Alternative femoral bearing surface options for knee replacement in young patients

Abstract

Total knee arthroplasty is one of the most successful and development of osteolysis. While osteolysis was first noted one of the most effective treatments for osteoarthritis of the knee joint. Long-term studies of selected patient cohorts, and the Scandinavian knee registries, have demonstrated high survivorship rates after more than 15 years. On the basis of this success, total knee replacement is being performed increasingly in younger and more active patients. However, there are at least two problems that a young or active patient faces with regard to the prosthetic joint. First, the use of the implant is more intense and secondly the patient’s life expectancy is longer and the potential total number of loading cycles is increased proportionally. Technical considerations such as leg alignment, ligamentous balancing and component design contribute to the improvement of survival of the prosthesis in young patients. In chronological order, the factors limiting the longevity of a total knee prosthesis are the surgical technique, fixation of the implant to the bone, osteolysis (often associated with wear of the bearing), fatigue failure of the implants, and longterm skeletal remodeling. No implant system can overcome inadequate surgical technique. The durability of implant fixation in the patients has been improved during the last 20 years. So today a large proportion of re-operations are for loosening of the components mostly caused by degradation of parts of the supporting bony structures into fibrous or granulation tissue initiated by polyethylene wear particles [3,14]. Thus, further improvement in the success rates depends on the reduction or avoidance of such wear particles. Wear is dependent on materials. The desired goal of alternative bearing surfaces is a reduction in biologically active particulate wear debris and thus a reduction in the occurrence of osteolysis and aseptic loosening. Polyethylene wear with production of particulate debris may lead to the