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Wear and Osteolysis Around Total Knee Arthroplasty

Dr. Naudie is Assistant Professor, Division of Orthopaedic Surgery, University of Western Ontario, and Director, Musculoskeletal Imaging Unit, Robarts Research Institute, London, ON, Canada. Ms. Ammeen is Project Director, Clinical Knee Research, Anderson Orthopaedic Research Institute, Alexandria, VA. Dr. Engh is Director, Knee Research, Anderson Orthopaedic Research Institute. Dr. Rorabeck is Professor, Division of Orthopaedic Surgery, University of Western Ontario.

Dr. Naudie or the department with which he is affiliated has received research or institutional support from DePuy and Smith & Nephew. Ms. Ammeen has received nothing of value from nor does she own stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. Engh or the department with which he is affiliated has received royalties from DePuy. Dr. Rorabeck or the department with which he is affiliated has received research or institutional support from DePuy and Smith & Nephew.

Reprint requests: Dr. Naudie, Division of Orthopaedic Surgery, University of Western Ontario, London Health Sciences Centre, Office B9-006, University Campus, 339 Windermere Road, London, ON, Canada N6A 5A5.

Osteolysis induced by wear debris of ultra-high-molecular-weight polyethylene has emerged as a significant problem after total knee arthroplasty. The generation of polyethylene wear and the development of osteolysis around total knee arthroplasty are caused by a combination of patient, implant, and surgical factors. Activity level over time may be the most important patient factor affecting the loads placed on a total knee replacement, but it is the most difficult to manage. Multiple factors related to the manufacturing of the polyethylene implant influence the extent of wear, and surgeons should be cautious in considering enhanced polyethylenes pending results of further investigations. The optimal design of the articular bearing surface remains controversial but needs to be considered with respect to the stresses imparted on component-bone and modular tibial backside interfaces. Surgical factors, including restoration of alignment and ligament balance, are important for long-term durability of the implant. Methods of measuring the wear of total knee implants are still evolving. Thus, when confronted with a worn total knee implant and developing osteolysis, the surgeon should consider each of these factors in selecting the best management option to eliminate the source of debris and minimize the potential for wear and osteolysis following revision.

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