Abstract
INTRODUCTION
The specific factors affecting wear of the ultrahigh molecular weight polyethylene (UHMWPE) tibial component of total knee replacements (TKR) are poorly understood. One recent study demonstrated that lower conforming inserts produced less wear in knee simulators. The purpose of this study is to investigate the effect of insert conformity and design on articular surface wear of postmortem retrieved UHMWPE tibial inserts.
METHODS
Nineteen NexGen cruciate-retaining (NexGen CR) and twenty-five NexGen posterior-stabilized (NexGen PS) (Zimmer) UHWMPE tibial inserts were retrieved at postmortem from fifteen and eighteen patients respectively. Articular surfaces were scanned at 100×100μm using a coordinate measuring machine (SmartScope, OGP Inc.). Autonomous mathematical reconstruction of the original surface was used to calculate volume loss and linear penetration maps of the medial and lateral plateaus. Wear rates for the medial, lateral and total articular surface were calculated as the slope of the linear regression line of volume loss against implantation time. Volume loss due to creep was estimated as the regression intercept. Student t-tests were used to check for significant.
RESULTS
The NexGen CR and NexGen PS patient groups were approximately the same age at time of implantation (mean±SD: 72.1±9.9 and 68.7±8.8 years respectively, p=0.260) and implantation times were not significantly different (8.7±3.1 and 9.1±3.7 years, p=0.670). Both groups showed high variability in wear scars. No significant difference in wear rates on the total surface (mean±SE: 11.89±5.01 mm3/year vs. 11.09±4.18 mm3/year, p=0.905). However, NexGen CR components showed significantly higher volume loss due to creep than NexGen PS components (70.22±47.07 mm3 vs. 31.30±41.15 mm3, p=0.007). These results were reflected on the medial and lateral sides, with no significant differences in wear rates on the medial side (p=0.856) or lateral side (p=0.633) and higher volume losses due to creep associated with the NexGen CR components. While NexGen CR and NexGen PS showed a near equal mean percentage of volume loss on the medial side (CR: 52.4±11.7%, PS: 52.5±11.6%), a paired t-test showed that NexGen PS components showed a higher volume loss on the medial side (p=0.056), NexGen CR components did not (p=0.404).
DISCUSSION
The combination of higher conformity and more kinematic constraint in NexGen CR components may create larger contact areas with higher stresses, leading to higher volume loss due to creep observed in this study. However, these factors did not produce increased wear rates in the population. Constrained components may maintain more loading on medial side and limit sliding distance on lateral side, causing more wear medially. Total wear rates were very similar and resembled the previously reported rate of 12.9 ± 5.97 mm3/year for retrieved Miller-Galante II (Zimmer) components, which features a near flat articulating surface. These findings indicate that materials factors may be most important in producing wear and that higher conformity alone does not decrease wear.
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