title: Tibial interface wear in retrieved total knee components and correlations with modular insert motion.
abstract: BACKGROUND
  Wear occurring at the interface between the polyethylene insert and metal baseplate of a modular tibial component has become an increasingly common finding at the time of revision total knee arthroplasty. Although this so-called backside wear on retrieved polyethylene inserts has been evaluated in prior studies, wear on retrieved metal baseplates has not been described, to our knowledge. The purposes of the present study were to characterize backside wear on retrieved polyethylene inserts and on the mating surfaces of their corresponding baseplates and to investigate if there is a relationship between backside wear and relative motion of the modular elements.
  
  
  METHODS
  Twenty-nine retrieved modular tibial components of twelve fixed-bearing designs were analyzed in vitro with regard to backside wear and relative motion between the polyethylene insert and the metal baseplate. We graded the backside of each polyethylene insert and the mating surface of the metal baseplate for wear with use of a scoring system that consisted of three modes of wear and three levels of severity of wear. Relative motion between the insert and the baseplate was measured in the transverse plane with use of a mechanical testing machine. These measurements were used to compute the insert motion index, which served to quantify unrestricted motion of the insert with respect to the baseplate.
  
  
  RESULTS
  The mean insert motion index for the tibial components was 416 micro m (range, 104 micro m to 760 micro m). On a wear-grading scale ranging from 0 to 54 (with 0 indicating no wear), the mean backside wear score was 30 (range, 12 to 48) for the inserts and 28 (range, 7 to 51) for the baseplates. Insert motion was positively correlated with backside polyethylene wear (p = 0.003) and baseplate wear (p < 0.001). Baseplate wear was strongly correlated with backside polyethylene wear (p < 0.001).
  
  
  CONCLUSIONS
  Backside wear was correlated with the relative motion between the polyethylene insert and the metal baseplate. New locking mechanism designs directed toward better methods of securing the polyethylene insert to the tibial tray are needed to minimize the generation of particulate wear debris at the modular interface.
authors.affiliation: Anderson Orthopaedic Research Institute, Alexandria, Virginia 22307, USA.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Rao
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Engh
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Collier
authors.forename: Smain
authors.initials: S
authors.lastname: Lounici
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008422:Materials Testing; D008670:Metals; D008875:Middle Aged; D009038:Motion; D011095:Polyethylenes; D011336:Probability; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013314:Stress, Mechanical; D013499:Surface Properties; D013977:Tibia
chemical_list: D008670:Metals; D011095:Polyethylenes