Wear and Roughening of Knee Replacement Components
+1Malikian, R; 4Maruthainar, K; 2Skinner, J A; 2Carrington, R; 3Maruthainar, N; 2Cannon, S R; 2Briggs, T W R; 3Dowd, G; 4Blunn, G W
+1University College London Medical School. Gower Street, London, WC1E 6BT, UK, 2The Royal National Orthopaedic Hospital Trust, Brockley
Hill, Stanmore, Middlesex, HA7 4LP, UK, 3The Royal Free Hospital Trust, Pond Street, London. NW3 2QG, UK, 4John Scales Centre for Biomedical
Engineering, Royal National Orthopaedic Hospital Trust
r.malikian@ucl.ac.uk Senior author g.blunn@ucl.ac.uk
INTRODUCTION:
Knee replacements provide a cost effective treatment for the
treatment of severe arthritis (Lavernia et al. 1997;Liang et al. 1986) and
in the USA total knee replacement has overtaken total hip replacement
(Klenerman 2002). Many knee replacements fail on the basis of
infection, primary malalignment at surgery and aseptic loosening (Ecker
et al. 1987) often requiring revision knee arthroplasty operations. The
incidence of revision surgery is higher if the patient is less than 65 years
old (Drury P et al. 2007).
Tripling the roughness of the femoral surface of the knee replacement
can increase the ultra high molecular weight polyethylene (UHMWPE)
wear by a factor of 10 (Schmalzried and Callaghan 1999) and a few
scratches on a metallic surface can increase the wear rate of UHMWPE
by a factor of 70 (DesJardins et al. 2008). It has been shown that
roughened femoral components increase the UHMWPE wear rate by
more than a factor of 3 (Muratoglu et al. 2004) and that the wear rate of
UHMWPE is proportional to Ra1.4 (Weightman and Light 1986).
Marketing of some novel alternate bearing surfaces is based in part on
their significantly lower surface roughness over time compared to
Cobalt-Chrome (CoCr) components (White et al. 1994), however, there
are contradictory findings in the literature regarding roughness of
femoral knee components in vivo, with some groups reporting no
significant roughening (Lakdawala et al. 2005) whilst others report
significant differences (Engh et al. 1992;White, Whiteside, McCarthy,
Anthony, & Poggie 1994).
The aim of this study is to observe wear patterns of knee
replacements that have loosened aseptically or due to sepsis and find out
why these implants become scratched.
The hypothesis is that there will be significant roughening of total
knee replacement , and that roughening occurs early after implantation
METHODS:
Retrieval analysis: Implants were retrieved from first and single stage
revision arthroplasty procedures at RNOH and RFH, then soaked in
Hycolin for 24 hours for decontamination. Average surface roughness
(Ra) was measured using a profilometer (Talysurf 10, Taylor Hobson
LTD, UK) with Vh and Vv set at 0.08mm and 10000x respectively.
Measurements were taken at 6 points across 3 regions of the articulating
region on each femoral condyle, giving 18 values which were averaged
to give an overall Ra for each condyle. The average surface roughness
from a non-articulating region on each component was also measured to
serve as a control.
Wear test: 6 spherical radius CoCr pins were hand polished to a
mirror finish. 6 discs of UHMWPE were cut from the same cylindrical
bar, hand polished and γ-irradiated in vacuum. A six station hydraulic
pin-on-plate fatigue testing machine (RDP-Howden LTD, UK) was used
and set up to conditions of: 1 Hz cycles at 20° Celsius, an axial load of
1.5kN, 5° internal and external rotation, and 10 mm of A-P sliding,
using fluid which was 30% calf serum (Newborn calf serum from bovine
calves, sterile filtered, Sigma Aldrich Inc, USA), 1% sodium azide and
5mmol/L 2-[2-(Bis(carboxymethyl)amino)ethyl-
(carboxymethyl)amino]acetic acid (EDTA). Ra was measured at 0, 10,
100 and 1000 cycles perpendicular to the direction of movement of the
pins using the profilometer above.
Statistical analysis was made using Excel 2007 (Microsoft
Corporation, USA) and SPSS 16.0.1 (SPSS Inc, USA). Surface
roughness measurements were compared using paired samples T-test.
Ethical committee permission was granted by the Ethics committee of
The Royal National Orthopaedic Hospital.
RESULTS:
Retrieval analysis: 14 CoCr knee replacement components were
retrieved. Average duration in situ was 78 months (9-241 months),
average patient age was 69 and the implants came from 6 females and 7
males. 1 had no corresponding clinical data. 2 of the components were
unicondylar, and the remaining were all posterior cruciate retaining from
7 different manufacturers. All of the femoral components appeared to
have visible signs of wear on inspection. All had parallel scratching in
Poster No. 1145 • ORS 2011 Annual Meeting
an anterior-posterior direction. No pitting, abrasion or corrosion was
seen on any of the femoral components. Parallel lines seen under
scanning electron microscopy indicate scratching of the CoCr surface
belonging to a unicondylar femoral knee replacement component which
was found to be significantly (p<0.05) roughened.
Wear test: After 10 cycles the disc surfaces lost their mirror finish,
after 100 cycles, there were visible scratches along surface of the pin in
the same plane as which the pin was moving relative to the UHMWPE
disc. After 1000 cycles central regions of the articulating surface of the
pin appeared more dull, and had more scratches across its surface.
Scanning electron microscopy of the articulating surface of the CoCr
pins showed parallel marks consistent with scratching at 100 and 1000
cycles. After 100 and 1000 cycles the average roughness articulating
surface of the CoCr pins was significantly greater than the initial average
roughness at 0 cycles.
DISCUSSION:
A large proportion – 8 out of 14 retrievals - of knee replacement
components roughened significantly in vivo, supporting the hypothesis.
Significant roughening of total knee replacement components may begin
very soon after implantation, as indicated by the in vitro testing.
However, average surface roughness of those significantly roughened
was within acceptable limits for orthopaedic implants (0.05μm). Further
work is to be carried out in an attempt to determine the cause of the
roughening of the femoral components of the knee replacement
prostheses.
REFERENCES
DesJardins, J.D., Burnikel, B., & LaBerge, M. 2008. UHMWPE wear
against roughened oxidized zirconium and CoCr femoral knee
components during force-controlled simulation. Wear, 264, (3-4) 245-
256 .
Drury P, Morrison J, Newell C, Pickford M, Royall M, Swansom M, &
May L. National Joint Registry for England and Wales 4th Annual
Report. 26-9-2007. Department of Health, National Joint Registry. Ref
Type: Online Source
Ecker, M.L., Lotke, P.A., Windsor, R.E., & Cella, J.P. 1987. Long-term
results after total condylar knee arthroplasty: significance of radiolucent
lines. Clinical Orthopaedics and Related Research (216) 151-158 4.
Engh, G.A., Dwyer, K.A., & Hanes, C.K. 1992. Polyethylene wear of
metal-backed tibial components in total and unicompartmental knee
prostheses. Journal of Bone & Joint Surgery, British Volume, 74, (1) 9-
17 5. Klenerman, L. 2002. The evolution of orthopaedic surgery
RSM Press
Lakdawala, A., Todo, S., & Scott, G. 2005. The significance of surface
changes on retrieved femoral components after total knee replacement.
Journal of Bone & Joint Surgery, British Volume, 87, (6) 796-799
Lavernia, C.J., Guzman, J.F., & Gachupin-Garcia, A. 1997. Cost
effectiveness and quality of life in knee arthroplasty. Clin.Orthop.Relat
Res. (345) 134-139 available from: PM:9418630
Liang, M.H., Cullen, K.E., Larson, M.G., Thompson, M.S., Schwartz,
J.A., Fossel, A.H., Roberts, W.N., & Sledge, C.B. 1986. Cost-
effectiveness of total joint arthroplasty in osteoarthritis. Arthritis
Rheum., 29, (8) 937-943 available from: PM:3091041
Muratoglu, O.K., Burroughs, B.R., Bragdon, C.R., Christensen, S.,
Lozynsky, A., & Harris, W.H. 2004. Knee Simulator Wear of
Polyethylene Tibias Articulating against Explanted Rough Femoral
Components. Clinical Orthopaedics and Related Research, 428, 108-
113
Schmalzried, T.P. & Callaghan, J.J. 1999. Wear in total hip and knee
replacements. J Bone Joint Surg Am, 81, (1) 115-136 Weightman, B. &
Light, D. 1986. The effect of the surface finish of alumina and stainless
steel on the wear rate of UHMW polyethylene. Biomaterials, 7, (1) 20-
24 available from: PM:3955153 12. White, S.E., Whiteside,
L.A., McCarthy, D.S., Anthony, M., & Poggie, R.A. 1994. Simulated
knee wear with cobalt chromium and oxidized zirconium knee femoral
components. Clin Orthop Relat Res, 309, 176-184