{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:16:14Z","timestamp":1790316974300,"version":"4.1.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>At our institution, surgeons were observing cases of failed total knee arthroplasties (TKAs) with surface delamination of the tibial insert fabricated by direct compression molding. The increase in unexpected failure led us to investigate the prevalence of delamination and its causes through the use of retrieval analysis and reviews of clinical, demographic, and radiographic data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between 2000 and 2019, a total of 519 Exactech Optetrak posterior-stabilized direct-compression-molded polyethylene inserts had been retrieved. To determine prevalence, we utilized institutional usage data, manufacturer sales to our institution, and hospital records to determine the delamination rate. Eighty-six retrieved specimens (16 with delamination) were assessed for oxidation with use of infrared spectroscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Sixty-four (12%) of the 519 inserts had delamination. The delamination rate was 0.36% across the 20-year period. Osteolysis was the reason for revision in 25% of delaminated cases, compared with 4% of non-delaminated cases. The mean oxidation index of the delaminated inserts was 2.67 \u00b1 1.4 (range, 1.2 to 6.6). Delamination was not associated with surgical factors (cement viscosity and tibial insert thickness) or processes associated with manufacturing and implantation of the inserts into the patients (implantation year, shelf life, and packaging and sterilization dates).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The lack of causative factors for the increase in delamination was perplexing. In 2021, following the completion of our study, the manufacturer determined that since 2004, polyethylene inserts were packaged in \u201cnon-conforming\u201d vacuum bags that were missing a secondary barrier layer intended to markedly lessen oxygen permeation. The use of non-conforming bags apparently increased the risk of premature oxidation, delamination, and associated osteolysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00857","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T14:06:13Z","timestamp":1745503573000},"page":"e58","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Delamination and Oxidation in Compression-Molded Polyethylene"],"prefix":"10.2106","volume":"107","author":[{"given":"Brian T.","family":"Nickel","sequence":"first","affiliation":[{"name":"University of Wisconsin-Madison, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2789-4718","authenticated-orcid":false,"given":"Lydia","family":"Weitzler","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7451-7676","authenticated-orcid":false,"given":"Elexis B.","family":"Padgett","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2752-2306","authenticated-orcid":false,"given":"Madeline","family":"Lang","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey H.","family":"Westrich","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Wright","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas E.","family":"Padgett","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"bib1-20260205","doi-asserted-by":"crossref","DOI":"10.1097\/00003086-200211000-00003","article-title":"Insall Award paper. Why are total knee arthroplasties failing today?","volume":"404","author":"Sharkey","year":"2002","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib2-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2013.07.024","article-title":"Why are total knee arthroplasties failing today\u2014has anything changed after 10 years?","volume":"29","author":"Sharkey","year":"2014","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib3-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2017.09.041","article-title":"Failure After Modern Total Knee Arthroplasty: A Prospective Study of 18,065 Knees","volume":"33","author":"Pitta","year":"2018","journal-title":"J Arthroplasty."},{"issue":"8","key":"bib4-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2011.01.009","article-title":"Eleven-year implant survival rates of the all-polyethylene and metal-backed modular Optetrak posterior stabilized knee in bilateral simultaneous cases","volume":"26","author":"Robinson","year":"2011","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib5-20260205","doi-asserted-by":"crossref","DOI":"10.1007\/s11420-011-9196-1","article-title":"Average 7-year survivorship and clinical results of a newer primary posterior stabilized total knee arthroplasty","volume":"7","author":"Ehrhardt","year":"2011","journal-title":"HSS J."},{"issue":"8","key":"bib6-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2010.11.020","article-title":"Midterm results of Optetrak posterior-stabilized total knee system after 7 to 12 years in a university hospital","volume":"26","author":"Garc\u00eda-Crespo","year":"2011","journal-title":"J Arthroplasty."},{"issue":"5","key":"bib7-20260205","doi-asserted-by":"crossref","DOI":"10.1002\/jbm.820170510","article-title":"Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses","volume":"17","author":"Hood","year":"1983","journal-title":"J Biomed Mater Res."},{"issue":"3","key":"bib8-20260205","doi-asserted-by":"crossref","DOI":"10.1002\/jbm.b.32805","article-title":"In vivo oxidation in retrieved highly crosslinked tibial inserts","volume":"101","author":"Currier","year":"2013","journal-title":"J Biomed Mater Res B Appl Biomater."},{"issue":"1","key":"bib9-20260205","doi-asserted-by":"crossref","DOI":"10.1007\/s11999-016-4820-5","article-title":"Crosslink density is reduced and oxidation is increased in retrieved highly crosslinked polyethylene TKA tibial inserts","volume":"475","author":"Liu","year":"2017","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib11-20260205","doi-asserted-by":"crossref","DOI":"10.1007\/s11999-011-1872-4","article-title":"History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene","volume":"469","author":"Kurtz","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib12-20260205","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.M.01534","article-title":"Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery","volume":"97","author":"Thiele","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib13-20260205","doi-asserted-by":"crossref","DOI":"10.1007\/s11420-018-9608-6","article-title":"Less midterm damage and oxidation are seen in retrieved highly crosslinked ultrahigh-molecular-weight polyethylene tibial inserts than in direct compression molded polyethylene inserts","volume":"14","author":"Stavrakis","year":"2018","journal-title":"HSS J."},{"issue":"4","key":"bib14-20260205","doi-asserted-by":"crossref","DOI":"10.5312\/wjo.v9.i4.60","article-title":"Why total knees fail-A modern perspective review","volume":"9","author":"Lum","year":"2018","journal-title":"World J Orthop."},{"issue":"7","key":"bib15-20260205","doi-asserted-by":"crossref","DOI":"10.1007\/s11999-014-3540-y","article-title":"Current modes of failure in TKA: infection, instability, and stiffness predominate","volume":"472","author":"Le","year":"2014","journal-title":"Clin Orthop Relat Res."},{"key":"bib16-20260205","doi-asserted-by":"crossref","DOI":"10.1097\/BLO.0b013e3181591c62","article-title":"PFC knee replacement: osteolytic failures from extreme polyethylene degradation","volume":"464","author":"Casey","year":"2007","journal-title":"Clin Orthop Relat Res."},{"issue":"14","key":"bib18-20260205","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.I.01006","article-title":"In vivo oxidation in remelted highly cross-linked retrievals","volume":"92","author":"Currier","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib19-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.otsr.2012.04.008","article-title":"Poor results of the Optetrak\u2122 cemented posterior stabilized knee prosthesis after a mean 25-month follow-up: analysis of 110 prostheses","volume":"98","author":"Thelu","year":"2012","journal-title":"Orthop Traumatol Surg Res."},{"issue":"6","key":"bib20-20260205","article-title":"Commentary on an article","volume":"98","author":"Petty","year":"2012","journal-title":"Orthop Traumatol Surg Res."},{"issue":"6","key":"bib21-20260205","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2022.02.051","article-title":"A postmortem analysis of polyethylene damage and periprosthetic tissue in rotating platform and fixed bearing tibial inserts","volume":"37","author":"Chen","year":"2022","journal-title":"J Arthroplasty."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:37:35Z","timestamp":1787751455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.00857","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,24]]}}}