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Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance

  • Arianna CerquigliniEmail author
  • Johann Henckel
  • Harry Hothi
  • Lukas B. Moser
  • Antti Eskelinen
  • Michael T. Hirschmann
  • Alister J. Hart
KNEE
  • 3 Downloads

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.

Keywords

Total knee arthroplasty Polyethylene Retrieval analysis Polyethylene surface damage Polyethylene linear deformation 

Notes

Funding

There is no direct funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All investigations were conducted in conformity with ethical principles of research and that institutional approval of the human protocol for this investigation was obtained.

Informed consent

Informed consent for participation in the study was obtained.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Arianna Cerquiglini
    • 1
    Email author
  • Johann Henckel
    • 1
  • Harry Hothi
    • 1
  • Lukas B. Moser
    • 2
    • 3
  • Antti Eskelinen
    • 4
  • Michael T. Hirschmann
    • 2
    • 3
  • Alister J. Hart
    • 1
  1. 1.Institute of Orthopaedics and Musculoskeletal ScienceUniversity College London, Royal National Orthopaedic HospitalStanmoreUK
  2. 2.Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
  3. 3.University of BaselBaselSwitzerland
  4. 4.The Coxa Hospital for Joint ReplacementTampereFinland

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