Total meniscectomy has been shown to induce osteoarthritic changes in the underlying articular cartilage(AC) and bone in the natural knee (Fairbank 1948; McDermott 2006). This indicates the meniscus plays an important protective role, providing joint congruity and distributing contact forces, hence reducing contact stress. However, no friction and wear studies have been performed on meniscectomy. The aim of this study was to study the tribological response of the medial compartmental natural knee with and without the intact meniscus, under physiological dynamic loading and motion. The effect of normal and reduced loading was investigated.

Eighteen month old bovine medial compartmental knees were used. A pendulum friction simulator (Simulation Solutions, UK) was used to apply a dynamic axial loads with peak loads of 1000N (normal) and 260N (reduced). Flexion-extension of amplitude 23degrees was applied and the experiments ran for 3600 cycles at 1Hz. Lubricant was 25% bovine serum in saline. A 9.4 Tesla MRI (Bruker) scanner and Analyze software (Mayo Clinic, US) were used to calculate wear volumes. A surface profilometer (Talysurf, Taylor-Hobson, UK) was used to measure the surface roughness of the specimen before and after the test.

Coefficient of friction was found to increase with increased loading, with and without meniscus. With meniscus intact, no wear was found on AC and contact stresses were 4.9MPa and 2.8MPa, for normal and reduced loading respectively. On removal of meniscus, friction was higher at both loading conditions and surface fibrillation found on some of the AC surfaces. Contact stresses rose to 17.2MPa and 8.6MPa for normal and reduced loading.

This study has shown for the first time, the direct elevation of the coefficient of friction, immediate surface fibrillation and biomechanical wear of AC upon removal of the meniscus. On removal of meniscus, peak stresses rose and surface damage occurred on AC surfaces. The removal of the meniscus means forces act across smaller areas and contact stresses are increased. Wear is increased due to the subsequent increase in direct solid-solid contact and loss of fluid support due to the unique biphasic nature of AC. This further supports retaining meniscus whenever possible in knee joint surgery.

Clinical reports of surgical intervention options, such as spacers or hemi-arthroplasties, particularly for treatment of young arthritic patients, have been poor [1]. Knowledge of the tribology of the cartilage-prosthesis interaction of these devices would potentially provide an insight to the reasons for the premature failure of these devices and the development of more appropriate intervention treatment solutions for arthritic patients. Frictional studies of articular cartilage have been reported, using simple pin-on-plate geometric configurations [2], which do not accurately represent the geometric and stress conditions in the natural joint. A more representative model, based on the medial compartment of the knee joint has been developed in the Part 1 of this study [3] for the pre-clinical tribological testing the natural joint and their related arthroplasty devices. Bearing geometry is an important consideration in limiting wear, as shown in congruous meniscal knee replacement, which exhibited lower wear rates than incongruous designs [4,5]. The aim of this study was to use a unicompartmental hemi-arthroplasty model to examine the effect of tibial conformity and stress on the friction and wear of articular cartilage.

Experiments were conducted in an anatomic pendulum friction simulator (SimSol, UK) using the medial femoral condyle of a bovine knee joint articulating against two conforming stainless steel (316L) tibial plates (R=50mm and 100mm). A simplified physiologic knee loading profile was applied represent both low loading and much higher physiological loading conditions, with peak load between 259N – 1.5kN). Tests were conducted in 25% bovine serum and run for 3600 and 300 cycles under the low and high loading conditions respectively. The motion was cycled at 1Hz with amplitude between −10°–13.1°. Cartilage wear was assessed qualitatively from surface roughness measurements using a surface profile using a surface profilometer (Taylor Hobson, UK). The friction and wear of cartilage articulating against the conforming tibial plates were compared to a positive control flat tibial plate model [3]. The conforming plate models were found to produce significantly lower cartilage friction and surface damage (μ=0.022–0.035, Ra=0.136–0.145μm) than the flat plate model (μ=0.078, Ra=2.70μm). No damage on the cartilage surface was observed under low loads, however, under higher, more physiological loading cartilage friction increased (μ=0.08) in the conforming plate model, with a significant surface damage. An anatomic unicompartmental knee joint model has been developed to successfully examine the effect of counterface conformity on cartilage friction and wear for pre-clinical testing of a hemi-arthroplasty device. Counterface conformity was shown to significantly reduce cartilage friction and wear. This was attributed to the increased surface area and reduced stresses experienced in comparison to an incongruent bearing articulation.