This study evaluated the effects of polyethylene quality and locking mechanism on damage to the nonarticulating (backside) surface of retrieved tibial inserts in total knee arthroplasty. Inserts with peripheral capture (PC) locking mechanisms and ethylene oxide (EtO)-sterilized polyethylene were hypothesized to prevent major backside damage. A total of 156 inserts were sorted by locking mechanism and sterilization method and analyzed by damage scoring methods. Ninety-seven specimens exhibited burnishing. Significant positive linear correlations were observed between damage score and age in vivo for all combinations, but damage occurred at a significantly lower rate for second-generation PC implants with EtO sterilization. Most specimens in this group were undamaged (46/72), with others exhibiting only burnishing. Sex, body mass index, and weight did not influence backside damage.
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