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Review Question - QID 1301

QID 1301 (Type "1301" in App Search)
A 69-year-old female 16 years status post total knee arthroplasty complains of knee pain. A radiograph is provided in Figure A. Which of the following is true regarding the pathogenesis of the bony abnormality seen in the distal femur?
  • A

It is related to the toughness of the polyethylene liner

3%

102/3386

It is more likely to occur with highly cross-linked polyethylene compared to conventional polyethylene

2%

55/3386

It is caused by macrophage activation by polyethylene particles

93%

3150/3386

It is most frequently caused by infection

1%

22/3386

It occurs more frequently in patients taking immunosuppressive medications.

1%

43/3386

  • A

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The radiograph demonstrates polyethylene wear and osteolysis around the femoral component of a total knee replacement. Osteolysis is caused by macrophage activation from polyethylene particles. Ingham et al reviews the pathologic role of macrophages in osteolysis. Answer #1 is incorrect because toughness of the polyethylene is not related to wear rate, but does affect its overall mechanical strength. Answer #2 is incorrect because highly cross-linked polyethylene liners have lower wear rates compared to conventional polyethylene. The listed reference by Huang concludes that there is an increased rate of osteolysis in mobile bearing TKA. This is a contradictory finding as mobile-bearing designs were created to decrease the stress and subsequent wear of the polyethylene

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