Biological activity of polyethylene wear debris produced in the patellofemoral joint

Abstract

Polyethylene wear is considered a threat to the long term survival of total knee replacements. The aim of this study was to investigate the contribution that resurfacing the patella makes to wear debris-induced osteolysis following total knee replacement. Ultra-high molecular-weight polyethylene wear particles were isolated from simulator lubricant. Particle shape, size, and volume distributions were recorded allowing the osteolytic potential of the wear debris produced in the patellofemoral joint to be estimated using the concept of specific biological activity and functional biological activity. Values were compared with those reported for the tibiofemoral joint. Specific biological activity for the patellofemoral joint was not significantly different from the values for the tibiofemoral joint of total knee replacement devices, and therefore, has a similar potential to stimulate osteolytic cytokine release from macrophages. Functional biological activity was significantly lower for the patellofemoral joint compared with the tibiofemoral joint. Functional biological activity was significantly lower for the patellofemoral joint compared with the fixed bearing and rotating platform total knee replacement devices. However, as patellar resurfacing is commonly fitted as part of a total knee replacement system, this results in a 20% increase in overall functional biological activity for the system. Therefore, implanting a patellar resurfacing will increase the potential for osteolysis in the knee.

Keywords

Patellofemoral joint patellar resurfacing patellar button osteolysis knee replacement knee prosthesis biological activity polyethylene wear debris

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References

Calvisi

Camillieri

Lupparelli

. Resurfacing versus nonresurfacing the patella in total knee arthroplasty: a critical appraisal of the available evidence. Archives Orthopaedic Trauma Surg 2009; 129(9): 1261–1270.

Lygre

SHL

Espehaug

Havelin

. Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty. Acta Orthopaedica 2010; 81(1): 99–107.

Nizard

Biau

Porcher

. A meta-analysis of patellar replacement in total knee arthroplasty. Clinical Orthop Related Res 2005; 432: 196.

Robertsson

Bizjajeva

Fenstad

. Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthopaedica 2010; 81(1): 82–89.

Clements

Miller

Whitehouse

. Early outcomes of patella resurfacing in total knee arthroplasty. Acta Orthopaedica 2010; 81(1): 108–113.

National Joint Registry for England and Wales. 7th Annual Report - Surgical data to December 2009. September 2010, pp. 1–128.

Andersen

Ernst

Frandsen

. Polyethylene failure of metal-backed patellar components – 111 AGC total knees followed for 7–22 months. Acta Orthopaedica Scandinavica 1991; 62(1): 1–3.

Bayley

Scott

Ewald

. Failure of the metal backed patellar component after total knee arthroplasty. J Bone Joint Surg Am 1988; 70: 668–674.

Huang

Liau

. Polyethylene failure of the patellar component in New Jersey low -contact stress total knee arthroplasties. J Arthroplasty 2005; 20(2): 202–208.

10.

Ellison

Fisher

. Assessment of the damage in retrieved patellar components. J Long-Term Effects of Medical Implants 2010; 20(1): 57–72.

11.

Collier

McNamara

Surprenant

. All-polyethylene patellar components are not the answer. Clinical Orthop Related Res 1991; 273: 198–203.

12.

Schwartz

Aunallah

Levitin

. Wear pattern of retrieved patellar implants. Acta Orthopaedica Belgica 2002; 68(4): 362–369.

13.

Lindsey

Conner

Godleski

. Patellar button wear patterns in well-functioning total knee arthroplasty retrievals. J Long-Term Effects Of Medical Implants 2010; 20(1): 73.

14.

Teramura

Sakoda

Terao

. Reduction of wear volume from ultrahigh molecular weight polyethylene knee components by the addition of vitamin E. J Orthop Res 2008; 26(4): 460–464.

15.

Revell

Al-Saffar

Kobayashi

. Biological reaction to debris in relation to joint prostheses. Proc IMechE, Part H: J Engineering in Medicine 1997; 211(2): 187–197.

16.

Green

Fisher

Stone

. Polyethylene particles of a ‘critical size’ are necessary for the induction of cytokines by macrophages in vitro. Biomaterials 1998; 19: 2297–2302.

17.

Shanbhag

Jacobs

Black

. Macrophage/particle interactions: effect of size, composition and surface area. J Biomedical Mater Res 1994; 28(1): 81–90.

18.

Gelb

Ralph Schumacher

Cuckler

. In vivo inflammatory response to polymethylmethacrylate particulate debris: effect of size, morphology, and surface area. J Orthop Res 1994; 12(1): 83–92.

19.

Glant

Jacobs

. Response of three murine macrophage populations to particulate debris: bone resorption in organ cultures. J Orthop Res 1994; 12(5): 720–731.

20.

Fisher

Bell

Barbour

PSM

. A novel method for the prediction of functional biological activity of polyethylene wear debris. Proc IMechE, Part H: J Engineering in Medicine 2001; 215(2): 127–32.

21.

Bowsher

Williams

Clarke

. “Severe” wear challenge to 36 mm mechanically enhanced highly crosslinked polyethylene hip liners. J Biomedical Mater Res Part B: Applied Biomater 2008; 86(1): 253–263.

22.

Dumbleton

D’Antonio

Manley

. The basis for a second-generation highly cross-linked UHMWPE. Clinical Orthop Related Res 2006; 453: 265–271.

23.

Endo

Tipper

Barton

. Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylenes in hip prostheses. Proc IMechE, Part H: J Engineering in Medicine 2002; 216(2): 111–122.

24.

Ellison

Barton

Esler

. In vitro simulation and quantification of wear within the patellofemoral joint replacement. J Biomech 2008; 41(7): 1407–1416.

25.

Jennings

Bell

Ingham

. The influence of femoral condylar lift-off on the wear of artificial knee joints. Proc IMechE, Part H: J Engineering in Medicine 2007; 221(3): 305–314.

26.

Richards

Brown

Stone

. Identification of nanometre-sized ultra-high molecular weight polyethylene wear particles in samples retrieved in vivo. J Bone Joint Surg Br 2008; 90-B(8): 1106–1113.

27.

Sokal

Rohlf

. Biometry: the principles and practice of statistics in biological research. New York: WH Freeman and Company, 1995.

28.

Beaule

Campbell

Walker

. Polyethylene wear characteristics in vivo and in a knee stimulator. J Biomed Mater Res 2002; 60(3): 411–419.

29.

Grupp

Kaddick

Schwiesau

. Fixed and mobile bearing total knee arthroplasty–influence on wear generation, corresponding wear areas, knee kinematics and particle composition. Clinical Biomech 2009; 24(2): 210–217.

30.

Ellison

Tipper

Jennings

., (eds). Resurfacing the patella increases osteolytic potential. In: Proceedings of the 56th annual meeting of the Orthopaedic Research Society, 7–10 March 2010; New Orleans, LA: Orthopaedic Research Society.

31.

Marsh

Vicars

Tipper

., (eds) Comparison of UHMWPE wear debris from ProDisc-L Total disc replacements, total hip & total knee replacements. In: Annual meeting of the British Orthopaedic Research Society, 22–23 June 2009, Newcastle British Orthopaedic Research Society.

32.

Lygre

SHL

Espehaug

Havelin

. Failure of total knee arthroplasties with or without patella resurfacing. A study from the Norwegian Arthroplasty Register with 0–15 years follow-up. Acta Orthopaedica 2011; 82(3): 282–292.