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In vitro effects on mobile polyethylene insert under highly demanding daily activities: stair climbing

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Abstract

Purpose

Wear and survival of total joint replacements do not depend on the duration of the implant in situ, but rather on the amount of its use, i.e. the patient’s activity level. With this in mind, the present study was driven by two questions: (1) How does total knee replacement (TKR) respond to the simulation of daily highly demanding activities? (2) Are certain activities to be advised against or, on the contrary, useful to implanted patients, in order to reduce wear of TKR and its related problems?

Methods

One set of the same total knee prosthesis (TKP), equal in design and size, was tested on a three-plus-one knee joint simulator for two million cycles using a highly demanding daily load waveform, replicating a stair-climbing movement. The results were compared with a set of TKP previously tested with the ISO level walking task. A digital microscope was used to characterise the superficial structure of all the TKPs. Gravimetric and micro-Raman spectroscopic analyses were carried out on the polyethylene inserts. Visual comparison with in vivo explants was carried out.

Results

The average volumetric mass loss after two million cycles was 44 ± 6 mm3. Microscope examinations showed some deep scratches along the flexion/extension movements for all the components. Also, the metallic backside surface showed intense non-linear scratches and the polyethylene counterface was characterised by some craters. A decrease in crystallinity, induced by mechanical stress was observed on all polyethylene components and was quantitatively confirmed by the orthorhombic fraction αo value.

Conclusions

The results of this study demonstrated that the forces and motion sustained by the knee are highly activity-dependent. Moreover, this test confirmed that under more severe conditions, the material properties change according to a different wear mechanism and a decrease in crystallinity occurs. Loading characteristics for specific activities should be considered for the design of functional and robust TKRs.

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Acknowledgments

The authors thank Alberto Leardini (Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna) for his help with the data from fluoroscopy. This work was partially supported by the Italian Program of Donation for Research “5 per mille”, year 2010.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy

    Sami Abdel Jaber, Alessandra Sudanese & Saverio Affatato

  2. Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Via Belmeloro 8/2, 40126, Bologna, Italy

    Paola Taddei & Silvia Tozzi

  3. Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d’anca e di ginocchio, Istituto Ortopedico Rizzoli, Bologna, Italy

    Alessandra Sudanese

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  1. Sami Abdel Jaber
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Correspondence to Saverio Affatato.

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Jaber, S.A., Taddei, P., Tozzi, S. et al. In vitro effects on mobile polyethylene insert under highly demanding daily activities: stair climbing. International Orthopaedics (SICOT) 39, 1433–1440 (2015). https://doi.org/10.1007/s00264-014-2622-5

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  • DOI: https://doi.org/10.1007/s00264-014-2622-5

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