{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:54:09Z","timestamp":1787028849205,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Materials"],"abstract":"<jats:p>(1) Background: Analyses of retrieved inserts allow for a better understanding of TKA failure mechanisms and the detection of factors that cause increased wear. The purpose of this implant retrieval study was to identify whether insert volumetric wear significantly differs among groups of common causes of total knee arthroplasty failure, whether there is a characteristic wear distribution pattern for a common cause of failure, and whether nominal insert size and component size ratio (femur-to-insert) influence linear and volumetric wear rates. (2) Methods: We digitally reconstructed 59 retrieved single-model cruciate-retaining inserts and computed their articular load-bearing surface wear utilizing an optical scanner and computer-aided design models as references. After comprehensively reviewing all cases, each was categorized into one or more of the following groups: prosthetic joint infection, osteolysis, clinical loosening of the component, joint malalignment or component malposition, instability, and other isolated causes. The associations between volumetric wear and causes of failure were estimated using a multiple linear regression model adjusted for time in situ. Insert linear penetration wear maps from the respective groups of failure were further processed and merged to create a single average binary image, highlighting a potential wear distribution pattern. The differences in wear rates according to nominal insert size (small vs. medium vs. large) and component size ratio (\u22641 vs. &gt;1) were tested using the Kruskal\u2013Wallis test and the Mann\u2013Whitney test, respectively. (3) Results: Patients with identified osteolysis alone and those also with clinical loosening of the component had significantly higher volumetric wear when compared to those without both causes (p = 0.016 and p = 0.009, respectively). All other causes were not significantly associated with volumetric wear. The instability group differentiated from the others with a combined peripheral antero-posterior wear distribution. Linear and volumetric wear rates showed no significant differences when compared by nominal insert size (small vs. medium vs. large, p = 0.563 and p = 0.747, respectively) or by component (femoral-to-insert) size ratio (\u22641 vs. &gt;1, p = 0.885 and p = 0.055, respectively). (4) Conclusions: The study found increased volumetric wear in cases of osteolysis alone, with greater wear when combined with clinical loosening compared to other groups. The instability group demonstrated a characteristic peripheral anterior and posterior wear pattern. Insert size and component size ratio seem not to influence wear rates.<\/jats:p>","DOI":"10.3390\/ma17205007","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T07:47:05Z","timestamp":1728892025000},"page":"5007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Linear and Volumetric Polyethylene Wear Patterns after Primary Cruciate-Retaining Total Knee Arthroplasty Failure: An Analysis Using Optical Scanning and Computer-Aided Design Models"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4500-5652","authenticated-orcid":false,"given":"Matej","family":"Vali\u010d","sequence":"first","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Milo\u0161ev","sequence":"additional","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"},{"name":"Jo\u017eef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-7395","authenticated-orcid":false,"given":"Vesna","family":"Leva\u0161i\u010d","sequence":"additional","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateja","family":"Blas","sequence":"additional","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7449-7038","authenticated-orcid":false,"given":"Eva","family":"Podov\u0161ovnik","sequence":"additional","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"},{"name":"Faculty of Tourism Studies-Turistica, University of Primorska, Obala 11a, 6320 Portoro\u017e, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaka","family":"Koren","sequence":"additional","affiliation":[{"name":"Faculty of Electrical Engineering, University of Ljubljana, Tr\u017ea\u0161ka cesta 25, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1075-3351","authenticated-orcid":false,"given":"Rihard","family":"Treb\u0161e","sequence":"additional","affiliation":[{"name":"Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280 Ankaran, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.2106\/JBJS.OA.22.00112","article-title":"Projections and Epidemiology of Primary Hip and Knee Arthroplasty in Medicare Patients to 2040\u20132060","volume":"8","author":"Shichman","year":"2023","journal-title":"JBJS Open Access"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5792\/ksrr.2016.28.1.1","article-title":"Patient Satisfaction after Total Knee Arthroplasty","volume":"28","author":"Choi","year":"2016","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1302\/0301-620X.100B6.BJJ-2017-1292.R1","article-title":"The Rate and Predictors of Patient Satisfaction after Total Knee Arthroplasty Are Influenced by the Focus of the Question: A Standard Satisfaction Question Is Required","volume":"100-B","author":"Clement","year":"2018","journal-title":"Bone Jt. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1016\/j.arth.2017.03.066","article-title":"Current Epidemiology of Revision Total Knee Arthroplasty in the United States","volume":"32","author":"Delanois","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_5","first-page":"62","article-title":"Machine Learning: The Future of Total Knee Replacement","volume":"39","author":"Dossett","year":"2022","journal-title":"Fed. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1302\/0301-620X.98B1.36293","article-title":"The Epidemiology of Failure in Total Knee Arthroplasty: Avoiding Your next Revision","volume":"98-B","author":"Khan","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Postler, A., L\u00fctzner, C., Beyer, F., Tille, E., and L\u00fctzner, J. (2018). Analysis of Total Knee Arthroplasty Revision Causes. BMC Musculoskelet. Disord., 19.","DOI":"10.1186\/s12891-018-1977-y"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5435\/00124635-200701000-00006","article-title":"Wear and Osteolysis Around Total Knee Arthroplasty","volume":"15","author":"Naudie","year":"2007","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8046","DOI":"10.1016\/j.actbio.2013.05.005","article-title":"Osteolysis around Total Knee Arthroplasty: A Review of Pathogenetic Mechanisms","volume":"9","author":"Gallo","year":"2013","journal-title":"Acta Biomater."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1302\/0301-620X.103B11.BJJ-2020-2334.R1","article-title":"What Factors Drive Polyethylene Wear in Total Knee Arthroplasty?: Results of a Large Retrieval Series","volume":"103-B","author":"Currier","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/00003086-200211000-00013","article-title":"Assessment of Backside Wear From the Analysis of 55 Retrieved Tibial Inserts","volume":"404","author":"Li","year":"2002","journal-title":"Clin. Orthop."},{"key":"ref_12","first-page":"326","article-title":"Backside Wear of Polyethylene Tibial Inserts: Mechanism and Magnitude of Material Loss","volume":"87","author":"Conditt","year":"2005","journal-title":"J. Bone Jt. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/BLO.0b013e31806dba05","article-title":"Mobile-Bearing Knees Reduce Rotational Asymmetric Wear","volume":"462","author":"Ho","year":"2007","journal-title":"Clin. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.arth.2008.01.003","article-title":"Analysis of Retrieved Ultra\u2013High-Molecular-Weight Polyethylene Tibial Components From Rotating-Platform Total Knee Arthroplasty","volume":"24","author":"Garcia","year":"2009","journal-title":"J. Arthroplast."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1302\/0301-620X.92B4.22560","article-title":"Wear-Pattern Analysis in Retrieved Tibial Inserts of Mobile-Bearing and Fixed-Bearing Total Knee Prostheses","volume":"92-B","author":"Lu","year":"2010","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.knee.2011.11.003","article-title":"Effect of Tibial Component Varus on Wear in Total Knee Arthroplasty","volume":"19","author":"Srivastava","year":"2012","journal-title":"Knee"},{"key":"ref_17","first-page":"449","article-title":"An Autonomous Mathematical Reconstruction to Effectively Measure Volume Loss on Retrieved Polyethylene Tibial Inserts","volume":"101","author":"Knowlton","year":"2012","journal-title":"J. Biomed. Mater. Res. B Appl. Biomater."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1007\/s11999-012-2274-y","article-title":"Surface Damage Versus Tibial Polyethylene Insert Conformity: A Retrieval Study","volume":"470","author":"Wimmer","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1007\/s11999-012-2248-0","article-title":"Knee Wear Measured in Retrievals: A Polished Tray Reduces Insert Wear","volume":"470","author":"Berry","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11999-012-2530-1","article-title":"Rotating-Platform Has No Surface Damage Advantage Over Fixed-Bearing TKA","volume":"471","author":"Stoner","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11999-012-2387-3","article-title":"The 2012 Mark Coventry Award: A Retrieval Analysis of High Flexion versus Posterior-Stabilized Tibial Inserts","volume":"471","author":"Paterson","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s11999-012-2513-2","article-title":"Can Microcomputed Tomography Measure Retrieved Polyethylene Wear? Comparing Fixed-Bearing and Rotating-Platform Knees","volume":"471","author":"Engh","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.arth.2013.05.029","article-title":"Retrieval Analysis of Posterior Stabilized Polyethylene Tibial Inserts and Its Clinical Relevance","volume":"29","author":"Pang","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3523","DOI":"10.1007\/s00167-014-3197-9","article-title":"Changes in Surface Topography at the TKA Backside Articulation Following in Vivo Service: A Retrieval Analysis","volume":"23","author":"Holleyman","year":"2015","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s11999-014-3648-0","article-title":"Does Increased Topside Conformity in Modular Total Knee Arthroplasty Lead to Increased Backside Wear?","volume":"473","author":"Schwarzkopf","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1002\/jbm.b.33684","article-title":"Relationship of Surface Damage Appearance and Volumetric Wear in Retrieved TKR Polyethylene Liners: RETRIEVED TKR POLYETHYLENE DAMAGE PATTERNS AND VOLUMETRIC WEAR","volume":"105","author":"Knowlton","year":"2017","journal-title":"J. Biomed. Mater. Res. B Appl. Biomater."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1007\/s11999-017-5477-4","article-title":"Polyethylene Damage Increases With Varus Implant Alignment in Posterior-Stabilized and Constrained Condylar Knee Arthroplasty","volume":"475","author":"Li","year":"2017","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1080\/17453674.2016.1248202","article-title":"Peripheral Snap-Fit Locking Mechanisms and Smooth Surface Finish of Tibial Trays Reduce Backside Wear in Fixed-Bearing Total Knee Arthroplasty: A Retrieval Analysis of 102 Inlays","volume":"88","author":"Kokoszka","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2970","DOI":"10.1007\/s11999-017-5494-3","article-title":"Current Total Knee Designs: Does Baseplate Roughness or Locking Mechanism Design Affect Polyethylene Backside Wear?","volume":"475","author":"Sisko","year":"2017","journal-title":"Clin. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Affatato, S., Ruzzi, S., Milosevic, M., and Ruggiero, A. (2020). Wear Characterization and Contact Surfaces Analysis of Menisci and Femoral Retrieved Components in Bi-Condylar Knee Prostheses. J. Mech. Behav. Biomed. Mater., 110.","DOI":"10.1016\/j.jmbbm.2020.103959"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1002\/jor.24710","article-title":"Joint Line Elevation and Tibial Slope Are Associated with Increased Polyethylene Wear in Cruciate-retaining Total Knee Replacement","volume":"38","author":"Pourzal","year":"2020","journal-title":"J. Orthop. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tone, S., Hasegawa, M., Naito, Y., Pezzotti, G., and Sudo, A. (2020). Raman Spectroscopy Reveals Creep and Wear Rate of E-Beam-Sterilized Conventional UHMWPE Tibial Inserts. J. Mech. Behav. Biomed. Mater., 110.","DOI":"10.1016\/j.jmbbm.2020.103902"},{"key":"ref_33","unstructured":"Leva\u0161i\u010d, V., Blas, M., Kova\u010d, S., and Milo\u0161ev, I. (2024). Valdoltra Knee Arthroplasty Registry Report 2023 (Data 2002\u20132022), Valdoltra Orthopeadic Hospital."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1","article-title":"The EBJIS Definition of Periprosthetic Joint Infection","volume":"103-B","author":"McNally","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00003086-198911000-00003","article-title":"The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System","volume":"248","author":"Ewald","year":"1989","journal-title":"Clin. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1016\/j.arth.2015.05.049","article-title":"Development of a Modern Knee Society Radiographic Evaluation System and Methodology for Total Knee Arthroplasty","volume":"30","author":"Meneghini","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_37","first-page":"95","article-title":"A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty","volume":"13","author":"Khalifa","year":"2021","journal-title":"Orthop. Res. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5792\/ksrr.2014.26.2.61","article-title":"Diagnosis, Causes and Treatments of Instability Following Total Knee Arthroplasty","volume":"26","author":"Chang","year":"2014","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1302\/2058-5241.4.180105","article-title":"The Stiff Total Knee Arthroplasty: Causes, Treatment Modalities and Results","volume":"4","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4196241","DOI":"10.1155\/2021\/4196241","article-title":"Osteolysis: A Literature Review of Basic Science and Potential Computer-Based Image Processing Detection Methods","volume":"2021","author":"Saadi","year":"2021","journal-title":"Comput. Intell. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13018-016-0374-1","article-title":"Cross-Linked versus Conventional Polyethylene for Total Knee Arthroplasty: A Meta-Analysis","volume":"11","author":"Yu","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3120","DOI":"10.1007\/s00167-022-06879-7","article-title":"Comparable Results between Crosslinked Polyethylene and Conventional Ultra-High Molecular Weight Polyethylene Implanted in Total Knee Arthroplasty: Systematic Review and Meta-Analysis of Randomised Clinical Trials","volume":"30","author":"Bistolfi","year":"2022","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1007\/s00167-022-07226-6","article-title":"Highly Cross-Linked Polyethylene versus Conventional Polyethylene in Primary Total Knee Arthroplasty: Comparable Clinical and Radiological Results at a 10-Year Follow-Up","volume":"31","author":"Giustra","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_44","unstructured":"Meyers, M.A., and Chawla, K.K. (2010). Mechanical Behavior of Materials, Cambridge University Press. [2nd ed.]."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Zhao, D., Sakoda, H., Sawyer, W.G., Banks, S.A., and Fregly, B.J. (2008). Predicting Knee Replacement Damage in a Simulator Machine Using a Computational Model with a Consistent Wear Factor. J. Biomech. Eng., 130.","DOI":"10.1115\/1.2838030"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1243\/0954411001535390","article-title":"Wear of Ultra-High Molecular Weight Polyethylene (UHMWPE) in Total Knee Prostheses: A Review of Key Influences","volume":"214","author":"McGloughlin","year":"2000","journal-title":"Proc. Inst. Mech. Eng. [H]"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.knee.2008.01.002","article-title":"Analysis of Third Body Particles Generated during Total Knee Arthroplasty: Is Metal Debris an Issue?","volume":"15","author":"Waelput","year":"2008","journal-title":"Knee"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s44174-023-00087-8","article-title":"Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective","volume":"2","author":"Kulkarni","year":"2024","journal-title":"Biomed. Mater. Devices"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.arth.2004.08.008","article-title":"The Measurement of Creep in Ultrahigh Molecular Weight Polyethylene","volume":"20","author":"Estok","year":"2005","journal-title":"J. Arthroplast."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.arth.2014.08.001","article-title":"Wear and Creep Behavior of Total Knee Implants Undergoing Wear Testing","volume":"30","author":"Teeter","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Valigi, M., Logozzo, S., and Affatato, S. (2017). New Challenges in Tribology: Wear Assessment Using 3D Optical Scanners. Materials, 10.","DOI":"10.3390\/ma10050548"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Affatato, S., Valigi, M., and Logozzo, S. (2017). Wear Distribution Detection of Knee Joint Prostheses by Means of 3D Optical Scanners. Materials, 10.","DOI":"10.3390\/ma10040364"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.knee.2022.08.004","article-title":"A High Physical Activity Level after Total Knee Arthroplasty Does Not Increase the Risk of Revision Surgery during the First Twelve Years: A Systematic Review with Meta-Analysis and GRADE","volume":"39","author":"Kornuijt","year":"2022","journal-title":"Knee"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1002\/jor.24720","article-title":"Backside Wear of Tibial Polyethylene Components Is Affected by Gait Pattern: A Knee Simulator Study Using Rare Earth Tracer Technology","volume":"38","author":"Ngai","year":"2020","journal-title":"J. Orthop. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/00003086-199811000-00021","article-title":"Malrotation Causing Patellofemoral Complications After Total Knee Arthroplasty","volume":"356","author":"Berger","year":"1998","journal-title":"Clin. Orthop."}],"container-title":["Materials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1996-1944\/17\/20\/5007\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:12:39Z","timestamp":1760112759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1996-1944\/17\/20\/5007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,13]]},"references-count":55,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["ma17205007"],"URL":"https:\/\/doi.org\/10.3390\/ma17205007","relation":{},"ISSN":["1996-1944"],"issn-type":[{"value":"1996-1944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,13]]}}}