(Fig 5-D.05) Radiographic Findings of Polyethylene Wear and Fracture

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📌 Polyethylene Wear in TKA

 

• Polyethylene components in Total Knee Arthroplasty (TKA) are susceptible to wear at the articular surfaces due to abrasion and fatigue. 
• Repetitive rolling, sliding, and rotating at these surfaces result in scratching, burnishing, and pitting, along with the shedding of polyethylene particles.

 

• The particulate polyethylene debris stimulates a foreign-body inflammatory response, which can ultimately lead to osteolysis and loosening of the implant.

 

✅ Factors Influencing Polyethylene Wear

• Malalignment and instability can accelerate wear.
• The weight of the patient.
• The patient’s activity level.
• Molecular composition and thickness of the polyethylene.
• Articular irregularities adjacent to the polyethylene.

 

✅ Imaging of Polyethylene Wear

• Polyethylene wear can be identified on sequential radiographs as progressive joint space narrowing in anteroposterior and lateral weight-bearing views over the medial and lateral compartments.
• Wear should be evaluated on weight-bearing anteroposterior and lateral radiographs. 
• The defect should be measured from the femoral condyles to the tibial baseplate. Moderate to severe wear appears as obvious joint space narrowing.

 

✅ NOTE: Asymmetry and Deformities

• When wear is asymmetric, varus or valgus deformity or patellar tilt may be present. 
• However, asymmetry alone of the medial and lateral compartments is not a reliable indicator of wear as this appearance can also be secondary to ligamentous laxity.

 

References

1. AJR 2017; 209:W231–W237
2. Semin Musculoskelet Radiol 2019;23:e20–e35.
3. Semin Musculoskelet Radiol 2017;21:147–164
4. AJR 2014; 202:W76–W86

 

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#PolyethyleneWear, #TKA, #TotalKneeArthroplasty, #JointReplacement, #Radiology, #Orthopedics, #Osteolysis, #JointSpaceNarrowing, #MedicalImaging, #ImplantLoosening