Journal article
Metal Fatigue Fracture After Revision Total Knee Arthroplasty: A Retrieval Analysis
Journal of orthopaedic research, v 44(4), e70198
Apr 2026
PMID: 41928628
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Most revision total knee arthroplasty patients experience excellent clinical outcomes. However, case studies document rare occurrences of metal component fractures promoted by the high cycles and low stresses that occur during daily use. In vivo, the mechanism that initiates metal fatigue fracture remains unclear. To address this gap, we collected implants from two retrieval programs. We asked: (1) what is the role of implant fixation in promoting fatigue fracture? (2) within modular junctions, what damage modes are associated with crack initiation? (3) how do equiaxed Ti-6Al-4V and wrought CoCrMo microstructures influence crack propagation? First, we compared clinical data for n = 8 fracture and n = 489 stemmed revision patients. Then, we performed retrieval analysis, combining radiographs with scanning electron microscopy and X-ray photoelectron spectroscopy. We found no differences in weight (p = 0.07) or implantation time (p = 0.10) when comparing revision and fracture cohorts. Radiographs of fractured components showed insufficient metaphyseal fixation at or near the stem's modular junction. At the taper interface, we identified Ti-6Al-4V thread wear and CoCrMo pitting. Sectioning near a Ti-6Al-4V crack initiation site revealed an oxidized interface and an intergranular corrosion attack. On the free surface, TiO increased (p < 0.0001) and TiO
decreased (p < 0.0001) after 20 min of sputter time. Fatigue cracks propagated through equiaxed Ti-6Al-4V and wrought CoCrMo grains. These data support a hypothesized mechanism where insufficient implant fixation with bone or cement promotes localized damage accumulation within the modular junction, fatigue crack initiation and subsequent fracture.
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Details
- Title
- Metal Fatigue Fracture After Revision Total Knee Arthroplasty: A Retrieval Analysis
- Creators
- Michael A Kurtz (Corresponding Author) - Drexel UniversityJeremy L Gilbert - Clemson UniversityAarti A Shenoy - Hospital for Special SurgeryGregg R Klein - Hackensack University Medical CenterArthur L Malkani - University of LouisvilleSteven M Kurtz - Drexel University
- Publication Details
- Journal of orthopaedic research, v 44(4), e70198
- Publisher
- Wiley
- Number of pages
- 17
- Grant note
- NSF National Nanotechnology Coordinated Infrastructure Program: NNCI-2025608, RRID: SCR_022684
We thank Jeffrey Hancock at the University of Pennyslvania and Arjun Sharma at Drexel University for their assistance sectioning components. At the Hospital for Special Surgery, we thank Grace Krebs for providing deidentified clinical data. We used two SEMs in this study: (1) at the University of Pennsylvania's Singh Center for Nanotechnology, supported by the NSF National Nanotechnology Coordinated Infrastructure Program under grant NNCI-2025608 and (2) at the Drexel University Material Characterization Core (MCC, RRID: SCR_022684). We additionally thank Bita Soltan Mohammadlou for her expert assistance performing NanoCT imaging at the MCC. XPS data acquisition also occurred at the MCC.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- School of Biomedical Engineering, Science, and Health Systems
- Web of Science ID
- WOS:001733149700001
- Scopus ID
- 2-s2.0-105034892504
- Other Identifier
- 991022171853704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Orthopedics