All ETDs from UAB

Advisory Committee Chair

Alan W Eberhardt

Advisory Committee Members

Dale S Feldman

Elie S Ghanem

Document Type

Thesis

Date of Award

2018

Degree Name by School

Master of Biomedical Engineering (MBE) School of Engineering

Abstract

Total knee replacement (TKR) is used to remedy end-stage joint deterioration. Despite advancements in TKR design, thousands of patients still experience aseptic loosening and the revision surgeries that follow. Wear and corrosion processes can lead to the harmful production of debris, causing osteolysis in the periprosthetic space. This study seeks to quantify the relationships of wear, corrosion, and micromotion as it relates to aseptic loosening in TKR. 17 TKR devices harvested at revision surgeries and 6 necropsy devices available through UAB’s retrieval program were scored for wear and inflammatory cell-induced corrosion (ICIC). All devices were implanted ≤ 10 years. All retrieval devices were removed due to aseptic loosening and all necropsy specimens were presumed to be functional upon patient death. Device and patient information including height, weight, age, BMI and the time in which the device was service were noted for analysis. Visual wear scoring was performed according to Hood et al. (1985). ICIC damage was quantified on the femoral component by summing the total area affected (mm2) through optical microscopy. In order to investigate correlations between wear scores and ICIC affected areas, a non-parametric Spearman correlation test (CI 95%) was performed. A micromotion test was performed on the necropsy devices in order to quantify the relationship between corrosion, polyethylene wear and micromotion in necropsy specimens. Scoring revealed the retrieval and necropsy devices had an average wear score of 40.3 and 20.5, respectively, and an average ICIC damage area on the femoral condyle of 2.29 mm2 and 1.86 mm2. Polyethylene wear scores positively correlated with time in vivo (p = 0.0092). No significant difference was found between ICIC on retrieval and necropsy specimens. Micromotion testing revealed no significant correlations with wear, and ICIC. The results of this study showed that the revised TKR devices removed due to aseptic loosening exhibited significantly higher polyethylene wear scores, on average, when compared to the necropsy devices. ICIC and wear scoring results suggest that the onset of aseptic loosening and subsequent revision was not related to the presence or absence of ICIC, but rather from polyethylene wear and the debris generated.

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