Abstract
Introduction A biomechanical model was developed to measure wear of all-polyethylene patellar components as it relates to femoral component mal-rotation. The model, based on high load and flexion activities such as stair climbing, was used to differentiate the effects of femoral mal-rotation and differing materials on a single patellar design.
Methods The patellar components (Scorpio®, Stryker-Howmedica-Osteonics) were cemented onto metal fixtures and articulated against “aligned” and “mal-aligned” (six degrees internally rotated) femoral components. The patellar components were subjected to a constant force and articulated against femoral components flexing from 600 to 1200. Patellae of identical geometry, made of conventional and highly cross-linked ultra-high molecular weight polyethylene, were tested to 1x106 cycles. Following testing, patellar wear was determined by gravimetric measurement relative to soaked control specimens.
Results All conventional polyethylene patellae demonstrated damage in the form of burnishing and scratching of the articular surface. The mal-aligned conventional ultra-high molecular weight patellae demonstrated increased weight loss or wear relative to the aligned components (p=.048). All rotationally mal-aligned highly cross-linked polyethylene components sustained polyethylene fracture or catastrophic failure of the cement-polyethylene construct.
Conclusions Rotational mal-alignment of the femoral component will result in increased wear of polyethylene patellar components. The newer highly cross-linked materials failed to resolve this wear problem and sustained catastrophic failure when mal-aligned. Attention needs to be given to the patella-femoral articulation when implanting knee components and when developing new polyethylene as the forces in this articulation may result in polyethylene behaviour that varies dramatically from the femoraltibial articulation.
In relation to the conduct of this study, one or more of the authors has received, or is likely to receive direct material benefits.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
