Cementless, Cruciate-Retaining Primary Total Knee Arthroplasty Using Conventional Instrumentation: Technical Pearls and Intraoperative Considerations.

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Abstract

Conflict of interest statement: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A458). 18. J Arthroplasty. 2016 Dec;31(12):2900-2906. doi: 10.1016/j.arth.2016.05.006. Epub 2016 May 12. Corrosion Damage and Wear Mechanisms in Long-Term Retrieved CoCr Femoral Components for Total Knee Arthroplasty. Arnholt CM(1), MacDonald DW(1), Malkani AL(2), Klein GR(3), Rimnac CM(4), Kurtz SM(5); Implant Research Center Writing Committee; Kocagoz SB(1), Gilbert JL(6). Author information: (1)Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania. (2)Jewish Hospital, Louisville, Kentucky. (3)Hartzband Center for Hip and Knee Replacement, Paramus, New Jersey. (4)Center for the Evaluation of Implant Performance, Case Western Reserve University, Cleveland, Ohio. (5)Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; Biomedical Engineering, Exponent, Inc, Philadelphia, Pennsylvania. (6)Syracuse Biomaterials Institute and Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York. BACKGROUND: Metal debris and ion release has raised concerns in joint arthroplasty. The purpose of this study was to characterize the sources of metallic ions and particulate debris released from long-term (in vivo >15 years) total knee arthroplasty femoral components. METHODS: A total of 52 CoCr femoral condyles were identified as having been implanted for more than 15 years. The femoral components were examined for incidence of 5 types of damage (metal-on-metal wear due to historical polyethylene insert failure, mechanically assisted crevice corrosion at taper interfaces, cement interface corrosion, third-body abrasive wear, and inflammatory cell-induced corrosion [ICIC]). Third-body abrasive wear was evaluated using the Hood method for polyethylene components and a similar method quantifying surface damage of the femoral condyle was used. The total area damaged by ICIC was quantified using digital photogrammetry. RESULTS: Surface damage associated with corrosion and/or CoCr debris release was identified in 51 (98%) CoCr femoral components. Five types of damage were identified: 98% of femoral components exhibited third-body abrasive wear (mostly observed as scratching, n = 51/52), 29% of femoral components exhibited ICIC damage (n = 15/52), 41% exhibited cement interface damage (n = 11/27), 17% exhibited metal-on-metal wear after wear-through of the polyethylene insert (n = 9/52), and 50% of the modular femoral components exhibited mechanically assisted crevice corrosion taper damage (n = 2/4). The total ICIC-damaged area was an average of 0.11 ± 0.12 mm2 (range: 0.01-0.46 mm2). CONCLUSION: Although implant damage in total knee arthroplasty is typically reported with regard to the polyethylene insert, the results of this study demonstrate that abrasive and corrosive damage occurs on the CoCr femoral condyle in vivo. Copyright © 2016 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2016.05.006 PMCID: PMC5107165