Spontaneous, Recurrent Dislodgment of the Polyethylene Tibial Insert After Total Knee Arthroplasty

2007 ◽  
Vol 89 (2) ◽  
pp. 404-407 ◽  
Author(s):  
John A. Anderson ◽  
Samuel J. MacDessi ◽  
Alejandro González Della Valle
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Insert ◽  
Total Knee

Isolated tibial insert exchange in revision total knee arthroplasty

2021 ◽  
Vol 103-B (6) ◽  
pp. 1103-1110
Author(s):  
Matthew W. Tetreault ◽  
Jeremy T. Hines ◽  
Daniel J. Berry ◽  
Mark W. Pagnano ◽  
Robert T. Trousdale ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Polyethylene Wear ◽  
Revision Total Knee Arthroplasty ◽  
Common Reason ◽  
Original Diagnosis ◽  
Tibial Insert ◽  
Total Knee ◽  
Component Loosening ◽  
Revision Tka

Aims This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA). Methods From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded. Results Survivorship free of any re-revision was 68% at ten years. For the indication of insert wear, survivorship free of any re-revision at ten years was 74%. Re-revisions were more frequent for index diagnoses other than wear (hazard ratio (HR) 1.9; p = 0.013), with ten-year survivorships of 69% for instability and 37% for insert fracture/dissociation. Following ITIE for wear, the most common reason for re-revision was aseptic loosening (33%, n = 7). For other indications, the most common reason for re-revision was recurrence of the original diagnosis. Mean Knee Society Scores improved from 54 (0 to 94) preoperatively to 77 (38 to 94) at ten years. Conclusion After ITIE, the risk and reasons for re-revision correlated with preoperative indications. The best results were for polyethylene wear. For other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication for the revision TKA. Cite this article: Bone Joint J 2021;103-B(6):1103–1110.

scholarly journals Clinical Results of Isolated Tibial Insert Exchange in Revision Total Knee Arthroplasty

2005 ◽  
Vol 54 (1) ◽  
pp. 63-67
Author(s):  
Hisataka Goto ◽  
Masafumi Kono ◽  
Masatsugu Suehiro ◽  
Kazunari Maeda ◽  
Toshio Kawahara ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Results ◽  
Revision Total Knee Arthroplasty ◽  
Tibial Insert ◽  
Total Knee

Outcome of isolated polyethylene tibial insert exchange after primary cemented total knee arthroplasty

2014 ◽  
Vol 39 (6) ◽  
pp. 1093-1097 ◽  
Author(s):  
Christian Konrads ◽  
Stefanie Brieske ◽  
Michael Holder ◽  
Matthias Walcher ◽  
Maximilian Rudert ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Insert ◽  
Total Knee

scholarly journals Optimal Design of Patient-Specific Total Knee Arthroplasty for Improvement in Wear Performance

2019 ◽  
Vol 8 (11) ◽  
pp. 2023 ◽  
Author(s):  
Yong-Gon Koh ◽  
Kyung-Hwan Jung ◽  
Hyoung-Taek Hong ◽  
Kang-Min Kim ◽  
Kyoung-Tak Kang
Keyword(s):  
Total Knee Arthroplasty ◽  
Optimal Design ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Patient Specific ◽  
Fe Modelling ◽  
Wear Performance ◽  
Wear Rates ◽  
Tibial Insert ◽  
Total Knee

Life expectancy is on the rise and, concurrently, the demand for total knee arthroplasty (TKA), which lasts a lifetime, is increasing. To meet this demand, improved TKA designs have been introduced. Recent advances in radiography and manufacturing techniques have enabled the production of patient-specific TKA. Nevertheless, concerns regarding the wear performance, which limit the lifespan of TKA, remain to be addressed. This study aims at reducing the wear in patient-specific TKA using design optimization and parametric three-dimensional (3D) finite-element (FE) modelling. The femoral component design was implemented in a patient-specific manner, whereas the tibial insert conformity remained to be determined by design variables. The gait cycle loading condition was applied, and the optimized model was validated by the results obtained from the experimental wear tests. The wear predictions were iterated for five million gait cycles using the computational model with force-controlled input. Similar patterns for internal/external rotation and anterior/posterior translation were observed in both initial and optimal models. The wear rates for initial and optimal models were recorded as 23.2 mm3/million cycles and 16.7 mm3/million cycles, respectively. Moreover, the experimental wear rate in the optimal design was 17.8 mm3/million cycles, which validated our optimization procedure. This study suggests that tibial insert conformity is an important factor in influencing the wear performance of patient-specific TKA, and it is capable of providing improved clinical results through enhanced design selections. This finding can boost the future development of patient-specific TKA, and it can be extended to other joint-replacement designs. However, further research is required to explore the potential clinical benefits of the improved wear performance demonstrated in this study.

What factors drive polyethylene wear in total knee arthroplasty?

2021 ◽  
Vol 103-B (11) ◽  
pp. 1695-1701
Author(s):  
John H. Currier ◽  
Barbara H. Currier ◽  
Matthew P. Abdel ◽  
Daniel J. Berry ◽  
Alexander J. Titus ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Wear Rate ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Wear Performance ◽  
Thickness Change ◽  
Wear Rates ◽  
Tibial Insert ◽  
Total Knee

Aims Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. Methods An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate. Results Five patient-specific variables and seven implant-specific variables were evaluated for significant association with lower insert wear rate. Six were significant when controlling for other factors: greater patient age, female sex, shorter duration in vivo, polished tray, highly cross-linked PE (HXLPE), and constrained knee design. Conclusion This study confirmed that knee wear rate increased with duration in vivo. Older patients and females had significantly lower wear rates. Polished modular tibial tray surfaces, HXLPE, and constrained TKA designs were device design factors associated with significantly reduced wear rate. Cite this article: Bone Joint J 2021;103-B(11):1695–1701.

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