Abstract
Introduction: Improvement of total knee arthroplasty (TKA) materials is one promising approach for extending the lifetime of endoprostheses. The target of this study was to evaluate the sufficiency of TKA-design-independent rolling–sliding screening tests. Additionally, this study attempted to assess the relevance of the design of TKA systems for wear performance by comparison with a simulator study. Materials and Methods: A TKA-design-independent rolling–sliding testing machine was employed at ISO (the International Organization for Standardization) 14243-near conditions and physiologic level unidirectional rolling–sliding. Contact surfaces were generalized into elementary forms at curvatures of real endoprostheses: CoCr-cylinders on flat UHMWPE (ultra-high-molecular-weight-polyethylene) cuboids. Materials varied in resin and crosslinking. One conventional UHMWPE and three highly crosslinked polyethylenes were charged with an axial load of 2.5 kN for 5 million cycles. Wear was determined gravimetrically and the ranking was compared to a simulator study. Results: No statistically significant differences between either material were found. This was inconsistent with the results of a simulator survey. Conclusions: The results of the study indicate that this type of screening test is not able to correctly rank UHMWPE for use in TKA systems. The use of a UHMWPE plate in the test setup with a rolling–sliding cylinder is capable of producing visible wear marks in the bearing area, but the setup followed by a gravimetric measurement does not show reliable results. As the tested materials did not significantly vary in wear performance, it can be concluded that for differences in TKA wear-production, the design of TKR-systems can matter.
Highlights
Improvement of total knee arthroplasty (TKA) materials is one promising approach for extending the lifetime of endoprostheses
The use of a UHMWPE plate in the test setup with a rolling–sliding cylinder is capable of producing visible wear marks in the bearing area, but the setup followed by a gravimetric measurement does not show reliable results
As materials used for total knee arthroplasty (TKA) are subject to wear, for a substantial number of patients the first prosthetic treatment of this joint is not the last
Summary
Improvement of total knee arthroplasty (TKA) materials is one promising approach for extending the lifetime of endoprostheses. Due to the success of this surgery shown by a high patient satisfaction level [2] with low morbidity and low mortality [3], Kurtz et al projected a growth of 673% of TKA between 2005 and 2030 in the USA [4]. In respect to this development, further possible improvements should be debated for primary and revision surgery [5], in particular to provide improved materials that can better resist wear. Applied UHMWPEs suffer from different material-specific insufficiencies [6], which are dependent on their respective basic bulk material and their multi-staged manufacturing process [7].
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