Total Articular Knee Replacement Using Polyurethane

Abstract

This study reviewed the early use of polyurethane for total knee resurfacing, the long-term results of polycarbonate urethane (PCU) for total knee replacement and conducted wear simulator testing of PCU. In 1959 and 1960, 10 patients underwent total articular polyurethane knee replacement (polyethylene was not available). The polyurethane was placed on the articular surface of the femur with metal surfaces on the tibia and patella. In 1996 and 1997, four patients received a newer PCU tibial insert in revision procedures; all had well-fixed prostheses, but no revision polyethylene implants were available. In addition, this study evaluated six new PCU tibial inserts in a 10-million cycle (Mc) wear simulator. All 10 of the early knees performed well clinically and 2 knees were functional for more than 30 years. Of the four more recent patients, all knees remain functional at more than 20 years' follow-up with no signs of wear or osteolysis. Wear simulator testing found mean material loss of 14.2 mg/Mc which equates to a volumetric wear of 11.9 mg/Mc, similar to the wear of conventional polyethylene. Polyurethane performs well as conventional polyethylene but not better than current cross-linked polyethylene tibial inserts. Its large wear particles (mean, 11 µm) and biocompatibility are less likely to cause an inflammatory response leading to pain and bone loss. Newer, superior polyurethanes can again be considered a candidate material for the tibial insert of a total knee replacement. A larger study may be able to validate polyurethane as an alternative material for joint replacement.

Keywords

polyurethane - knee resurfacing - knee replacement - arthroplasty - polyurethane wear

• References

• 1 Campbell WC. Interposition of Vitallium plates in arthroplasties of the knee. Am J Surg 1940; 47: 639-641
• 2 Insall JN. Presidential address to the Knee Society. Choices and compromises in total knee arthroplasty. Clin Orthop Relat Res 1988; (226) 43-48
• 3 MacIntosh DL. Hemiarthroplasty of the knee using a space occupying prosthesis for painful varus and valgus deformities. J Bone Joint Surg 1958; 40A: 1431
• 4 McKeever DC. The classic: tibial plateau prosthesis. 1960. Clin Orthop Relat Res 2005; 440 (18) 4-8 , discussion 3
• 5 Robinson RP. The early innovators of today's resurfacing condylar knees. J Arthroplasty 2005; 20 (01) (Suppl. 01) 2-26
• 6 Townley CO. Articular-plate replacement arthroplasty for the knee joint. 1964. Clin Orthop Relat Res 1988; (236) 3-7
• 7 Townley CO. Total knee arthroplasty. A personal retrospective and prospective review. Clin Orthop Relat Res 1988; (236) 8-22
• 8 Townley CO. Hemi and total articular replacement arthroplasty of the hip with the fixed femoral cup. Orthop Clin North Am 1982; 13 (04) 869-894
• 9 Pritchett JW. Curved-stem hip resurfacing: minimum 20-year followup. Clin Orthop Relat Res 2008; 466 (05) 1177-1185
• 10 Kimball FB, Mandarino MP. Low-friction arthroplasty. JAMA 1972; 219 (04) 512-513
• 11 Mandarino MP. Glue for broken bones. Time Magazine. July 13, 1959
• 12 Mandarino MP, Salvatore JE. Polyurethane polymer; its use in fractured and diseased bones. Am J Surg 1959; 97 (04) 442-446
• 13 Redler I. Polymer osteosynthesis. A clinical trial of ostamer in forty-two patients. J Bone Joint Surg Am 1962; 44: 1621-1652
• 14 Ostamer. Generic names of new drugs. J New Drugs 1962; 2: 63
• 15 Stewart T, Jin ZM, Fisher J. Friction of composite cushion bearings for total knee joint replacements under adverse lubrication conditions. Proc Inst Mech Eng H 1997; 211 (06) 451-465
• 16 Elsner JJ, Shemesh M, Mezape Y. , et al. Long-term evaluation of a compliant cushion form acetabular bearing for hip joint replacement: a 20 million cycles wear simulation. J Orthop Res 2011; 29 (12) 1859-1866
• 17 Pritchett J. Very large diameter polymer acetabular liners show promising wear simulator results. J Long Term Eff Med Implants 2016; 26 (04) 311-319
• 18 Scholes SC, Unsworth A, Jones E. Polyurethane unicondylar knee prostheses: simulator wear tests and lubrication studies. Phys Med Biol 2007; 52 (01) 197-212
• 19 Haboush EJ. A new operation for arthroplasty of the hip based on biomechanics, photoelasticity, fast-setting dental acrylic, and other considerations. Bull Hosp Jt Dis 1953; 14 (02) 242-277
• 20 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 21 Burgess IC, Kolar M, Cunningham JL, Unsworth A. Development of a six station knee wear simulator and preliminary wear results. Proc Inst Mech Eng H 1997; 211 (01) 37-47
• 22 Chakravarty R, Elmallah RD, Cherian JJ, Kurtz SM, Mont MA. Polyethylene wear in knee arthroplasty. J Knee Surg 2015; 28 (05) 370-375
• 23 Kretzer JP, Reinders J, Sonntag R. , et al. Wear in total knee arthroplasty--just a question of polyethylene?: Metal ion release in total knee arthroplasty. Int Orthop 2014; 38 (02) 335-340
• 24 Treharne RW, Young RW, Young SR. Wear of artificial joint materials III: Simulation of the knee joint using a computer-controlled system. Eng Med 1981; 10 (03) 137-142
• 25 Scales JT. Arthroplasty of the hip using foreign materials: a history. Proc- Inst Mech Eng 1966; 181: 63-84
• 26 Pritchett JW. Bicruciate-retaining total knee replacement provides satisfactory function and implant survivorship at 23 years. Clin Orthop Relat Res 2015; 473 (07) 2327-2333