Background: The capture mechanisms of modular tibial total knee
components may allow relative micromotion between the insert and the
base-plate, leading to wear at the nonarticulating (backside) surface.
Although retrieved components often display laxity in the capture mechanism in
the unloaded condition, the magnitude of the relative motion that actually
occurs under physiologic conditions has not been determined. This study was
performed to assess the impact of different modes of knee-loading on the
relative micromotion between the insert and the base-plate and the
relationship between the duration that the implant had been in situ and the
severity of backside wear.
Methods: Twenty-one posterior-stabilized total knee replacements of
one common design (Insall-Burstein II) were retrieved at one to 100 months
after implantation. The extent and severity of backside wear was graded with
use of stereomicroscopy. All components were soaked in a bath (of physiologic
saline solution at 37°C for four days prior to reassembly. The relative
micromotion between the insert and the base-plate of each specimen was
measured in vitro in two different conditions: with no axial load and with a
combination of loads and torques simulating the stance phase of gait.
Results: The capture mechanism laxity between the insert and the
tibial base-plate in the unloaded condition was approximately eight times
larger than the micromotion measured during simulated gait. The capture
mechanism laxity allowed a mean (and standard deviation) of 618 ± 226
µm of total relative micromotion compared with 103 ± 54 µm of
relative micromotion during the gait cycle. Under both loading conditions, the
predominant direction of interface motion was medial-lateral. No correlation
was found between the magnitude of capture mechanism laxity and the relative
micromotion measured during simulated gait (p = 0.11). Larger polyethylene
protrusions on the backside surface did not correlate with less micromotion (p
= 0.48) or with capture mechanism laxity (p = 0.06).
Conclusions: For the implant design that was studied, capture
mechanism laxity between the modular insert and the base-plate in the unloaded
condition was an order of magnitude larger than and not indicative of the
micromotion that occurred during simulated physiologic loading. In addition,
polyethylene protrusions into the screw-holes of tibial base-plates did not
seat or lock the insert in place and reduce relative motion.
Clinical Relevance: While some clearance between the insert and the
base-plate is required to allow assembly of modular tibial components at the
time of surgery, the amount of relative interface motion during a functional
activity such as normal gait, which can produce potentially damaging wear
debris, is unknown. However, the compressive forces applied to the articular
surface during a functional activity may substantially reduce micromotion
between the insert and the base-plate relative to the unloaded condition.