Subsurface oxidation of polyethylene

Vitamin E-stabilized highly crosslinked polyethylenes: The role and effectiveness in total hip arthroplasty

Morphology and design of ultra-high molecular weight polyethylene (UHMWPE or simply PE) acetabular components used in total hip arthroplasty (THA) have been evolving for more than half a century. Since the late-1990s, there were two major technological innovations in PE emerged from necessity to overcome the wear-induced periprosthetic osteolysis, i.e., the development of highly crosslinked PEs (HXLPEs). There are many literature reporting that radiation crosslinked and remelted/annealed (first-generation) HXLPEs markedly reduced the incidence of osteolysis and aseptic loosening. Regardless of such clinical success in the first-generation technologies, there were some recent shifts in Japan toward the use of new second-generation HXLPEs subjected to sequential irradiation/annealing or antioxidant vitamin E (α-tocopherol) incorporation. Although the selection rate of first-generation liners still account for more than half of all the PE THAs (∼58% in 2015), the use of vitamin E-stabilized liners has been steadily growing each year since their clinical introduction in 2010. In these contexts, it is of great importance to evaluate and understand the real clinical benefits of using the new second-generation liners as compared to the first generation. This article first summarizes structural evolution and characteristic features of first-generation HXLPEs, and then provides a detailed description of second-generation antioxidant HXLPEs in regard to the role of vitamin E incorporation on their chemical and mechanical performances in THA.

Oxidation and fusion defects synergistically accelerate polyethylene failure in knee replacement

We have previously reported upon a cohort of patients with premature failure of such material and postulated upon the impact of abnormally high concentrations of type 2 fusion defects whereby there is a lack of particle cohesion due to incomplete diffusion. In vivo oxidation has been purported to underscore the premature failure of polyethylene. The mechanism of such remains poorly delineated. New data has now been obtained by determining substrata oxidative profiles of 10 failed Kinemax Plus modular tibial insert analyses in conjunction with fusion defect detection. The full thickness of a series of cores was analysed using infra-red spectroscopy to identify higher levels of oxidation in loaded used material at both the articulating and non-articulating regions. A comparison was made to an unused control. Articulating, loaded, areas exhibited greater local concentrations of oxidised material and wider variation of such consistent with the higher presence of fusion defects. Subsurface analysis confirmed the presence of a major oxidative peak 2mm below the surface for all loaded areas irrespective of wear. Additionally we were able to identify a second major oxidative focus about halfway between the inferior (tibial baseplate) surface and the articulating area. We believe that the combination of high oxidation and fusion defects represents a second high stress zone consistent with the observation of tibial baseplate polyethylene dissociation and backside wear with resultant catastrophic material failure.

Examination of ten fractured Oxford unicompartmental knee bearings

Since the Oxford knee was first used unicompartmentally in 1982, a small number of bearings have fractured. Of 14 retrieved bearings, we examined ten samples with known durations in situ (four Phase 1, four Phase 2 and two Phase 3). Evidence of impingement and associated abnormally high wear (> 0.05 mm per year) as well as oxidation was observed in all bearings. In four samples the fracture was associated with the posterior radio-opaque wire. Fracture surfaces indicated fatigue failure, and scanning electron microscopy suggested that the crack initiated in the thinnest region. The estimated incidence of fracture was 3.20% for Phase 1, 0.74% for Phase 2, 0.35% for Phase 3, and 0% for Phase 3 without the posterior marker wire. The important aetiological factors for bearing fracture are impingement leading to high wear, oxidation, and the posterior marker wire. With improved surgical technique, impingement and high wear should be prevented and modern polyethylene may reduce the oxidation risk. A posterior marker wire is no longer used in the polyethylene meniscus. Therefore, the rate of fracture, which is now very low, should be reduced to a negligible level.

Determination of Crystallinity and Crystal Structure of Hylamer™ Polyethylene after in vivo Wear

Hylamer™ polyethylene is a crystalline form of polyethylene of 70% crystallinity whereas conventional polyethylene (PE) has 50% crystallinity. Crystallinity is the percentage by weight of the crystalline phase present in the whole polymer, which comprises both amorphous and crystalline phases.

Clinical experience has shown that Hylamer™ components used in joint prostheses, if sterilized by gamma rays in the presence of oxygen, are easily affected by wear, which leads to osteolysis. The authors have analyzed the crystallinity of polyethylene liners removed from seven patients who had received Hylamer™ polyethylene implants sterilized by gamma rays in air and had suffered prosthetic loosening, using Raman spectroscopy coupled with partial least squares (PLS) analysis. The results have been compared to those of two controls who had received Hylamer™ polyethylene implants sterilized by gamma irradiation in a nitrogen atmosphere. The crystal structure of wear particles released into the tissues from the Hylamer™ liners sterilized by gamma rays in air is also studied. The materials undergoing two different types of sterilization methods show different crystallinity values (71.50 vs. 69.43), but the crystallinity do not change according to wear (worn and unworn liner region). Both monoclinic and orthorhombic phases are present in the liner, while in wear debris prevalently monoclinic crystals are found in both types of sterilized liners. Different crystallinity rates can explain different wear rates observed in vivo.

Fractography evolution in accelerated aging of UHMWPE after gamma irradiation in air

We studied the fracture surface evolution of ultra high molecular weight polyethylene (UHMWPE) specimens, manufactured from GUR 1050 compression moulded sheets, after gamma sterilisation in air followed by different aging times after thermal treatment at 120 degrees C. Degradation profiles were obtained by FTIR and DSC measurements after 0, 7, 14, 24 and 36h aging. We observed by SEM the morphology patterns at these aging times, in surface fractographies after uniaxial tensile test of standardised samples. The results pointed out clear differences between short and long aging times. At shorter times, 7h, the behaviour was similar to non-degraded UHMWPE, exhibiting ductile behaviour. At longer times, 24-36h, this thermal protocol provided a highly degraded zone in the subsurface, similar to the white band found after gamma irradiation in air followed by natural aging, although closer to the surface, at 150-200mum. The microstructure of this oxidation zone, similarly found in gamma irradiated samples shelf-aged for 6-7 years, although with different distribution of microvoids, was formed by fibrils, associated with embrittlement of the oxidised UHMWPE. In addition, the evolution of the oxidation index, the enthalpy content, the mechanical parameters, and the depth of the oxidation front deduced from the fractographies versus aging time showed that a changing behaviour in the degradation rate appeared at intermediate aging times.

The effect of irradiation, annealing temperature, and artificial aging on the oxidation, mechanical properties, and fracture mechanisms of UHMWPE

UHMWPE crosslinked using Gamma radiation is believed to have improved wear properties, and this has been extensively studied during the past 10 years. Mechanical properties, oxidation, and wear properties of UHMWPE materials subjected to various thermal treatments have been investigated immediately after irradiation as well as after several years of aging. Nevertheless, the relationship between all these parameters is not yet fully understood. The aim of this study was to investigate the relationship between the thermal treatments that could be applied to irradiated UHMWPE [lower (gamma 60) or higher (gamma 150) than 140 degrees C, the melting temperature of the polymer] and the mechanical properties, the oxidation and the fracture behavior of the material. The effect of artificial aging on these properties was also investigated. This study concludes that immediately after the annealing, the mechanical properties (UTS and epsilon) of the irradiated and annealed material are improved compared with those of nonirradiated material. Although nonirradiated material has higher fracture toughness than irradiated and annealed materials, the materials break according to the same mechanism of fracture. After aging, no changes could be observed in any of the measured properties for nonirradiated material. On the other hand, important changes could be seen in both irradiated and annealed material after aging. Both UTS and epsilon decreased, much more so in the case of gamma 60. Furthermore, the aging induced a subsurface peak of oxidation in both irradiated and annealed materials, twice as intense for gamma 60 than for gamma 150. The mechanism of fracture of these materials changed drastically after aging, probably due to the presence of the oxidation peak, which seems to occur at a location where cracks initiate easily compared with the nonoxidized bulk of the material. In the case of gamma 60, it seems clear that a correlation between mechanical property, oxidation, and fracture mechanism exists. Such a relationship could not be found for gamma 150.

Oxidation-induced dynamic changes in morphology reflected on freeze-fractured surface of gamma-irradiated ultra-high molecular weight polyethylene components

Oxidative degradation of ultra-high molecular weight polyethylene (UHMWPE) attributed to sterilization by gamma-radiation in the presence of air has been cited as one of the major causes of premature wear in total joint arthroplasty. For example, in retrieved UHMWPE tibial bearings, not only adhesive and abrasive wear, but also fatigue wear characterized by delamination and fracture is frequently observed. In this study, we examined the effects of gamma radiation on the microstructural morphology of UHMWPE tibial bearings, and propose a severe fatigue wear mechanism. Scanning electron microscopic observations were conducted on freeze-fractured surface of retrieved UHMWPE components that had been sterilized with gamma radiation in air before implantation, unused components that had been stored on the shelf for several years (5-11) after sterilization, and disc specimens given an accelerated aging protocol after gamma radiation. Scanning electron microscopic observations showed that the freeze-fractured surface of these components had a double layer, which was bordered below the surface. A closer observation of the subsurface layer below the border revealed an extremely rough and porous honeycomb-like structure. Fourier transform infrared analysis demonstrated that the honeycomb-like region in the subsurface had a high oxidation level. The internal morphology of oxidized UHMWPE was classified into four categories based on the level of the oxidation. According to these results, the morphological changes with oxidative degradation of gamma-irradiated UHMWPEs in the presence of air could consistently be explained as the result of major chemical and physical changes such as increased crystallinity, elevated density, and reduced mechanical strength. We relate the morphological changes caused by oxidative degradation in the subsurface to the location of the origin of fatigue wear in total knee joints.

Interaction of oxidation and crosslinking in gamma-irradiated ultrahigh molecular-weight polyethylene

The interaction between oxidation and crosslinking in gamma-irradiated ultrahigh molecular-weight polyethylene with and without artificial aging was studied. The effect of the atmosphere during irradiation (air vs. low oxygen) occurred primarily within about 0.5 mm of the surface, that is, the depth to which oxygen had diffused when the polyethylene specimen was machined and when it was irradiated. Irradiation in the presence of oxygen induced oxidation instead of crosslinking, so that the level of crosslinking achieved was lower than that which normally would occur at the same dose in the absence of oxygen. Subsequent artificial aging reduced the gel content (crosslinking) and had a maximal effect on the surface and subsurface regions for the gamma-air and gamma-low oxygen polyethylenes, respectively. Thus the storage environments and durations prior to irradiation and prior to artificial aging must be taken into account when attempting to duplicate the oxidation-crosslinking profiles that occur with actual implants in clinical use. In addition, the oxidation mechanisms initiated by the artificial aging method used in this study (i.e., heating in air to 80 degrees C) initiated somewhat different oxidative reactions from those that occur during prolonged shelf life at room temperature or in vivo. In particular, the formation of a peak of oxidation below the free surface of the polyethylene is due to the combined effects of the distribution of residual free radicals and the diffusion gradient of the oxygen. The interactive relationship between oxidation and crosslinking characterized in the present study provides a fundamental basis for understanding the wear behavior of gamma-sterilized components in past clinical use. It also provides guidelines for the development of polyethylenes with improved resistance to oxidation and wear, with particular relevance to estimation of the amount of crosslinking need- ed to potentially eliminate the clinical problem of osteolysis.

Numerical oxidation model for gamma radiation-sterilized UHMWPE: consideration of dose-depth profile

Gamma sterilization of UHMWPE hip and knee joint replacement components secondarily creates free radicals along the polymer chains. Though crosslinking between radicals may improve mechanical properties, typical post-irradiation environments (air shelf storage or in vivo service) may instead favor scission reactions with oxygen from the surroundings. As such aging of irradiated UHMWPE joint replacement components has important consequences such as osteolysis, increased insight has been sought through descriptive models of this oxidation process. The quantitative numerical model presented here accounts for a free radical concentration that varies with position (because of irradiation dose-depth profile) and time (because of free radical decay through crosslinking). A moving front of diffusing O(2) is allowed to traverse the UHMWPE medium containing depth- and time-dependent free radical concentration, and these diffusing molecules react with available free radicals persisting at the front. This model's capabilities are illustrated in three examples of irradiated UHMWPE aging behavior: In room-temperature air (shelf-aging), in atmospheres of augmented oxygen partial pressure and temperature intended to accelerate aging while otherwise remaining simulative of real-time aging; and following post-irradiation vacuum storage intended to consume free radicals through complete crosslinking, but often performed to an incomplete extent.

Effects of the sterilisation method on the wear of UHMWPE acetabular cups tested in a hip joint simulator

Ultra-high molecular-weight-polyethylene is the most commonly used bearing material in total joint replacement. Wear of polyethylene is a Serious Clinical problem that limits the longevity of orthopaedic implants. Information on degradative changes in the material properties and on the methods used for the sterilisation of polyethylene may help in the selection process of orthopaedic implants with the best wear resistance. This study was performed to investigate the effects of the sterilisation method (gamma irradiation and ethylene oxide treatment) on the wear and on the changes in physical properties of polyethylene acetabular cups. At this purpose, gamma-sterilised and ethylene oxide (EtO)-sterilised acetabular cups were tested against CoCr femoral heads in a hip joint simulator run for 5 million cycles in bovine calf serum. The crystallinity of the cups was evaluated by micro-Raman spectroscopy as a function of the inner surface position. The partial least square calibration was used to correlate the Raman spectra with the crystallinity of the polymer measured by differential scanning calorimetry. The analysis performed on soak control acetabular cups demonstrated that the gamma-sterilised cups are significantly more crystalline than the EtO-sterilised ones. The mean crystallinity values obtained for the gamma-sterilised and EtO-sterilised soak control cups were 65.0% and 63.4%, respectively. Weight loss measurements revealed that the gamma-sterilised acetabular cups exhibited a lower wear rate than that by EtO-sterilised. Thc Raman results obtained on gamma-sterilised and EtO-sterilised acetabular cups showed that the changes in surface crystallinity were mainly caused by irradiation rather than by the mechanical friction during the in vitro tests.

Time- and depth-dependent changes in crosslinking and oxidation of shelf-aged polyethylene acetabular liners

Since crosslinking and oxidation of ultrahigh-molecular-weight polyethylene (UHMWPE) have important roles in determining the wear resistance of UHMWPE total joint components, the time and depth dependence of crosslinking and oxidation of new shelf-aged (2-11 years), ready-to-implant acetabular liners were studied by using solvent extraction and Fourier transform infrared spectroscopy. The ultrastructure of these materials also was examined by using low-voltage scanning electron microscopy in an oil-free vacuum. Oxidation levels increased with time and with depth (p < 0.0001) from the surface of the older liners to a maximum value at about 1-2 mm below the surface, then decreased. They were minimal at the midsection of the liners. The crosslinking of these liners decreased with time and depth (p < 0.0001) and was inversely proportional to the level of oxidation. High and depth-dependent oxidation levels were observed in all older liners made from GUR 415 and 412 resins but were distinctly absent from a comparably aged (i.e., 9 years) liner made from 1900 CM-resin. Some liners showed varying degrees of inhomogeneous and discontinuous morphologic ultrastructure in addition to varying amounts of porosity while others had a more homogeneous ultrastructure. Oxidation and crosslinking of polyethylene are time- and depth-dependent processes that are mutually competitive. We suggest that resin choice and perhaps consolidation-related variables lead to differences in polyethylene's ultrastructure. These ultrastructural differences in polyethylene's inhomogeneities, that is, the type (interconnected or closed-cell) or extent may affect the oxidation resistance of polyethylene. While oxygen diffusion to free radicals in polyethylene already is known to explain some of these time- and depth-dependent effects, perhaps such ultrastructural variations also may facilitate or retard oxygen diffusion in this material. Resin-based ultrastructural variability partially may explain the variability in the clinical performance of polyethylene total joint implant components. Thus resin choice or processing modifications related to polyethylene's ultrastructure may increase its oxidation resistance and ultimately improve the clinical wear performance of polyethylene total joint orthopedic implants.