title: Damage in total knee replacements from mechanical overload.
abstract: The mechanical loads acting across the knee joint following total knee replacements (TKR) during activities of daily living have recently been measured using instrumented TKRs. Using a series of postmortem retrieved TKR constructs we investigated whether these mechanical loads could result in damage to the implant bone interface or supporting bone in the tibia. Eighteen cemented en bloc tibial components (0 to 22 years in service) were loaded under axial compression in increments from 1 to 10 times body weight and digital image correlation was used to measure bone strain and interface micromotion during loading and unloading. Failure was considered to occur when micromotion exceeded 150µm or compressive bone strain exceeded 7300με. The results show that all retrieved specimens had sufficient bone strength to support most activities of daily living, but ~40% would be at risk under larger physiologic loads that might occur secondary to a higher impacts such as jogging or a stumble. The tray-bone micromotion (regression model R(2)=0.48, p=0.025) was greater for donors with lower age at implantation (p=0.0092). Proximal bone strain (model R(2)=0.46, p=0.03) was greater for donors with longer time in service (p=0.021). Distal bone strain (model R(2)=0.58, p=0.005) was greater for donors with more time in service (p=0.0054) and lower peri-implant BMD (p=0.049). High mechanical overload of a single or repetitive nature may be an initiating factor in aseptic loosening of total joint arthroplasties and should be avoided in order to prolong the life of the implant.
authors.affiliation: Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: zimmermw@upstate.edu.
authors.forename: William F
authors.initials: WF
authors.lastname: Zimmerman
authors.affiliation: Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: millerm@upstate.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Miller
authors.affiliation: Department of Statistics and Mathematics, Babson College, Wellesley, MA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cleary
authors.affiliation: Syracuse Orthopedic Specialists, Syracuse, NY, USA.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Izant
authors.affiliation: Department of Orthopedic Surgery, State University of New York, Upstate Medical University, 3216 IHP, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: mannk@upstate.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Mann
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D007720:Knee Prosthesis; D008422:Materials Testing; D008875:Middle Aged; D013314:Stress, Mechanical; D013977:Tibia / Q000502:physiology
keywords: Aseptic loosening; Bone damage; Micromotion; Postmortem retrievals; Total knee replacement