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Tytuł:
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Tibial tray debonding from the cement mantle is associated with deformation of the backside of polyethylene tibial inserts.
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Autorzy:
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Bhalekar RM; ExplantLab, Newcastle Upon Tyne, UK.
Nargol ME; ExplantLab, Newcastle Upon Tyne, UK.
Shyam N; ExplantLab, Newcastle Upon Tyne, UK.
Nargol AVF; University Hospital of North Tees, Stockton-on-Tees, UK.
Wells SR; Freeman Hospital, Newcastle upon Tyne, UK.
Collier R; Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia.
Pabbruwe M; Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia.
Joyce TJ; School of Engineering, Newcastle University, Newcastle upon Tyne, UK.
Langton DJ; ExplantLab, Newcastle Upon Tyne, UK.
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Źródło:
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The bone & joint journal [Bone Joint J] 2021 Dec; Vol. 103-B (12), pp. 1791-1801. Date of Electronic Publication: 2021 Sep 03.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: London : British Editorial Society of Bone & Joint Surgery
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MeSH Terms:
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Bone Cements*
Knee Prosthesis*
Polyethylene*
Prosthesis Design*
Arthroplasty, Replacement, Knee/*instrumentation
Prosthesis Failure/*etiology
Adult ; Aged ; Aged, 80 and over ; Device Removal ; Female ; Humans ; Male ; Middle Aged ; Regression Analysis
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Contributed Indexing:
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Keywords: Microscopy; National Joint Registry; Polyethylene; Revision; Tibial tray debonding; Total knee arthroplasty; chromium; cobalt; polyethylene (PE); polyethylene (PE) wear; randomized controlled trial; tibial components; tibial trays; total knee arthroplasties (TKAs)
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Substance Nomenclature:
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0 (Bone Cements)
9002-88-4 (Polyethylene)
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Entry Date(s):
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Date Created: 20210903 Date Completed: 20211208 Latest Revision: 20211214
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Update Code:
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20240105
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DOI:
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10.1302/0301-620X.103B.BJJ-2020-2555.R2
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PMID:
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34474593
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Aims: The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs).
Methods: At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays.
Results: A total of 114 explanted fixed-bearing TKAs were examined. This included 76 used with contemporary PE inserts which were compared with 15 used with older generation PEs. The Attune and NexGen (central locking) trays were found to have significantly less cement cover than Triathlon and PFC trays (peripheral locking group) (p = 0.001). The median planicity values of the PE inserts used with central locking trays were significantly greater than of those with peripheral locking inserts (205 vs 85 microns; p < 0.001). Attune and NexGen inserts had a characteristic pattern of backside deformation, with the outer edges of the PE deviating inferiorly, leaving the PE margins as the primary areas of articulation.
Conclusion: Explanted TKAs with central locking mechanisms were significantly more likely to debond from the cement mantle. The PE inserts of these designs showed characteristic patterns of deformation, which appeared to relate to the manufacturing process and may be exacerbated in vivo. This pattern of deformation was associated with PE wear occurring at the outer edges of the articulation, potentially increasing the frictional torque generated at this interface. Cite this article: Bone Joint J 2021;103-B(12):1791-1801.
