Failure Mechanism “Revisited” Total Knee Arthroplasty


  • Timothy McTighe, Dr. H.S. (hc)
  • Declan Brazil, PhD
  • Ian Clarke, PhD
  • Louis Keppler, MD
  • John Keggi, MD
  • Robert Kennon, MD



Total Knee Arthroplasty (TKA) has become a well-established treatment modality for surgical correction of knee disorders and pain generated by arthritis and other disorders such as trauma. Today a patient can expect to rely on his new knee to serve him with comfort for a fair number of years if not his entire life. TKA has taken on a predicated level of confidence and certain trends have developed over the years. Success has increased demand and the health care system is challenged to meet current and growing demand for surgery [In fact, the epidemiological studies have predicted that hips will grow only a little whereas knees are projected to have a 6-fold increase - see Kutz AAOS Scientific Exhibit 2006]. 

Surgical techniques are specializing into specific indications or camps for specialized product features. Uni-compartmental, Bi-compartmental, Total Knee with and without replacement of the patella, along with Patella-femoral replacement are some of the product classifications now available. The near future is now with articular focal defect replacement. New materials and techniques will open this area to increased indications as the sport-medicine surgeon finds his way into this growing surgical market. 


B. Shen, J. Yang, Z. Zhou, P. Kang, L. Wang, F. Pei: Survivorship comparison of all-polyethylene and metal-backed tibial components in cruciate-substituting total knee arthroplasty-Chinese experience. International Orthopaedics 1432-5195 (online) Aug. 2008

S. Najibi, R. Iorio, J.W. Surdam, W. Whang, D. Appleby, W.L. Healy: All-Polyethylene and metal-backed tibial components in total knee arthroplasty: a matched pair analysis of functional outcome. J. Arthroplasty, 2003 Oct; 18 (7 Suppl 1): 9-15

S. Kutz, E. Lau, M.A. Ke Zhao, F. Mowat, K. Ong, M. Halpern: The future burden of hip and knee revision: U.S. Projections from 2005 to 2030. AAOS scientific exhibit No. SE53 March 2006

R. Laskin, R. Denham, A. G. Apley: Replacement of the Knee. Springer- Verlag 1984

D. Dalury, D. Pomeroy, R. Gonzales, T. Gruen, M. J. Adams, J. Empson: Midterm results of all-polyethylene tibial components in primary total knee arthroplasty. J. Arthroplasty, vol 24, issue 4, 620-624, 2009

S. Sathappan, B. Wasserman, W. Jaffe, M. Bong, M. Walsh, P. Di Cesare: Midterm Results of Primary Total Knee Arthroplasty Using a Dished Polyethylene Insert with a Recessed or Resected Posterior Cruciate Ligament The Journal of Arthroplasty, vol 21, Issue 7, 1012-1016

A. Ranawat, S. Mohanty, S. Goldsmith, V.Rasquinha, J. Rodriguez, C. Ranawat: Experience with a all-polyethylene total knee arthroplasty in younger, active patients with follow-up from 2-11 years. The Journal of Arthroplasty, vol 20, 7-11

S.D. Mueller, J. Deehan, L.M.G. Kirk, P.J. Gregg, A.W. McCaskie: Should we reconsider all-polyethylene tibial implants in total knee replacement? JBJS British vol 88-B, issue 12, 1596-1602, 2006

J. Rodriguez, N. Baez, V. Rasquinha, C. Ranawat: Metal-backed and all-polyethylene tibial components in total knee replacement. Knee Society Meeting 20011, San Francisco, ETATS-UNIS (03/2001), Clinical Ortho & Related Research

S. Affatato, W. Leardini, M. Rocchi, A. Toni, and M. Viceconti. Investigation on Wear of Knee Prostheses Under Fixed Kinematic Conditions. Art. Org. 32(1):13–18, 2007.

M B. Collier, C. A. Engh, Jr., J P. Mcauley, S D. Ginn and G A. Engh Osteolysis After Total Knee Arthroplasty: Influence of Tibial Baseplate, Surface Finish and Sterilization of Polyethylene Insert. Findings at Five to Ten Years Postoperatively. J Bone Joint Surg Am. 87:2702-2708, 2005

M A. Conditt, M T. Thompson, M M. Usrey, S K. Ismaily and P C. Noble Backside Wear of Polyethylene Tibial Inserts: Mechanism and Magnitude of Material Loss. J Bone Joint Surg Am. 2005;87:326-331. J M. Cottrell, O Babalola, B S. Furman and T M. Wright. Stair Ascent Kinematics Affect UHMWPE Wear and Damage in Total Knee Replacements Journal of Biomedical Materials Research Part B: Applied Biomaterials, 15-19, 2005.

DA. Dennis and RD. Komistek. Mobile-bearing Total Knee Arthroplasty: Design Factors in Minimizing Wear. Clin Orthop Rel Res. 452, pp. 70–77, 2006.

J. DesJardins, A. Aurora, S L Tanner, T B Pace, K B Acampora, and M LaBerge. Increased total knee arthroplasty ultra-high molecular weight polyethylene wear using a clinically relevant hyaluronic acid simulator lubricant. Proc. IMechE, Part H: 220, 609-623, 2006.

H.S. Gill , J.C. Waite, A. Short, C.F. Kellett, A.J. Price and D.W. Murray In vivo measurement of volumetric wear of a total knee replacement. The Knee 13, (2006) 312 – 317.

TM. Grupp, Kaddick C., Schwiesau J., Maas A. and Stulberg S.D. Fixed and mobile bearing total knee arthroplasty – Influence on wear generation, corresponding wear areas, knee kinematics and particle composition. Clinical Biomechanics 24 (2009) 210–217.

R. Tsukamoto, PA. Williams, H. Shoji, K. Hirakawa, K. Yamamoto,3 M. Tsukamoto, IC. Clarke. Wear of Sequentially Enhanced 9-Mrad Polyethylene in 10 Million Cycle Knee Simulation Study. Journal of Biomedical Materials Research Part B: Applied Biomaterials (2008), 119- 124.

R. Tsukamoto, PA. Williams, IC. Clarke, G. Pezzotti, H Shoji, M. Akagi and K, Yamamoto. Y-TZP Zirconia Run Against Highly Crosslinked UHMWPE Tibial Inserts: Knee Simulator Wear and Phase-Transformation Studies. Biomedical Materials Research Part B: Applied Biomaterials (2008), 145- 153




How to Cite

McTighe, Dr. H.S. (hc), T., Brazil, PhD, D., Clarke, PhD, I., Keppler, MD, L., Keggi, MD, J., & Kennon, MD, R. (2011). Failure Mechanism “Revisited” Total Knee Arthroplasty. Reconstructive Review, 1(1).



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