title: Comparison of articular and backside polyethylene wear in mobile bearing unicompartmental knee replacement.
abstract: BACKGROUND
  Unicompartmental knee replacement (UKR) is an alternative to total knee replacement for selected patients with isolated medial or lateral compartment osteoarthritis. One of the most popular UKR implants was introduced as a mobile-bearing design in part to reduce polyethylene wear. However, backside wear of the mobile-bearing implant has not been examined independently from the articular surface.
  
  
  METHODS
  Sixteen retrieved polyethylene inserts from a medial mobile-bearing UKR from 16 patients were examined after an average of 4.2years implantation (range 1.5 to 10.0years). Reasons for revision included aseptic loosening, pain, and progression of osteoarthritis. Each retrieved insert was evaluated using visual damage scoring across the articular and backside surfaces. Inserts were also micro-CT scanned and compared to a reference insert of the same size, to measure wear on the articular and backside surfaces.
  
  
  RESULTS
  The total damage scores were greater (p=0.01) on the articular surface (27.2±5.7 (standard deviation)) than the backside surface (23.8±6.2). Burnishing, abrasions, and pitting were the most common damage modes on both surfaces, with only pitting greater (p=0.03) on the articular surface than the backside surface. There was no difference (p=0.46) in wear rate between the articular surface (0.028±0.025mm/year) and backside surface (0.029±0.017mm/year).
  
  
  CONCLUSIONS
  The retrieved mobile-bearing UKR polyethylenes demonstrated good overall wear resistance, with no evidence of severe damage. However, backside wear was equal to articular wear, suggesting that the backside surface is a potential source of polyethylene wear debris.
authors.affiliation: Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Electronic address: matthew.teeter@lhsc.on.ca.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Teeter
authors.affiliation: Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.affiliation: Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada.
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCalden
authors.affiliation: Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Naudie
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D001672:Biocompatible Materials; D006801:Humans; D007720:Knee Prosthesis; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure
chemical_list: D001672:Biocompatible Materials; D020959:Polyethylene
keywords: Backside wear; Micro-CT; Mobile bearing; Polyethylene wear; Unicompartmental knee replacement