title: Surface damage of patellar components used in total knee arthroplasty.
abstract: BACKGROUND
  Patellofemoral complications are a common cause of failure of total knee replacement. In this study, we examined eighty-five patellar components that had been retrieved for a variety of reasons after a mean of 71.9 months in vivo. The objective of this study was to identify factors contributing to surface damage of patellar components in total knee replacements.
  
  
  METHODS
  The retrieved patellar components were of three primary designs: dome-shaped, sombrero-shaped, and pseudo-anatomic. Five zones on each specimen were evaluated for five different types of damage (creep, pitting, delamination, abrasion, and burnishing). The severity of the damage was assigned a score of 0 to 4, with 0 indicating no damage and 4 indicating extreme damage. The extent of the damage was also assigned a score of 0 to 4, with 0 indicating 0% and 4 indicating 76% to 100%. An asymmetry ratio was calculated for each damage pattern to evaluate the uniformity of the distribution of the damage across each component.
  
  
  RESULTS
  Eighty-six percent of the components had a damage score of > or =4 (product of the extent and severity scores) for at least one damage mechanism (creep for 38% of the components, pitting for 47%, delamination for 26%, abrasion for 49%, and burnishing for 76%). Components that had been in situ for more than two years had significantly more severe creep, delamination, and burnishing than components that had been in place for less than two years. Metal-backed designs had more severe damage than all-polyethylene components. Factors that reduced the occurrence and severity of polyethylene damage were a congruent patellar design (a non-dome-shaped component) and the use of an asymmetric femoral component.
  
  
  CONCLUSIONS
  Damage to the patellar component was a common finding, particularly when the implant had been retrieved more than two years after implantation. Moreover, delamination was frequently found on the patellar components, as has been observed by others who examined retrieved tibial inserts. The results of this study suggest that the use of congruent patellar components may reduce damage.
authors.affiliation: Institute of Orthopedic Research and Education, 6550 Fannin, Suite 2512, Houston, TX 77030, USA. mconditt@bcm.tmc.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Conditt
authors.forename: Philip C
authors.initials: PC
authors.lastname: Noble
authors.forename: Bryce
authors.initials: B
authors.lastname: Allen
authors.forename: Ming
authors.initials: M
authors.lastname: Shen
authors.forename: Brian S
authors.initials: BS
authors.lastname: Parsley
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Mathis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013997:Time Factors