title: Pop-top tibial component: elimination of back-side wear with potential modularity.
abstract: Survivorship analysis has demonstrated the excellent long-term clinical success of total knee arthroplasty (TKA). Despite multiple attempts to enhance fixation with cementless technology, cemented TKA continues to be the "gold standard." The rate of loosening has diminished as the accuracy of implantation has been improved through sophisticated instrumentation and enhanced experience. Current technology with respect to computer-assisted surgery serves only to improve the accuracy of implantation, leaving materials as the weakest link in the long-term survivorship of TKA. Failure secondary to polyethylene wear has ranked as one of the most frequent causes for revision. Many issues have been identified as contributory to polyethylene wear and include the quality of the polyethylene, manufacturing process, nature of the tibial-femoral or patellofemoral articulation, area of contact, sterilization process, and issues pertaining to modularity and so-called backside wear. Long-term clinical studies have documented the success of direct compression-molded monoblock tibial components. However, the benefits of modularity are widely recognized and include the ability to fine tune soft-tissue balance after implantation of metallic devices. In an effort to combine the long-term success of direct compression molded monoblock tibial components with the occasional need for modularity, a convertible tibial component has been introduced. This device is manufactured as a direct compression-molded monoblock tibial component. The surgeon has the ability at the time of the surgical intervention, or any subsequent intervention, to convert the tibial component into a modular device. Therefore, this device addresses, in the majority of cases, the concerns that arise from backside wear.
authors.affiliation: Joint Implant Surgeons, Inc., Department of Surgery, New Albany Surgical Hospital and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mallory
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D001696:Biomechanical Phenomena; D019245:Compressive Strength; D006801:Humans; D007720:Knee Prosthesis; D008422:Materials Testing; D011095:Polyethylenes / Q000737:chemistry*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013977:Tibia
chemical_list: D011095:Polyethylenes