Debris resulting from damage to the surface of polyethylene components
of total joint replacements has previously been shown to contribute to
long-term problems such as loosening and infection. Surface damage has been
associated with fatigue processes due to stresses arising from contact
between the metal and polyethylene components in these prostheses. In the
present study, we used elasticity and finite-element solutions to determine
these stresses for total hip replacements with head diameters of twenty-two
and twenty-eight millimeters and for a condylar total knee replacement. We
also examined the effect on these stresses of using carbon-fiber-reinforced
polyethylene instead of plain polyethylene. Stresses associated with
surface damage in the tibial component of the total knee replacement were
much larger than those in the hip replacements. The analysis of contact
stress as a function of thickness of the polyethylene insert for tibial
components showed that a thickness of more than eight to ten millimeters
should be maintained when possible. The contact stress in the tibial
components was reduced most when the articulating surfaces were more
conforming in the medial-lateral direction. Contact stresses were much less
sensitive to changes in geometry in the anterior-posterior direction. For
the hip components, the stresses were lower in the acetabular component of
the twenty-eight-millimeter hip replacement than in the
twenty-two-millimeter replacement. The use of carbon-fiber-reinforced
polyethylene resulted in stresses that were higher by as much as 40 per
cent. Because the contact area between articulating surfaces moves during
flexion, portions of the surface will be subjected to cyclic stresses. The
contact area for the knee replacements in flexion was smaller than for the
hip replacements, and the range of the maximum principal stress was larger.
Consequently, the combination of the higher stress and the moving contact
area is more likely to cause surface damage due to fatigue in tibial
components than in acetabular components, which is consistent with clinical
observations.