The Coventry Award. Modular tibial insert micromotion. A concern with contemporary knee implants

This study investigates micromotion between modular tibial components, one of the causes of wear on the undersurface of polyethylene inserts. The authors measured motion at the interface of nine contemporary total knee implant designs by mechanically testing the implants in a servohydraulic testing machine. Anteroposterior and mediolateral motion between the tibial insert and baseplate were measured with an extensometer placed across the interface. These tests revealed that in all implants analyzed, sufficient motion occurred to create fretting at the modular interface. Although the testing configuration in this study was not a stimulation of in situ loading patterns, the authors observed hundreds of microns of motion even under a 100 N load and variability between implants of the same design, showing that there is room for improvement among locking mechanisms in modular total knee implants.