{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:16:48Z","timestamp":1791825408452,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R01AR059843"],"award-info":[{"award-number":["R01AR059843"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The purpose of this retrieval study was to determine the effect of implant positioning on wear, taking patient\u2010related factors into account. Therefore, the volumetric material loss of 59 retrieved tibial liners was quantitatively determined using a coordinate measuring\u2010machine. All retrievals were made of the same polyethylene and design by a single manufacturer. Using time in\u2010situ and linear regression, a wear rate for each liner was determined and corrected for bedding\u2010in. Backside damage was qualitatively scored. The following implant positioning parameters were obtained from radiographs: anatomical lateral\u2010distal femoral angle, anatomical medial\u2010proximal tibial angle, femoral tilt angle, and posterior tibial slope. The patella position was assessed by the Blackburne\u2010Peel index and the Insall\u2010Salvati ratio. Unlike the Insall\u2010Salvati ratio, the Blackburne\u2010Peel index is known to detect surgical joint line elevation. Using general linear modeling the most impactful factors on wear rate and backside damage was determined, thereby taking patient demographic factors into account. The mean volumetric wear rate was 11.6\u2009mm<jats:sup>3<\/jats:sup>\/y. Wear decreased with older age (<jats:italic>P<\/jats:italic>\u2009=\u2009.021) and female sex (<jats:italic>P<\/jats:italic>\u2009=\u2009.001). The wear rate increased with joint line elevation as indicated from a decreased Blackburne\u2010Peel index (<jats:italic>P<\/jats:italic>\u2009=\u2009.019), and increased with increased posterior tibial slope (<jats:italic>P<\/jats:italic>\u2009=\u2009.026). The backside damage score also increased with joint line elevation (<jats:italic>P<\/jats:italic>\u2009=\u2009.036). A Blackburne\u2010Peel index decrease of 0.1, signifying joint line elevation, was found to increase the wear rate by 1.8\u2009mm<jats:sup>3<\/jats:sup>\/y and increase back\u2010sided wear. A high tibial slope (&gt;7\u00b0) led to a 9.3\u2009mm<jats:sup>3<\/jats:sup>\/y increase in wear rate compared with a low tibial slope (&lt;3\u00b0). The results of this study demonstrate that tibial liner positioning has a significant impact on polyethylene wear with potential implications on osteolysis over time.<\/jats:p>","DOI":"10.1002\/jor.24710","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T12:58:12Z","timestamp":1588769892000},"page":"1596-1606","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Joint line elevation and tibial slope are associated with increased polyethylene wear in cruciate\u2010retaining total knee replacement"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9610-4864","authenticated-orcid":false,"given":"Robin","family":"Pourzal","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Rush University Medical Center Chicago 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