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Retrieval Analysis of an Early Fracture of a Vitamin E-Stabilized Tibial Liner in Total Knee ArthroplastyA Case Report
Robert L. Barrack, MD1
1 Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address: barrackr@wustl.edu
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Investigation performed at the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, and the Dartmouth Biomedical Engineering Center of the Thayer School of Engineering at Dartmouth, Hanover, New Hampshire



Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. He, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 May 08;3(2):e44 1-6. doi: 10.2106/JBJS.CC.L.00276
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Extract

The application of cross-linked polyethylene in total knee arthroplasty (TKA) has been controversial1. Some studies have proposed that cross-linking can diminish mechanical properties such as fatigue crack propagation resistance2,3. Decreased mechanical properties are more of a concern in the knee than the hip because the knee is a less-conforming articulation; fracture of the insert, fracture of the post on posterior stabilized inserts, liner dislodgment, and locking mechanism disruption have been proposed as potential concerns with the use of cross-linked polyethylene for a tibial insert4. Vitamin E stabilization has been suggested as a method of preventing polyethylene oxidation, while retaining the mechanical properties of cross-linked polyethylene inserts5-7. We report a case of early fracture of a vitamin E-stabilized polyethylene tibial insert following primary TKA. Both institutions approved the human protocol for this investigation, and all investigations were conducted in conformity with ethical principles of research. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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