Original Articles
Activity level and wear in total knee arthroplasty: A study of autopsy retrieved specimens*,**

https://doi.org/10.1054/arth.2001.23509Get rights and content

Abstract

We assessed the correlation between activity level, length of implantation (LOI), and wear in total knee arthroplasty. Twenty-eight implants were retrieved at autopsy from 8 men and 15 women. Linear, volumetric, and visual wear and the presence or absence of creep were quantitated. Functional level was classified using the Knee Society, the standard Charnley classification, and the UCLA activity level scale. The average age at surgery was 68 years ± 14.0 SD and average LOI was 74 months ± 38 SD. The average linear and volumetric wear rates were 0.127 mm/y ± 0.104 SD and 31.80 mm3/y ± 42.8 SD. LOI (B coefficient = −0.656 ± 0.0 SE; P<.001) correlated with linear, volumetric, and visual wear rates. Charnley C patients showed decreased volumetric wear in the lateral compartment (P=.01). Decreased activity level (UCLA) correlated with areas of less extent and severity of creep (P=.001 and P<.001).

Section snippets

Materials and methods

The patient cohort studied consisted of 22 nonconsecutive patients with 28 polyethylene inserts that had undergone primary TKA. All the specimens were obtained from an ongoing autopsy retrieval program at the John Hopkins University and patients consented for the retrieval before their death. All patients had received a primary Porous Coated Anatomic (PCA) prosthesis and had died with a clinically successful TKA. All of the inserts were of the nonconforming flat-on-flat design and manufactured

Results

Preoperatively, 13 patients' knees were classified as Charnley A, 4 were B, and 11 were C. According to the UCLA activity scale preoperatively, 2 patients were wholly inactive, dependent on others, and could not leave their residence (group 1); 5 patients were mostly inactive or restricted to minimal activities of daily living (group 2); 17 patients sometimes or regularly participated in mild activities, such as walking, limited housework, and limited shopping (group 3); and 3 patients

Discussion

Numerous studies have been published on insert wear in total hip arthroplasty and TKA 7, 9, 17, 23. Acetabular polyethylene wear has been measured on autopsy retrieved components, and in vivo wear rates have been calculated 24, 25. These studies have associated increased wear with prosthesis design, material issues 9, 26, 32-mm head sizes 24, 25, titanium bearing surfaces, and polyethylene quality and thickness 9, 17, 27. Age and activity level have been reported to be important factors

Conclusions

1. Activity level correlated with deformation and creep patterns in polyethylene inserts in TKAs with this particular design.

2. Age and activity level showed little correlation.

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      Jassim et al. [28] explored whether patients were able to return to athletic activity after TKA, with a secondary aim to evaluate implant survival. They found no increased risk of implant failure in active patients, based on a retrieval study [17] (not included in this review) and a case–control study by Jones et al. [24] (included in this review). The second systematic review focused on which host factors (e.g., sex, BMI and activity levels) affect aseptic loosening after TKA.

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    *

    This work was supported by a generous grant from the Arthritis Surgery Research Foundation.

    **

    Reprint requests: Carlos J. Lavernia, MD, 1321 NW 14th Street, Suite 203, Miami, FL 33125.

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