The 2012 Mark Coventry award: a retrieval analysis of high flexion versus posterior-stabilized tibial inserts.
BACKGROUND
High flexion (HF) implants were introduced to increase ROM and patient satisfaction, but design changes to the implant potentially have deleterious effects on polyethylene wear. It is unclear whether the HF implants affect wear.


OBJECTIVE
We therefore examined whether the design changes between HF and posterior-stabilized (PS) tibial inserts would affect overall damage or damage on their articular surface, backside, and tibial post and whether flexion angle achieved related to damage.


METHODS
We matched 20 retrieved HF inserts to 20 retrieved PS inserts from the same implant system on the basis of duration of implantation, body mass index, and age. Inserts were divided into 16 zones and a microscopic analysis of surface damage was carried out. Five inserts were scanned using micro-CT to further quantify instances of severe post notching. We determined overall damage with a scoring system.


RESULTS
We found greater backside and post damage in the HF group but no difference in the articular surface or overall damage scores. Backside and post damage scores correlated to flexion angle in the HF group. There was no flexion/damage correlation in the PS group. Notch depths around the post in both groups ranged from 0.6 to 1.9 mm.


CONCLUSIONS
HF inserts are more susceptible to post damage, possibly as a result of higher contact stresses from greater flexion. The increased backside damage was unexpected because the two groups have the same tibial component, locking mechanism, and sterilization method.


CONCLUSIONS
The introduction of a highly crosslinked HF insert will require close scrutiny as a result of the potential for post damage demonstrated in this series.
Division of Orthopaedic Surgery, London Health Sciences Centre-University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada.
Nicholas R
NR
Paterson
Matthew G
MG
Teeter
Steven J
SJ
MacDonald
Richard W
RW
McCalden
Douglas D R
DD
Naudie
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D001363:Awards and Prizes; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013977:Tibia / Q000601:surgery*