2009 Knee Society Presidential Guest Lecture Polyethylene Wear in Total Knees
2009 Knee Society Presidential Guest Lecture Polyethylene Wear in Total Knees
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DOI：
10.1007/s11999-009-1033-1
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发表时间：
2010-01-01
影响因子：
4.2
通讯作者：
Ingham, Eileen
中科院分区：
文献类型：
--
作者：
Fisher, John;Jennings, Louise M.;Ingham, Eileen
年轻和活跃患者的膝关节置换术会显著增加终身摩擦学需求和磨损诱导骨质溶解的可能性。聚乙烯材料近年来取得了进展，降低了氧化降解和分层失效的可能性。考虑摩擦学设计变量及其减少表面磨损和骨溶解长期风险的潜力是及时的。研究了旋转平台移动平台膝关节设计中减少的交叉剪切和低顺应性固定平台膝关节中减少的表面磨损面积的影响。在多方向钉-板研究和膝关节模拟器研究中的旋转平台移动平台设计中，交叉剪切力的降低显著降低了磨损。在膝关节模拟器研究中，关节面接触面积的减少显著降低了多向钉-板模拟和低顺应性固定关节面膝关节设计中的表面磨损。这为膝关节设计的范式转变提供了可能性，这是通过增强新聚合物材料的机械性能来预测的。我们描述了两种不同的低磨损摩擦学设计解决方案：（1）具有降低的交叉剪切的旋转平台设计解决方案提供了降低的磨损，同时具有贴合性和内在稳定性;以及（2）具有降低的表面积的低贴合性固定关节面，提供了降低的磨损，但具有较低的内在稳定性，并且需要良好的软组织功能。
Knee arthroplasties in young and active patients place a substantial increase in the lifetime tribological demand and potential for wear-induced osteolysis. Polyethylene materials have advanced in recent years, reducing the potential for oxidative degradation and delamination failure. It is timely to consider tribological design variables and their potential to reduce surface wear and the long-term risk of osteolysis. The influence of reduced cross shear in rotating platform mobile-bearing knee designs and reduced surface wear area in low conforming fixed-bearing knees has been investigated. A reduction in cross shear substantially reduced wear in both multidirectional pin-on-plate studies and in rotating platform mobile-bearing designs in knee simulator studies. A reduction in bearing surface contact area substantially reduced surface wear in multidirectional pin-on-plate simulations and in low conforming fixed-bearing knee designs in knee simulator studies. This offers potential for a paradigm shift in knee design predicated by enhanced mechanical properties of new polymer materials. We describe two distinct low-wearing tribological design solutions: (1) a rotating platform design solution with reduced cross shear provides reduced wear with conformity and intrinsic stability; and (2) a low conformity fixed bearing with reduced surface area, provides reduced wear, but has less intrinsic stability and requires good soft tissue function.