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      The Clinical Significance of Wear in Total Hip and Knee Prostheses

      1
      Journal of Biomaterials Applications
      SAGE Publications

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          The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement.

          Debris resulting from damage to the surface of polyethylene components of total joint replacements has previously been shown to contribute to long-term problems such as loosening and infection. Surface damage has been associated with fatigue processes due to stresses arising from contact between the metal and polyethylene components in these prostheses. In the present study, we used elasticity and finite-element solutions to determine these stresses for total hip replacements with head diameters of twenty-two and twenty-eight millimeters and for a condylar total knee replacement. We also examined the effect on these stresses of using carbon-fiber-reinforced polyethylene instead of plain polyethylene. Stresses associated with surface damage in the tibial component of the total knee replacement were much larger than those in the hip replacements. The analysis of contact stress as a function of thickness of the polyethylene insert for tibial components showed that a thickness of more than eight to ten millimeters should be maintained when possible. The contact stress in the tibial components was reduced most when the articulating surfaces were more conforming in the medial-lateral direction. Contact stresses were much less sensitive to changes in geometry in the anterior-posterior direction. For the hip components, the stresses were lower in the acetabular component of the twenty-eight-millimeter hip replacement than in the twenty-two-millimeter replacement. The use of carbon-fiber-reinforced polyethylene resulted in stresses that were higher by as much as 40 per cent. Because the contact area between articulating surfaces moves during flexion, portions of the surface will be subjected to cyclic stresses. The contact area for the knee replacements in flexion was smaller than for the hip replacements, and the range of the maximum principal stress was larger. Consequently, the combination of the higher stress and the moving contact area is more likely to cause surface damage due to fatigue in tibial components than in acetabular components, which is consistent with clinical observations.
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            Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses.

            A technique for the classification and quantification of damage in retrieved total knee prostheses is presented and applied to the examination of 48 removed total condylar-type knee replacements. The technique involves inspection of all metallic and polyethylene components for evidence of gross deformation, fracture, and damage to articulating surfaces. A grading system was developed to quantitate surface damage on polyethylene components. Results of the examinations are combined with patient variables (weight, activity level, radiographic findings, time of implantation, and results of histology performed on surrounding tissue) to determine correlations between clinical variables and the mechanical damage experienced by the prostheses. For the 48 total condylar-type prostheses, significant positive correlations were found for the surface damage correlated with the patient's weight and the time the prosthesis was implanted.
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              Ten-year follow-up study of total hip replacement.

              Of the first 300 consecutive patients who had a Charnley total hip replacement at the Mayo Clinic during the years 1960 to 1970, 207 (231 hips) were re-evaluated ten years postoperative by questionnaire and roentgenograms. Forty-three of these were also evaluated by personal examination. Roentgenographic loosening of the acetabular component was determined using the criterion of a complete radiolucent line more than one millimeter in width at the bone-cement interface or any migration or tilting of the component. For the femoral component, the criterion for loosening was a radiolucent line more than one millimeter wide at either the bone-cement or the cement-prosthesis interface, or any change in the position of the component. As previously reported, the incidence of loose components at five years was 6.5 per cent for the acetabular component and 24 per cent for the femoral component. At ten years the incidence of loosening had increased to 11.3 per cent for the acetabular component and 29.9 per cent for the femoral component. Therefore, between five and ten years postoperatively the rate of femoral loosening decreased, while the rate of acetabular loosening remained about the same. The overall-revision rate for loosening of total hip components increased from 3 per cent at five years to 7.4 per cent at ten years. Acetabular wear was not a significant problem. Resorption of the medial femoral cortex near the calcar was generally non-progressive and was not significantly related to loosening. two modes of loosening are suggested, the more common being cracking of the cement mantle due to circumferential (hoop) stresses within the cement. This series probably represents a so-called worst-case experience, since changes in design and materials as well as the improvements in surgical technique that have evolved over the past decade should provide significantly better long-term fixation.
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                Author and article information

                Journal
                Journal of Biomaterials Applications
                J Biomater Appl
                SAGE Publications
                0885-3282
                1530-8022
                July 2016
                January 1988
                July 2016
                January 1988
                : 3
                : 1
                : 3-32
                Affiliations
                [1 ]Howmedica Rutherford, NJ 07070
                Article
                10.1177/088532828800300101
                668239ad-1aae-4fe8-8bcd-b3868331815a
                © 1988

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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