walking cycle tests, some as full DM, some as FB controls, some DM with the outer-articulation deliberately immobilized, and some the inner. Wear and three-dimensional-frictional torques were measured and friction independent of size was deduced. RESULTS The DM hips produced lower wear and friction-torque than the FB hips. The DM Wear during walking gait comes mostly from the smaller inner articular surface. If the outer surface was immobilized, the wear and torque of the inner alone would be small, but the full DM (inner and outer free-to-move) wear and torque were smallest of all. Friction measurements expectedly showed larger hips having higher frictional torques, but the DM showed the lowest, again because its motion was mostly the smaller inner articulation; smaller than even a modern fixed-bearing hip. CONCLUSION The DM hips appear to combine the benefits of greater range of motion and less impingement of larger hips, with the lower wear and friction of smaller FB hips, with some benefits compromised if the outer or inner articulations are immobilized.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Joel Weisenburger
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Ryan Siskey
- Exponent: Engineering and Scientific Consulting, 3440 Market Street, Philadelphia, PA, 19104
| | - Christopher Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Curtis Hartman
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Konigsberg
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Kevin Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE, 68198
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A Postmortem Analysis of Polyethylene Damage and Periprosthetic Tissue in Rotating Platform and Fixed Bearing Tibial Inserts. J Arthroplasty 2022; 37:1203-1209. [PMID: 35183710 DOI: 10.1016/j.arth.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mobile bearing designs are intended to reduce wear, but mixed results were reported from retrieval analyses. Postmortem evaluation (PM) provides the opportunity to assess polyethylene damage in successful implants. We compared damage patterns, MRI presentation, and histology between mobile-bearing and fixed tibial inserts retrieved postmortem and compared these results to our prior findings from implants retrieved at revision. METHODS Eleven postmortem knees with rotating platform (RP) implants and 13 with fixed bearing (FB) implants were examined. All were MRI scanned, and tissue samples were collected from standardized regions for histology. Polyethylene inserts were subjectively scored to assess articular, backside, and PS post surfaces for damage modes and severity. RESULTS Average duration of implantation was 9.3 years (1.7-19.6 years). Surface burnishing was the most common polyethylene damage mode. Average damage scores were higher for RP (53.4) compared to FB inserts (34.4) due to greater backside damage (13.4 for RP vs 1.4 for FB). A minimal difference in damage was observed on the articular surfaces (37.4 RP vs 30.0 FB). Mild innate macrophage reactions were seen in 8 (72.7%) RP and 5 (45.5%) FB specimens. Polyethylene particles were identified in 7 (63.6%) RP and 3 (27.7%) FB specimens. CONCLUSIONS Postmortem inserts showed low damage levels and mild tissue reactions compared to those reported for implants removed at revision arthroplasty. Nonetheless, trends in comparing RP and FB inserts were consistent with those seen in retrieval analyses, demonstrating the usefulness of retrieval studies in capturing performance differences among TKA designs.
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Increasing the height of the anterior lip on a tibial insert in a posterior stabilized knee prosthesis has little effect on the wear rate. Med Eng Phys 2021; 91:48-53. [PMID: 34074465 DOI: 10.1016/j.medengphy.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/22/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
A high anterior lip on a total knee prosthesis is an effective way of reducing anterior translation, but the effect on joint wear is unclear. Using finite element analysis (FEA), this study quantitatively compared wear rates and anterior contact stresses in three posterior stabilized knee prostheses with different heights for the anterior lip during six daily activities (walking, stair ascent, stair descent, sit-to-stand, pivot turn and crossover turn). The wear rate and location of maximum wear depth were similar for the three lip heights tested, but the knee with the highest anterior lip also showed slight anterior wear scaring due to articular contact stress during swing phase, which was highly dependent on the shape of the contact interface. This study illustrates that tibial inserts with a high anterior lip maintain a wear rate similar to moderate and low lip posterior stabilized designs.
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Maag C, Metcalfe A, Cracaoanu I, Wise C, Auger DD. The development of simulator testing for total knee replacements. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mihalko WM, Haider H, Kurtz S, Marcolongo M, Urish K. New materials for hip and knee joint replacement: What's hip and what's in kneed? J Orthop Res 2020; 38:1436-1444. [PMID: 32437026 DOI: 10.1002/jor.24750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 02/04/2023]
Abstract
Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning adverse local tissue reactions, aseptic and septic loosening. The implants and the materials we utilize have improved over the last two decades and in knee and hip replacement there has been a decrease in the failures attributed to wear and osteolysis. Despite these advancements there are still issues with patient satisfaction and early revisions due to septic and aseptic loosening in knee replacement patients. This article reviews the state of current implant material technology in hip and knee replacement surgery, discusses some of the unmet needs we have in biomaterials, and reviews some of the current biomaterials and technology that may be able to solve the most common issues in the knee and hip replacement surgery.
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Affiliation(s)
- William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hani Haider
- Orthopaedic Biomechanics and Advanced Surgical Technologies Laboratory, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | - Steven Kurtz
- Exponent Inc., Drexel University, Philadelphia, Pennsylvania
| | - Michele Marcolongo
- Department of Materials Science and Engineering, Drexel University, Philadelphia, Pennsylvania
| | - Kenneth Urish
- Department of Orthopaedic Surgery, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Okazaki Y, Hosoba M, Miura S, Mochizuki T. Effects of knee simulator control method and radiation dose on UHMWPE wear rate, and relationship between wear rate and clinical revision rate in National Joint Registry. J Mech Behav Biomed Mater 2019; 90:182-190. [DOI: 10.1016/j.jmbbm.2018.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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Powell AJ, Crua E, Chong BC, Gordon R, McAuslan A, Pitto RP, Clatworthy MG. A randomized prospective study comparing mobile-bearing against fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties with ten-year minimum follow-up. Bone Joint J 2018; 100-B:1336-1344. [PMID: 30295539 DOI: 10.1302/0301-620x.100b10.bjj-2017-1450.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS This study compares the PFC total knee arthroplasty (TKA) system in a prospective randomized control trial (RCT) of the mobile-bearing rotating-platform (RP) TKA against the fixed-bearing (FB) TKA. This is the largest RCT with the longest follow-up where cruciate-retaining PFC total knee arthroplasties are compared in a non-bilateral TKA study. PATIENTS AND METHODS A total of 167 patients (190 knees with 23 bilateral cases), were recruited prospectively and randomly assigned, with 91 knees receiving the RP and 99 knees receiving FB. The mean age was 65.5 years (48 to 82), the mean body mass index (BMI) was 29.7 kg/m2 (20 to 52) and 73 patients were female. The Knee Society Score (KSS), Knee Society Functional Score (KSFS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short-Form Health Survey Physical and Mental Component Scores (SF-12 PCS, SF-12 MCS) were gathered and recorded preoperatively, at five-years' follow-up, and at ten years' follow-up. Additionally, Knee Injury and Osteoarthritis Outcome Scores (KOOS) were collected at five- and ten-year follow-ups. The prevalence of radiolucent lines (RL) on radiographs and implant survival were recorded at five- and ten-year follow-ups. RESULTS At the ten-year follow-up, the RP group (n = 39) had a statistically significant superior score in the OKS (p = 0.001), WOMAC (p = 0.023), SF-12 PCS (p = 0.019), KOOS Activities of Daily Living (ADL) (p = 0.010), and KOOS Sport and Recreation (Sport/Rec) (p = 0.006) compared with the FB group (n = 46). The OKS, SF-12 PCS, and KOOS Sport/Rec at ten years had mean scores above the minimal clinically important difference (MCID) threshold. There was no significant difference in prevalence of radiolucency between groups at five-years' follow-up (p = 0.449), nor at ten-years' follow-up (p = 0.08). Implant survival rate at 14 years postoperative was 95.2 (95% CI 90.7 to 99.8) and 94.7 (95% CI 86.8 to 100.0) for the RP and FB TKAs, respectively. CONCLUSION At ten-year follow-up, the mobile-bearing knee joint arthroplasty had statistically and clinically relevant superior OKS, SF-12 PCS, and KOOS (Sport/Rec) than the fixed-bearing platform. No difference was seen in prevalence of radiolucent lines. There was a greater than 94% implant survival rate for both cohorts at 14 years. Cite this article: Bone Joint J 2018;100-B:1336-44.
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Affiliation(s)
- A J Powell
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - E Crua
- Department of Trauma and Orthopaedic Surgery, Ascot Hospital, Auckland, New Zealand
| | - B C Chong
- University of Auckland, School of Medicine, Auckland, New Zealand
| | - R Gordon
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - A McAuslan
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - R P Pitto
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - M G Clatworthy
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
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Angerame MR, Jennings JM, Dennis DA. Fracture of the insert cone of a polyethylene liner in a failed posterior-stabilized, rotating-platform total knee arthroplasty. Arthroplast Today 2018; 4:148-152. [PMID: 29896543 PMCID: PMC5994790 DOI: 10.1016/j.artd.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/05/2017] [Indexed: 11/01/2022] Open
Abstract
Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.
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Affiliation(s)
- Marc R. Angerame
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
| | - Jason M. Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
- Department of Biomedical Engineering, University of Denver, Denver, CO, USA
| | - Douglas A. Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
- Department of Biomedical Engineering, University of Denver, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
- Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO, USA
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Breugem SJM, Linnartz J, Sierevelt I, Bruijn JD, Driessen MJM. Evaluation of 1031 primary titanium nitride coated mobile bearing total knee arthroplasties in an orthopedic clinic. World J Orthop 2017; 8:922-928. [PMID: 29312851 PMCID: PMC5745435 DOI: 10.5312/wjo.v8.i12.922] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the influence of the titanium nitride (TiN) coating on the results of a total knee arthroplasty (TKA).
METHODS A total of 910 patients (338 men; 572 woman), with a mean age of 65 (range 36-94) undergoing 1031 primary TKAs were assessed. Clinical evaluation and patient-reported outcomes were gathered one year after surgery. The questionnaires included the Knee injury and Osteoarthritis Outcome Score (KOOS)-Dutch version, Visual Analogue Scale (VAS) pain scores in rest and during active knee movement, VAS-satisfaction scores, and EQ-5D-3L health scores. This was aimed to assess the overall knee function and patient satisfaction, and to enable us to make a gross comparison to other TKAs.
RESULTS At a mean follow-up of 46 mo (range 1-92) the overall implant survival was 97.7% and 95.1% for any operative reason related to the implant. Twenty-three knees (2.2%) required revision surgery. Arthrofibrosis was the most common indication for a re-operation. The clinical evaluation and patient-reported outcomes revealed good to excellent patient satisfaction and function of the arthroplasty. The median postoperative VAS-pain scores on a scale of 0-100, at one year after surgery were 1 in rest and 2 during movement.
CONCLUSION The TiN coated, mobile bearing TKA results are excellent and similar to those of other widely used TKA designs. Residual pain of the knee remains a concern and the TiN coating in combination with the mobile bearing does not seem to be the simple solution to this problem. Future research will have to show that the coating gives a better survival than the cobalt chrome version.
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Affiliation(s)
| | - Jeroen Linnartz
- Orthopedium, Orthopedic Clinic, Delft 2616 LS, The Netherlands
| | | | - Jon D Bruijn
- Orthopedium, Orthopedic Clinic, Delft 2616 LS, The Netherlands
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Gothesen O, Lygre SHL, Lorimer M, Graves S, Furnes O. Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements. Acta Orthop 2017; 88:649-656. [PMID: 28929828 PMCID: PMC5694810 DOI: 10.1080/17453674.2017.1378533] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Given similar functional outcomes with mobile and fixed bearings, a difference in survivorship may favor either. This study investigated the risk of aseptic loosening for the most used subtypes of mobile-bearing rotating-platform knees, in Norway and Australia. Patients and methods - Primary TKRs reported to the Norwegian and Australian joint registries, between 2003 and 2014, were analyzed with aseptic loosening as primary end-point and all revisions as secondary end-point. We hypothesized that no difference would be found in the rate of revision between rotating-platform and the most used fixed-bearing TKRs, or between keeled and non-keeled tibia. Kaplan-Meier estimates and curves, and Cox regression relative risk estimates adjusted for age, sex, and diagnosis were used for comparison. Results - The rotating-platform TKRs had an increased risk of revision for aseptic loosening compared with the most used fixed-bearing knees, in Norway (RR =6, 95% CI 4-8) and Australia (RR =2.1, 95% CI 1.8-2.5). The risk of aseptic loosening as a reason for revision was highest in Norway compared with Australia (RR =1.7, 95% CI 1.4-2.0). The keeled tibial component had the same risk of aseptic loosening as the non-keeled tibia (Australia). Fixation method and subtypes of the tibial components had no impact on the risk of aseptic loosening in these mobile-bearing knees. Interpretation - The rotating-platform TKRs in this study appeared to have a higher risk of revision for aseptic loosening than the most used fixed-bearing TKRs.
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Affiliation(s)
- Oystein Gothesen
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine (K1), Faculty of Medicine and Dentistry, University of Bergen, Bergen,Department of Orthopaedic Surgery, Haugesund Hospital, Helse Fonna HF, Haugesund,Correspondence:
| | - Stein Hakon L Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Michelle Lorimer
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Stephen Graves
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine (K1), Faculty of Medicine and Dentistry, University of Bergen, Bergen
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No differences between fixed- and mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1757-1777. [PMID: 27324479 DOI: 10.1007/s00167-016-4195-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 06/07/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE For years, numerous studies have been performed to determine whether mobile-bearing total knee arthroplasty (MB-TKA) or fixed-bearing total knee arthroplasty (FB-TKA) is the preferential design in total knee arthroplasty. Reviews and meta-analyses on this subject have focused on a relatively small number of randomised controlled trials, possibly missing important results of smaller studies. The goal of this review was to provide a comprehensive overview of all literature comparing MB-TKA and FB-TKA in the treatment of osteoarthritis of the knee. METHODS An extensive literature search was performed in the PubMed database. All studies that compared MB-TKA with FB-TKA and looked at one of four theorised advantages (insert wear, signs of loosening, survival rate of the prosthesis and clinical outcome) were included. RESULTS The initial search yielded 258 articles, of which 127 were included after the first screening. The included studies consisted of 9 meta-analyses, 3 systematic reviews, 48 RCT's, 44 comparative studies, 10 reviews and 13 studies that examined patients who received bilateral TKA (one MB-TKA and one FB-TKA). Combining the results of all studies showed that almost all studies found no difference between MB-TKA and FB-TKA. CONCLUSIONS Even when examining all different types of studies on MB-TKA and FB-TKA, the results of this review showed no difference in insert wear, risk of loosening, survivorship or clinical outcome. In daily practice, the choice between MB-TKA and FB-TKA should be based on the experience and judgment of the surgeon, since no clear differences are observed in the scientific literature. LEVEL OF EVIDENCE III.
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Bailey O, Ferguson K, Crawfurd E, James P, May PA, Brown S, Blyth M, Leach WJ. No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1653-9. [PMID: 24509880 DOI: 10.1007/s00167-014-2877-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE It is hypothesized that mobile polyethylene bearings in total knee arthroplasty (TKA) may confer benefits with regard to range of motion and have improved clinical outcome scores in comparison with an arthroplasty with a fixed-bearing design. Our study compares clinical outcomes between patients who undergo TKA with either a rotating platform or fixed bearing using a posterior cruciate-retaining design. METHODS Three hundred and thirty-one patients were randomized to receive either a rotating-platform (161 patients) or a fixed-bearing (170 patients) implant. All patients were assessed pre-operatively and at 1 and 2 years post-operatively using standard tools (range of movement, Oxford Knee Score, American Knee Society Score, SF12 and Patella Score). RESULTS There was no difference in pre- to 2-year post-operative outcomes between the groups with regard to improvement in range of motion (10° ± 16 vs. 9° ± 15), improvement in Oxford Knee Score (-17.6 ± 9.9 vs. -19.1 ± 8.4), improvement in American Knee Society Score (49.5 ± 24.7 vs. 50.7 ± 21.0), function (23.6 ± 19.6 vs. 25.0 ± 22.5) and pain (34.9 ± 16.2 vs. 35.8 ± 14.1) subscores, improvement in SF12 Score (10.0 ± 16.3 vs. 12.3 ± 15.8) or improvement in Patella Score (9.7 ± 7.4 vs. 10.6 ± 7.1). CONCLUSION No difference was demonstrated in clinical outcome between patients with a rotating-platform and fixed-bearing posterior cruciate-retaining TKA at 2-year follow-up. LEVEL OF EVIDENCE I.
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Affiliation(s)
- O Bailey
- Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK,
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CR TKA UHMWPE wear tested after artificial aging of the vitamin E treated gliding component by simulating daily patient activities. BIOMED RESEARCH INTERNATIONAL 2014; 2014:567374. [PMID: 25506594 PMCID: PMC4258372 DOI: 10.1155/2014/567374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/15/2014] [Accepted: 09/28/2014] [Indexed: 11/18/2022]
Abstract
The wear behaviour of total knee arthroplasty (TKA) is dominated by two wear mechanisms: the abrasive wear and the delamination of the gliding components, where the second is strongly linked to aging processes and stress concentration in the material. The addition of vitamin E to the bulk material is a potential way to reduce the aging processes. This study evaluates the wear behaviour and delamination susceptibility of the gliding components of a vitamin E blended, ultra-high molecular weight polyethylene (UHMWPE) cruciate retaining (CR) total knee arthroplasty. Daily activities such as level walking, ascending and descending stairs, bending of the knee, and sitting and rising from a chair were simulated with a data set received from an instrumented knee prosthesis. After 5 million test cycles no structural failure of the gliding components was observed. The wear rate was with 5.62 ± 0.53 mg/million cycles falling within the limit of previous reports for established wear test methods.
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NexGen® LPS mobile bearing total knee arthroplasty: 10-year results. Knee Surg Sports Traumatol Arthrosc 2014; 22:1786-92. [PMID: 24781274 DOI: 10.1007/s00167-014-3019-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Mobile bearing (MB) knee prostheses were designed to improve the performances of the total knee arthroplasties (TKA). The clinical superiority of MB prosthesis compared to its fixed bearing counterpart has remained elusive. This study prospectively evaluates the cumulative survivorship, clinical, radiographic results, and complications of a large series of MB TKAs in relation to patient age, sex, severity of arthritis, and patellar resurfacing. METHODS This study evaluates the 5- to 10-year cumulative survival rate of the NexGen(®) LPS MB. Between 2000 and 2005, we performed a consecutive series of 332 MB, posterior-stabilized TKA in 249 patients (mean age 71.2 years, SD 6.9). The implants were clinically evaluated with the Hospital Special Surgery Knee Score (HSS-KS) and radiographically with the Knee Society Roentgenographic Evaluation System (KS-RES). The mean follow-up was 76.3 months (minimum 5 years). RESULTS The HSS-KS improved from 55 pre-operatively to 86 at the end of follow-up. According to the KS-RES, the implants were anatomically aligned and progressive radiolucent lines appeared in four knees (1.2 %). The patella was selectively resurfaced in 162 of 332 knees. Patients with the patella resurfaced had better clinical results compared to those not resurfaced, but there was no difference in terms of survival. The cumulative survival rate was 98.4 % at 10 years (Kaplan-Meier's analysis). CONCLUSIONS This MB implant provided reliable and durable clinical results with a survivorship of over 98 % at 10 years, in unselected patients regardless of age, sex, severity of disease, and patellar treatment.
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Dynamic finite element analysis of mobile bearing type knee prosthesis under deep flexional motion. ScientificWorldJournal 2014; 2014:586921. [PMID: 25133247 PMCID: PMC4124825 DOI: 10.1155/2014/586921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/22/2014] [Indexed: 11/17/2022] Open
Abstract
The primary objective of this study is to distinguish between mobile bearing and fixed bearing posterior stabilized knee prostheses in the mechanics performance using the finite element simulation. Quantifying the relative mechanics attributes and survivorship between the mobile bearing and the fixed bearing prosthesis remains in investigation among researchers. In the present study, 3-dimensional computational model of a clinically used mobile bearing PS type knee prosthesis was utilized to develop a finite element and dynamic simulation model. Combination of displacement and force driven knee motion was adapted to simulate a flexion motion from 0° to 135° with neutral, 10°, and 20° internal tibial rotation to represent deep knee bending. Introduction of the secondary moving articulation in the mobile bearing knee prosthesis has been found to maintain relatively low shear stress during deep knee motion with tibial rotation.
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Biotribology of a mobile bearing posterior stabilised knee design - Effect of motion restraint on wear, tibio-femoral kinematics and particles. J Biomech 2014; 47:2415-23. [DOI: 10.1016/j.jbiomech.2014.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 11/19/2022]
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Heyse TJ, Haas SB, Efe T. The use of oxidized zirconium alloy in knee arthroplasty. Expert Rev Med Devices 2014; 9:409-21. [DOI: 10.1586/erd.12.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Gøthesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P, Hallan G, Furnes O. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009. Bone Joint J 2013; 95-B:636-42. [PMID: 23632673 DOI: 10.1302/0301-620x.95b5.30271] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We evaluated the rates of survival and cause of revision of seven different brands of cemented primary total knee replacement (TKR) in the Norwegian Arthroplasty Register during the years 1994 to 2009. Revision for any cause, including resurfacing of the patella, was the primary endpoint. Specific causes of revision were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing TKRs, two fixed non-modular bearing PCR TKRs and two mobile-bearing posterior cruciate-sacrificing TKRs were investigated in a total of 17 782 primary TKRs. The median follow-up for the implants ranged from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from 89.5% to 95.3%. Cox's relative risk (RR) was calculated relative to the fixed modular-bearing Profix knee (the most frequently used TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision for aseptic tibial loosening was higher in the mobile-bearing LCS Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared with the Profix. These implants (except AGC Universal) also had an increased risk of revision for femoral loosening (RR 2.3 (95% CI 1.1 to 4.8), RR 3.7 (95% CI 1.6 to 8.9), and RR 3.4 (95% CI 1.1 to 11.0), respectively). These results suggest that aseptic loosening is related to design in TKR.
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Affiliation(s)
- O Gøthesen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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20
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Advances in tribological testing of artificial joint biomaterials using multidirectional pin-on-disk testers. J Mech Behav Biomed Mater 2013; 31:117-34. [PMID: 23831149 DOI: 10.1016/j.jmbbm.2013.05.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 04/02/2013] [Accepted: 05/13/2013] [Indexed: 11/20/2022]
Abstract
The introduction of numerous formulations of Ultra-high molecular weight polyethylene (UHMWPE), which is widely used as a bearing material in orthopedic implants, necessitated screening of bearing couples to identify promising iterations for expensive joint simulations. Pin-on-disk (POD) testers capable of multidirectional sliding can correctly rank formulations of UHMWPE with respect to their predictive in vivo wear behavior. However, there are still uncertainties regarding POD test parameters for facilitating clinically relevant wear mechanisms of UHMWPE. Studies on the development of POD testing were briefly summarized. We systematically reviewed wear rate data of UHMWPE generated by POD testers. To determine if POD testing was capable of correctly ranking bearings and if test parameters outlined in ASTM F732 enabled differentiation between wear behavior of various formulations, mean wear rates of non-irradiated, conventional (25-50kGy) and highly crosslinked (≥90kGy) UHMWPE were grouped and compared. The mean wear rates of non-irradiated, conventional and highly crosslinked UHMWPEs were 7.03, 5.39 and 0.67mm(3)/MC. Based on studies that complied with the guidelines of ASTM F732, the mean wear rates of non-irradiated, conventional and highly crosslinked UHMWPEs were 0.32, 0.21 and 0.04mm(3)/km, respectively. In both sets of results, the mean wear rate of highly crosslinked UHMPWE was smaller than both conventional and non-irradiated UHMWPEs (p<0.05). Thus, POD testers can compare highly crosslinked and conventional UHMWPEs despite different test parameters. Narrowing the allowable range for standardized test parameters could improve sensitivity of multi-axial testers in correctly ranking materials.
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Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. ACTA ACUST UNITED AC 2012; 94:1321-9. [PMID: 23015555 DOI: 10.1302/0301-620x.94b10.29411] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.
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Affiliation(s)
- S S Sarmah
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
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22
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Grupp TM, Saleh KJ, Mihalko WM, Hintner M, Fritz B, Schilling C, Schwiesau J, Kaddick C. Effect of anterior-posterior and internal-external motion restraint during knee wear simulation on a posterior stabilised knee design. J Biomech 2012; 46:491-7. [PMID: 23159092 DOI: 10.1016/j.jbiomech.2012.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/10/2012] [Accepted: 10/21/2012] [Indexed: 12/28/2022]
Abstract
The objective of our study was to examine the effect of biphaseal AP translation and IE rotation restraint, using a system defined specifically for posterior stabilised knee designs, on wear, kinematics and particle release in comparison to linear motion restraint as required by the established ISO 14243-1:2002(E) protocol. In the ISOlinear groups, an AP motion restraint of 30 N/mm and an IE rotation restraint of 0.6 Nm/° were applied in the knee wear simulation. In the ISOgap biphaseal groups with PCL sacrificing implants, the restraining AP force was zero in a ±2.5mm range with, externally, a constant of 9.3N/mm applied proportionally to the AP translation of the tibia plateau, whereas the restraining IE torque was zero in a ±6° range with, externally, a constant of 0.13 Nm/° applied proportionally to the IE rotation of the tibia plateau. Using the ISOgap biphaseal protocol on a posterior stabilised knee design, we found an increase of 41% in AP translation and of 131% in IE rotation, resulting in a 3.2-fold higher wear rate compared to the results obtained using the ISOlinear protocol. Changes in AP translation and IE rotation ligament motion restraints have a high impact on knee joint kinematics and wear behaviour of a fixed bearing posterior stabilised knee design.
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Affiliation(s)
- Thomas M Grupp
- Aesculap AG, Research & Development, Tuttlingen, Germany.
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23
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Petrella AJ, Armstrong JR, Laz PJ, Rullkoetter PJ. A novel cross-shear metric for application in computer simulation of ultra-high molecular weight polyethylene wear. Comput Methods Biomech Biomed Engin 2012; 15:1223-32. [DOI: 10.1080/10255842.2011.585975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Wolterbeek N, Garling EH, Mertens BJ, Nelissen RGHH, Valstar ER. Kinematics and early migration in single-radius mobile- and fixed-bearing total knee prostheses. Clin Biomech (Bristol, Avon) 2012; 27:398-402. [PMID: 22055272 DOI: 10.1016/j.clinbiomech.2011.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mobile-bearing variant of a single-radius design is assumed to provide more freedom of motion compared to the fixed-bearing variant because the insert does not restrict the natural movements of the femoral component. This would reduce the contact stresses and wear which in turn may have a positive effect on the fixation of the prosthesis to the bone and thereby decreases the risk for loosening. The aim of this study was to evaluate early migration of the tibial component and kinematics of a mobile-bearing and fixed-bearing total knee prosthesis of the same single-radius design. METHODS Twenty Triathlon single-radius posterior-stabilized knee prostheses were implanted (9 mobile-bearing and 11 fixed-bearing). Fluoroscopy and roentgen stereophotogrammetric analysis (RSA) were performed 6 and 12 months post-operatively. FINDINGS The 1 year post-operative RSA results showed considerable early migrations in 3 out of 9 mobile-bearing patients and 1 out of 11 fixed-bearing patients. The range of knee flexion was the same for the mobile-bearing and fixed-bearing group. The mobile insert was following the femoral component during motion. INTERPRETATION Despite the mobile insert following the femoral component during motion, and therefore performing as intended, no kinematic advantages of the mobile-bearing total knee prosthesis were seen. The fixed-bearing knee performed as good as the mobile-bearing knee and maybe even slightly better based on less irregular kinematics and less early migrations.
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Affiliation(s)
- N Wolterbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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25
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Haider H, Weisenburger JN, Kurtz SM, Rimnac CM, Freedman J, Schroeder DW, Garvin KL. Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty? J Arthroplasty 2012; 27:461-9. [PMID: 22146382 DOI: 10.1016/j.arth.2011.03.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 03/11/2011] [Indexed: 02/01/2023] Open
Abstract
Concerns about reduced strength, fatigue resistance, and oxidative stability of highly cross-linked and remelted ultrahigh-molecular-weight polyethylene (UHMWPE) have limited its clinical acceptance for total knee arthroplasty. We hypothesized that a highly cross-linked UHMWPE stabilized with vitamin E would have less oxidation and loss of mechanical properties. We compared the oxidation, in vitro strength, fatigue-crack propagation resistance, and wear of highly cross-linked UHMWPE doped with vitamin E to γ-inert-sterilized direct compression-molded UHMWPE (control). After accelerated aging, the control material showed elevated oxidation, loss of small-punch mechanical properties, and loss of fatigue-crack propagation resistance. In contrast, the vitamin E-stabilized material had minimal changes and exhibited 73% to 86% reduction in wear for both cruciate-retaining and posterior-stabilized total knee arthroplasty designs. Highly cross-linked vitamin E-stabilized UHMWPE performed well in vitro.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical, Center, Omaha, Nebraska 68198, USA
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26
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Tanaka A, Nakamura E, Okamoto N, Banks SA, Mizuta H. Three-dimensional kinematics during deep-flexion kneeling in mobile-bearing total knee arthroplasty. Knee 2011; 18:412-6. [PMID: 20833548 DOI: 10.1016/j.knee.2010.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 08/02/2010] [Accepted: 08/16/2010] [Indexed: 02/02/2023]
Abstract
We performed an in vivo radiographic analysis of tibiofemoral and polyethylene (PE) insert motions during weight-bearing kneeling beyond 120° of flexion in one high-flexion knee arthroplasty design to determine if kinematics changed over time and if axial rotation occur between the PE insert and the tibial baseplate. Twenty knees implanted with a posterior-stabilized rotating-platform (RP) knee arthroplasty were postoperatively evaluated at 3, 6, and 12 months. The averaged flexion angles were 122°, 129°, and 131° at 3, 6, and 12 months, respectively, showing that the improvement of flexion was achieved up to 6 months. The femoral condyles translated posteriorly from extension to maximum flexion. There was a significant increase in AP translation of femoral lateral condyle in the maximum flexion kneeling between 12 months and the two other intervals (p=0.0003 at 3 months and p=0.016 at 6 months), while no differences in those of medial condyle between all intervals. Almost all rotation occurred at the surface between the tibial baseplate and the PE insert (p=0.0479 at 3 months, p=0.0008 at 6 months, and p=0.0479 at 12 months), almost no rotation occurred at the surface between the PE insert and the femoral component. There were significant increases in the amount of internal rotation angle during full flexion between the tibial component and the PE insert up to 12 months. Knees implanted with this RP knee arthroplasty design show deep-flexion knee kinematics that are consistent with the implant design intent.
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Affiliation(s)
- Azusa Tanaka
- Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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Kretzer JP, Jakubowitz E, Reinders J, Lietz E, Moradi B, Hofmann K, Sonntag R. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 2011; 7:710-5. [PMID: 20883831 DOI: 10.1016/j.actbio.2010.09.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 11/16/2022]
Abstract
Unicondylar knee arthroplasty is an attractive alternative to total knee arthroplasty for selected patients with osteoarthritis. Mobile bearing knee designs have been developed to improve knee kinematics, lower contact stresses and reduced wear of ultra-high molecular weight polyethylene compared with fixed bearing designs. This study compared in vitro wear behavior of fixed and mobile unicondylar bearing designs. Analysis was performed using a force-controlled AMTI knee simulator according to ISO 14243-1:2002(E). The wear volume of the implants was determined gravimetrically. Optical surface characterization and an estimation of wear particle size and morphology were performed. Implant kinematic data for both designs were determined. The wear rates averaged 10.7 ± 0.59 mg per 10(6) cycles for the medial and 5.38 ± 0.63 mg per 10(6) cycles for the lateral components of the mobile bearings, compared with 7.51 ± 0.29 mg per 10(6) cycles and 3.04 ± 0.35 mg per 10(6) cycles for the fixed bearings. The mobile bearings therefore exhibited higher wear rates (P<0.01) compared with the fixed bearings. The tibial polyethylene inserts of the mobile bearings showed pronounced backside wear at the inferior surface. The kinematics of both designs was similar. However, anterior-posterior translation was lower in the mobile bearings. The wear particles were mainly elongated and small in size for both designs (P=0.462). This study shows that wear may play an important role in unicondylar mobile bearing knee designs. Advantages of unicondylar mobile designs compared with fixed bearing designs, which have been proposed in terms of wear behavior and improved kinematics, could not be confirmed.
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Affiliation(s)
- J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopedics, Traumatology and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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28
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In Vitro Knee Wear, Kinematics, and Particle Morphology Among Different Bearing Geometries in a Mobile Bearing Knee System. ACTA ACUST UNITED AC 2011. [DOI: 10.1520/jai103304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Post ZD, Matar WY, van de Leur T, Grossman EL, Austin MS. Mobile-bearing total knee arthroplasty: better than a fixed-bearing? J Arthroplasty 2010; 25:998-1003. [PMID: 19775858 DOI: 10.1016/j.arth.2009.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 07/12/2009] [Indexed: 02/01/2023] Open
Abstract
The purported advantages of mobile-bearing knee include increased survivorship and restoration of more natural knee kinematics compared to a standard fixed-bearing design. To evaluate these claims, an extensive review of the available literature was undertaken. We compared survivorship and clinical function, including patient preference. We found no difference in survivorship at 12 to 23 years. Kinematic profiles of both designs did not differ significantly: rotation, flexion, and extension were comparable. Studies evaluating both designs in the same patient showed no difference in range of motion, knee preference, knee scores, and survivorship at midterm follow-up. Both designs were capable of producing excellent long-term results and clinical outcomes if properly implanted. The available evidence does not point to the superiority of one design over another in survivorship and clinical function.
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Affiliation(s)
- Zachary D Post
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, Pennsylvania, USA
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30
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Lu YC, Huang CH, Chang TK, Ho FY, Cheng CK, Huang CH. Wear-pattern analysis in retrieved tibial inserts of mobile-bearing and fixed-bearing total knee prostheses. ACTA ACUST UNITED AC 2010; 92:500-7. [PMID: 20357325 DOI: 10.1302/0301-620x.92b4.22560] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Components from 73 failed knee replacements (TKRs) consisting of rotating-platform, mobile-bearing and fixed-bearing implants were examined to assess the patterns of wear. The patterns were divided into low-grade (burnishing, abrasion and cold flow) and high-grade (scratching, pitting/metal embedding and delamination) to assess the severity of the wear of polyethylene. The rotating-platform group had a higher incidence of low-grade wear on the upper surface compared with the fixed-bearing group. By contrast, high-grade wear comprising scratching, pitting and third-body embedding was seen on the lower surface. Linear regression analysis showed a significant correlation of the wear scores between the upper and lower surfaces of the tibial insert (R(2) = 0.29, p = 0.04) for the rotating-platform group, but no significant correlation was found for the fixed-bearing counterpart. This suggests that high-grade wear patterns on the upper surface are reduced with the rotating-platform design. However, the incidence of burnishing, pitting/third-body embedding and scratching wear patterns on the lower surface was higher compared with that in the fixed-bearing knee.
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Affiliation(s)
- Y-C Lu
- Mackay Memorial Hospital, Taipei, 10449 Taiwan
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31
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Kretzer JP, Jakubowitz E, Sonntag R, Hofmann K, Heisel C, Thomsen M. Effect of joint laxity on polyethylene wear in total knee replacement. J Biomech 2010; 43:1092-6. [DOI: 10.1016/j.jbiomech.2009.12.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 11/30/2022]
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Smith TO, Ejtehadi F, Nichols R, Davies L, Donell ST, Hing CB. Clinical and radiological outcomes of fixed- versus mobile-bearing total knee replacement: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2010; 18:325-40. [PMID: 19851756 DOI: 10.1007/s00167-009-0909-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 08/21/2009] [Indexed: 02/04/2023]
Abstract
Controversy exists regarding the clinical and radiological differences in outcomes between fixed- and mobile-bearing total knee replacements (TKR). The aim of this study was to compare these two TKR designs using a meta-analysis of the electronic databases MEDLINE, EMBASE, CINAHL and AMED in addition to a review of unpublished material. All included papers were critically appraised using a modified PEDro critical appraisal tool. Thirty-three studies were eligible, assessing the outcomes of 3532 TKRs. Analysis suggested that there was no significant difference in clinical or radiological outcomes and complication rates between fixed- and mobile-bearing TKRs.
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Affiliation(s)
- Toby O Smith
- Institute of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR2 7UY, UK.
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33
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Lemaire RG. Mid-term results with a highly congruous mobile-bearing knee prosthesis. Knee Surg Sports Traumatol Arthrosc 2010; 18:170-80. [PMID: 19701626 DOI: 10.1007/s00167-009-0883-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 07/24/2009] [Indexed: 12/19/2022]
Abstract
Two hundred and six consecutive total knee arthroplasties were performed in 180 patients with a highly congruous mobile-bearing knee prosthesis. At mean follow-up of 78 months (range: 60-102 months), the outcomes of 181 knees in 158 patients were evaluated using the American Knee Society's Knee and Functional scoring system and Radiological scoring system. Mean values for Knee and Function scores were 92.6 and 81.1, respectively versus 51.8 and 43.4 preoperatively; mean flexion range was 113.6 degrees versus 110.8 degrees preoperatively. There were no cases of bearing dislocation and no radiological signs of loosening or osteolysis. Secondary patella resurfacing was done in 7 of 52 knees in which the patella was not primarily resurfaced. Arthroplasty survival with revision for aseptic loosening as the endpoint was 100% (95% CI: 97.7-100) at 5 years and at 8 years (95% CI: 87.2-100); with revision of the arthroplasty for any reason including one revision for infection as the endpoint, survival was 99.5% (95% CI: 96.9-100) at 5 years and at 8 years (95% CI: 86.9-100). The overall results were satisfactory and compared with those of other mobile-bearing knee prostheses featuring full or partial congruence. No significant differences were noted for range of motion, knee scores and function scores between two subsets of knees that received a bearing allowing only rotation or rotation and 5 mm anteroposterior translation. Longer follow-up is needed to evaluate possible benefits of high congruence and of specific modes of bearing mobility with respect to wear and bony fixation.
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Affiliation(s)
- Roger G Lemaire
- Orthopaedic Department, Liège University Hospital, Liège, Belgium.
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