In vivo experimental analysis of silicone implants used with titanium grommets.

This study evaluated the titanium grommets recommended to reduce breakage by protecting hinge implants from bone edges. Silastic HP-100 (Dow Corning Wright, Arlington, TN) flexible finger implants (size 5) were used to replace one knee of 10 rabbits, and implants plus titanium grommets were used in another 10. X-ray films were taken monthly; deaths from each group were 1 animal at 2 and 4 months, 2 animals at 6, and 3 each at 12 and 16 months. X-ray films revealed that 4 of 10 implants from each group had fractured. Silicone fractures occurred identically at the proximal stem-hinge junction in both groups, destruction was always most pronounced at the dorsal surface of the proximal stems. The time from surgery to x-ray film evidence of implant fracture without grommets was an average of 9 months and with grommets 13 months. Although grommets delayed x-ray film evidence of fracture onset, after 14 months all implants in both groups of animals fractured. These findings do not support the hypothesis that grommets prevent silicone hinge implant wear or fracture in this experimental model.