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13.09.2017 | Clinical Research | Ausgabe 12/2017

Clinical Orthopaedics and Related Research® 12/2017

Current Total Knee Designs: Does Baseplate Roughness or Locking Mechanism Design Affect Polyethylene Backside Wear?

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 12/2017
Autoren:
MD Zachary W. Sisko, PhD Matthew G. Teeter, MD, MSc, FRCSC Brent A. Lanting, MD, MSc, FRCSC James L. Howard, MD, FRCSC Richard W. McCalden, MD, FRCSC Douglas D. Naudie, MD, FRCSC Steven J. MacDonald, MD, MSc, FRCSC Edward M. Vasarhelyi
Wichtige Hinweise
The institution of one or more of the authors (MGT, BAL, JLH, RWM, DDN, SJM, EMV) has received during the study period funding from Smith & Nephew (Memphis, TN, USA), DePuy (Warsaw, IN, USA), Stryker (Mahwah, NJ, USA), Zimmer (Warsaw, IN, USA), and Microport (Arlington, TN, USA).
One of the authors certifies that he (BAL) or a member of his immediate family has received, during the study period, an amount of less than USD 10,000 from DePuy (Warsaw, IN, USA), Integra (Plainsboro, NJ, USA), an amount of less than USD 10,000 from Intellijoint (Waterloo, ON, Canada), and an amount of less than USD 10,000 from Stryker (Mahwah, NJ, USA); and grants in an amount USD 10,001 to USD 100,000 from DePuy (Warsaw, IN, USA); an amount USD 10,001 to USD 100,000 from Microport (Arlington, TX, USA), an amount USD 10,001 to USD 100,000 from Stryker (Mahwah, NJ, USA), and an amount less than USD 10,000 from Zimmer (Warsaw, IN, USA).
One of the authors certifies that he (JLH) or a member of his immediate family has received during the study period, an amount of less than USD 10,000 from DePuy (Warsaw, IN, USA) and an amount of USD 10,001 to USD 100,000 from Stryker (Mahwah, NJ, USA).
One of the authors certifies that he (RWM) or a member of his immediate family has received during the study period, an amount of USD 100,001 to USD 1,000,000, from Smith & Nephew (Memphis, TN, USA).
One of the authors certifies that he (DDN) or a member of his immediate family has received during the study period, an amount of USD 10,001 to USD 100,000 from Exactech (Gainesville, FL, USA), an amount of USD 10,001 to USD 100,000 from Smith & Nephew (Memphis, TN, USA), an amount of USD 10,001 to USD 100,000 from Stryker (Mahwah, NJ, USA), and an amount of USD 10,001 to USD 100,000 from Zimmer (Warsaw, IN, USA).
One of the authors certifies that he (SJM) or a member of his immediate family has received during the study period, an amount of USD 100,001 to USD 1,000,000 from DePuy (Warsaw, IN, USA).
One of the authors certifies that he (EMV) or a member of his immediate family has received during the study period, an amount of less than USD 10,000 from (DePuy, Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at London Health Sciences Centre and the Schulich School of Medicine & Dentistry at Western University, University Hospital (London, Ontario, Canada).

Abstract

Background

Tibial baseplate roughness and polyethylene-insert micromotion resulting from locking-mechanism loosening can lead to polyethylene backside wear in TKAs. However, many retrieval studies examining these variables have evaluated only older TKA implant designs.

Questions

We used implant-retrieval analysis to examine if there were differences in: (1) backside damage scores, (2) backside damage modes, and (3) backside linear wear rates in five TKA implant designs owing to differing baseplate surface roughness and locking mechanisms. Additionally, we examined if (4) patient demographics influence backside damage and wear.

Methods

Five TKA implant models (four modern and one historical design) were selected with different tibial baseplate and/or locking mechanism designs. Six tibial inserts retrieved at the time of revision from each TKA model were matched for time in vivo, age of the patient at TKA revision, BMI, sex, revision number, and revision reason. Each insert backside was analyzed for: (1) visual total damage score and (2) individual visual damage modes, both by two observers and with an intraclass correlation coefficient of 0.66 (95% CI, 0.39–0.92), and (3) linear wear rate measured by micro-CT. Median primary outcomes were compared among the five designs. For our given sample size among five groups we could detect with 80% power a 10-point difference in damage score and an 0.11-mm per year difference in wear rate.

Results

The polished tibial design with a partial peripheral capture locking mechanism and anterior constraint showed a lower total damage score compared with the nonpolished tibial design with only a complete peripheral-rim locking mechanism (median, 12.5; range, 9.5–18.0; 95% CI, 9.58–16.42 versus median, 22.3; range, 15.5–27.0; 95% CI, 17.5–26.5; p = 0.019). The polished baseplate with a tongue-in-groove locking mechanism showed more abrasions than the nonpolished baseplate with a peripheral-rim capture and antirotational island (median, 7.25; range, 0.5–8.0; 95% CI, 2.67–8.99 versus median, 0.75; range, 0–1.5; 95% CI, 0.20–1.47; p = 0.016)). Dimpling was a unique wear mode to the nonpolished baseplates with the peripheral-rim capture and antirotational island (median, 5.5; range, 2.0–9.0; 95% CI, 2.96–8.38) and the peripheral-rim capture alone (median, 9.0; range, 6.0–10.0; 95% CI, 7.29–10.38). Overall, the linear wear rate for polished designs was lower than for nonpolished designs (0.0102 ± 0.0044 mm/year versus 0.0224 ± 0.0119 mm/year; p < 0.001). Two of the polished baseplate designs, the partial peripheral capture with anterior constraint (median, 0.083 mm/year; range, 0.0037–0.0111 mm/year; 95% CI, 0.0050–0.0107 mm versus median, 0.0245 mm/year; range, 0.014–0.046 mm/year; 95% CI, 0.0130–0.0414 mm; p = 0.008) and the tongue-in-groove locking mechanism (median, 0.0085 mm/year; range, 0.005–0.015 mm/year; 95% CI, 0.0045–0.0138 mm; p = 0.032) showed lower polyethylene linear wear rates compared with the nonpolished baseplate design with only a peripheral-rim capture.

Conclusions

Total damage scores and linear wear rates were highest involving the nonpolished design with only a peripheral rim capture. There were no differences among the other TKA designs regarding damage and wear, but this finding should be considered in the setting of a relatively small sample size.

Clinical Relevance

Our study showed that in the complex interplay between baseplate surface finish and locking mechanism design, a polished baseplate with a robust locking mechanism had the lowest backside damage and linear wear. However, improvements in locking mechanism design in nonpolished baseplates potentially may offset some advantages of a polished baseplate. Further retrieval analyses need to be done to confirm such findings, especially analyzing current crosslinked polyethylene. Additionally, we need mid- and long-term studies comparing TKA revisions attributable to wear and osteolysis among implants before understanding if such design differences are clinically relevant.

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