Limberg Afton K, Jevsevar Kori C, Orem Alexander R, Jevsevar David S, Van Citters Douglas W
Thayer School of Engineering at Dartmouth College, Hanover, New Hampshire.
Dartmouth-Hitchcock Medical Center Department of Orthopaedics, Lebanon, New Hampshire.
J Arthroplasty. 2025 Aug;40(8):2167-2171.e1. doi: 10.1016/j.arth.2025.01.041. Epub 2025 Jan 30.
Advanced materials for total knee arthroplasty, including crosslinked bearings and cobalt-chrome-molybdenum-alternative components, show promise for reducing wear rates and improving outcomes. The objective of the current study was to test whether an alternative femoral-bearing material achieved these goals.
An institutional review board-approved retrieval database was searched to identify 137 oxidized zirconium femoral total knee arthroplastycomponents from 2004 to 2023; 75 had a tibial bearing of never-irradiated polyethylene (PE) and 62 had a bearing of cross-linked polyethylene (XL). All had a polished tibial tray. The mean duration of implantation was 58 months for the PE group and 34 months for the XL group. The most common reasons for retrieval were instability and infection in the XL group and instability in the PE group. Dimensional change (creep plus wear) was measured from the thickness of the PE insert using short-duration (< 16 months) and never-implanted devices as a reference. Oxidation (maximum ketone oxidation index) was measured via fourier transform infraredusing a cross-section of the medial condyle of the PE at < three months postexplant. Statistical analyses were conducted using groups matched for in vivo duration. A P < 0.05 was considered significant.
Dimensional change rate and in vivo oxidation rate were statistically indistinguishable between the two bearing types. The mean dimensional change rate for the PE group was 0.018 ± 0.024 mm/year and 0.021 ± 0.030 mm/year for the XL group (P = 0.64). The mean oxidation rates were also not statistically different, with the mean rate for the PE group being 0.051 ± 0.052 arbitrary units (a.u.)/year and the mean value for the XL group being 0.064 ± 0.055 a.u./year (P = 0.19). Only one device (PE) exceeded the oxidation threshold, marking a decrease in mechanical properties.
The dimensional change rate and oxidation rate for tibial inserts against oxidized zirconium femoral components were low and consistent with previously reported literature values. The XL did not demonstrate superiority to PE in this analysis.
全膝关节置换术的先进材料，包括交联衬垫和钴铬钼替代部件，有望降低磨损率并改善治疗效果。本研究的目的是测试一种替代股骨衬垫材料是否能实现这些目标。
检索经机构审查委员会批准的检索数据库，以识别2004年至2023年期间的137个氧化锆股骨全膝关节置换部件；75个部件的胫骨衬垫为未辐照聚乙烯（PE），62个部件的衬垫为交联聚乙烯（XL）。所有部件都有一个抛光的胫骨托。PE组的平均植入时间为58个月，XL组为34个月。取出的最常见原因在XL组是不稳定和感染，在PE组是不稳定。使用短期（<16个月）和未植入的装置作为参考，从PE插入物的厚度测量尺寸变化（蠕变加磨损）。通过傅里叶变换红外光谱法在取出后<3个月时使用PE内侧髁的横截面测量氧化（最大酮氧化指数）。使用体内持续时间匹配的组进行统计分析。P<0.05被认为具有统计学意义。
两种衬垫类型之间的尺寸变化率和体内氧化率在统计学上无差异。PE组的平均尺寸变化率为0.018±0.024毫米/年，XL组为0.021±0.030毫米/年（P=0.64）。平均氧化率在统计学上也没有差异，PE组的平均率为0.051±0.052任意单位（a.u.）/年，XL组的平均值为0.064±0.055 a.u./年（P=0.19）。只有一个装置（PE）超过了氧化阈值，表明机械性能下降。
胫骨插入物与氧化锆股骨部件的尺寸变化率和氧化率较低，与先前报道的文献值一致。在该分析中，XL并未显示出优于PE的优势。
