title: Wear behavior of an unstable knee: stabilization via implant design?
abstract: BACKGROUND
  Wear-related failures and instabilities are frequent failure mechanisms of total knee replacements. High-conforming designs may provide additional stability for the joint. This study analyzes the effects of a ligamentous insufficiency on the stability and the wear behavior of a high-conforming knee design.
  
  
  METHODS
  Two simulator wear tests were performed on a high-conforming total knee replacement design. In the first, a ligamentous-stable knee replacement with a sacrificed anterior cruciate ligament was simulated. In the second, a ligamentous-unstable knee with additionally insufficient posterior cruciate ligament and medial collateral ligament was simulated. Wear was determined gravimetrically and wear particles were analyzed. Implant kinematics was recorded during simulation.
  
  
  RESULTS
  Significantly higher wear rates (P ≤ 0.001) were observed for the unstable knee (14.58 ± 0.56 mg/10(6) cycles) compared to the stable knee (7.97 ± 0.87 mg/10(6) cycles). A higher number of wear particles with only small differences in wear particle characteristics were observed. Under unstable knee conditions, kinematics increased significantly for translations and rotations (P ≤ 0.01). This increase was mainly attributed to higher tibial posterior translation and internal rotations.
  
  
  CONCLUSIONS
  Higher kinematics under unstable test conditions is a result of insufficient stabilization via implant design. Due to the higher kinematics, increased wear was observed in this study.
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Reinders
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: Robert
authors.identifier: 0000-0003-1809-7528
authors.initials: R
authors.lastname: Sonntag
authors.affiliation: Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
authors.forename: Jan Philippe
authors.initials: JP
authors.lastname: Kretzer
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007593:Joint Instability / Q000473:pathology*; D007719:Knee Joint / Q000473:pathology*; D008022:Ligaments / Q000473:pathology; D020959:Polyethylene / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013977:Tibia / Q000473:pathology
chemical_list: D020959:Polyethylene