Retrieval Analysis of Contemporary Antioxidant Polyethylene: Multiple Material and Design Changes May Decrease Implant Performance

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2019 Feb 12

PMID 30740622

Citations 7

Authors

Arianna Cerquiglini

Johann Henckel

Harry Hothi

Lukas B Moser

Antti Eskelinen

Michael T Hirschmann

Alister J Hart

Affiliations

Soon will be listed here.

Abstract

Purpose: With the introduction of the Attune Knee System (DePuy) in March 2013, a new polyethylene formulation incorporating anti-oxidants was used. Although several in vitro studies have demonstrated the positive effects of antioxidants on UHMWPE, no retrieval study has looked at polyethylene damage of this system yet. It was the aim of this study to investigate the in vivo performance of this new design, by comparing it with its predecessors in retrieval analysis.

Methods: 24 PFC (18 fixed bearing and 6 rotating platform designs) and 17 Attune (8 fixed bearing and 9 rotating platform designs) implants were retrieved. For retrieval analysis, a macroscopic analysis of polyethylene components, using a peer-reviewed damage grading method was used. Medio-lateral polyethylene thickness difference was measured with a peer-reviewed micro-CT based method. The roughness of metal components was measured. All findings were compared between the two designs.

Results: Attune tibial inserts with fixed bearings showed significantly higher hood scores on the backside surface when compared with their PFC counterparts (p = 0.01), no other significant differences were found in the polyethylene damage of all the other surfaces analysed, in the surface roughness of metal components and in medio-lateral linear deformations.

Conclusion: A significant difference between PFC and Attune fixed bearing designs was found in terms of backside surface damage: multiple changes in material and design features could lead to a potential decrease of implant performance. Results from the present study may help to understand how the new Attune Knee System performs in vivo, impacting over 600,000 patients.

Citing Articles

Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties.

Hasegawa M, Tone S, Naito Y, Sudo A Materials (Basel). 2023; 16(6).

PMID: 36984020 PMC: 10054334. DOI: 10.3390/ma16062140.

European Database of Explanted UHMWPE Liners from Total Joint Replacements: Correlations among Polymer Modifications, Structure, Oxidation, Mechanical Properties and Lifetime In Vivo.

Slouf M, Gajdosova V, Dybal J, Sticha R, Fulin P, Pokorny D Polymers (Basel). 2023; 15(3).

PMID: 36771869 PMC: 9921464. DOI: 10.3390/polym15030568.

Failure Analysis of Ultra-High Molecular Weight Polyethylene Tibial Insert in Total Knee Arthroplasty.

Manescu Paltanea V, Antoniac I, Antoniac A, Paltanea G, Miculescu M, Bita A Materials (Basel). 2022; 15(20).

PMID: 36295170 PMC: 9605650. DOI: 10.3390/ma15207102.

Comparative retrieval analysis of antioxidant polyethylene: bonding of vitamin-E does not reduce in-vivo surface damage.

Mathis D, Schmidli J, Hirschmann M, Amsler F, Henckel J, Hothi H BMC Musculoskelet Disord. 2021; 22(1):1003.

PMID: 34847880 PMC: 8630848. DOI: 10.1186/s12891-021-04898-y.

Reasons for failure in primary total knee arthroplasty - An analysis of prospectively collected registry data.

Mathis D, Lohrer L, Amsler F, Hirschmann M J Orthop. 2021; 23:60-66.

PMID: 33456217 PMC: 7797490. DOI: 10.1016/j.jor.2020.12.008.

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