Effect of 2‐methacryloyloxyethyl phosphorylcholine concentration on photo‐induced graft polymerization of polyethylene in reducing the wear of orthopaedic bearing surface

Zwitterionic Biomaterials

The term "zwitterionic polymers" refers to polymers that bear a pair of oppositely charged groups in their repeating units. When these oppositely charged groups are equally distributed at the molecular level, the molecules exhibit an overall neutral charge with a strong hydration effect via ionic solvation. The strong hydration effect constitutes the foundation of a series of exceptional properties of zwitterionic materials, including resistance to protein adsorption, lubrication at interfaces, promotion of protein stabilities, antifreezing in solutions, etc. As a result, zwitterionic materials have drawn great attention in biomedical and engineering applications in recent years. In this review, we give a comprehensive and panoramic overview of zwitterionic materials, covering the fundamentals of hydration and nonfouling behaviors, different types of zwitterionic surfaces and polymers, and their biomedical applications.

Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices

This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.

Efficacy of hydrated phospholipid polymer interfaces between all-polymer bearings for total hip arthroplasty

Measurements of wear resistance and metal ion release are important for designing bearing couples or interfaces in total hip arthroplasty (THA). In this study, we investigated wear resistance and metal ion release of surface-modified metal-free all-polymer hip bearings, such as poly(ether-ether-ketone), (PEEK) on cross-linked polyethylene (PEEK-on-CLPE), with a hydrated gel-like surface layer, to propose an improved alternative to the conventional materials used to design THA bearings. The PEEK surface resulted in less metal ion release than the cobalt-chromium-molybdenum (Co-Cr-Mo) alloy surface owing to the lack of metal. The PEEK-on-CLPE bearing (6.33 mg/10⁶  cycles) had lower wear (rate) than the bearing with Co-Cr-Mo alloy-on-CLPE (10.47 mg/10⁶  cycles) under controlled laboratory conditions; the wear performance of the all-polymer hip bearings was further improved with hemi- or both-surface modified with a hydrated poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) layer (3.74 and 3.06 mg/10⁶  cycles, respectively). The PMPC-grafted interface of PEEK-on-CLPE will be especially suitable for THA candidates. This study is of key importance for the design of lifelong THA and a better understanding of the limitations resulting from using PEEK. Further studies are necessary to evaluate the possibility of using this material in artificial hips.

Osteoblast Biocompatibility and Antibacterial Effects Using 2-Methacryloyloxyethyl Phosphocholine-Grafted Stainless-Steel Composite for Implant Applications

Poor osteogenesis and bacterial infections lead to an implant failure, so the enhanced osteogenic and antimicrobial activity of the implantable device is of great importance in orthopedic applications. In this study, 2-methacryloyloxyethyl phosphocholine (MPC) was grafted onto 316L stainless steel (SS) using a facile photo-induced radical graft polymerization method via a benzophenone (BP) photo initiator. Atomic force microscopy (AFM) was employed to determine the nanoscale morphological changes on the surface. The grafted BP-MPC layer was estimated to be tens of nanometers thick. The SS-BP-MPC composite was more hydrophilic and smoother than the untreated and BP-treated SS samples. Staphylococcus aureus (S. aureus) bacteria binding onto the SS-BP-MPC composite film surface was significantly reduced compared with the pristine SS and SS-BP samples. Mouse pre-osteoblast (MC3T3-E1) cells showed good adhesion on the MPC-modified samples and better proliferation and metabolic activity (73% higher) than the pristine SS sample. Biological studies revealed that grafting MPC onto the SS substrate enhanced the antibacterial efficiency and also retained osteoblast biocompatibility. This proposed procedure is promising for use with other implant materials.

Hydrated Phospholipid Polymer Gel-Like Layer for Increased Durability of Orthopedic Bearing Surfaces

Recently, traditional strategies for manipulating orthopedic bearing substrates have attempted to improve their wear resistance by adjusting polyethylene substrate through cross-linking and antioxidant blending. However, further research is required on the substrate, as well as the surface focused on the structure and role of articular cartilage. We therefore develop an orthopedic bearing surface comprising a nanometer-scale hydrated gel-like layer by grafting highly hydrophilic poly(2-methacryloyloxyethyl phosphorylcholine), with the aim of mimicking the lubrication mechanism of articular cartilage, and investigate its surface characteristics, bulk characteristics, and behavior under load bearing conditions upon accelerated aging. Neither the hydrophilicity nor lubricity of the gel-like surface was influenced by accelerated aging; instead, high stability was revealed, even under strong oxidation conditions. The characteristics of the hydrated gel-like surface potentiated the wear resistance of the cross-linked polyethylene liner, irrespective of accelerated aging. These results suggest that the hydrated gel-like surface enhances the longevity of cross-linked polyethylene bearings even under load-bearing conditions. Furthermore, the inflection point on the time series of wear can be a suitable indicator of the durability of the life-long protectant. In conclusion, the hydrated gel-like surface can positively increase orthopedic implant durability.

Developing a thermal grafting process for zwitterionic polymers on cross-linked polyethylene with geometry-independent grafting thickness

To overcome the drawbacks of the UV grafting method, an alternative, thermal grafting process is suggested. The uniform and geometry-independent grafting of zwitterionic polymers on curved cross-linked polyethylene (CLPE), which is used in artificial hip joints, surface was successfully achieved. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) and poly(2-(methacryloyloxy)ethyl)dimethyl(3-sulfopropyl)ammonium hydroxide) (PMEDSAH) were grafted on the CLPE by two methods: a UV-based process and a thermal process. The thermal method yielded zwitterionic surfaces with similar hydrophilicities and graft layer thicknesses to those prepared via the UV grafting method. The X-ray photoelectron spectra and surface zeta potential results showed that the PMPC and PMEDSAH layers were successfully grafted onto the CLPE surface. In addition, 3-D confocal microscopy, as well as friction and wear volume tests, confirmed that there was a significant decrease in the friction coefficient and wear, which indicates that the thermal grafting method can successfully substitute the UV grafting method. The thermally grafted polymer showed uniform graft layer thickness on the curved CLPE surface, whereas the UV-grafted polymer showed a geometry-dependent heterogeneous graft layer thickness. Thus, we confirmed that the thermal grafting method is advantageous for the preparation of uniform grafting layers on artificial joint surfaces with complicated shapes. STATEMENT OF SIGNIFICANCE: Formation of uniform grafting thickness of the zwitterionic polymers on the implant materials is a very important issue in the field of biomaterials. In this study, a thermal grafting process was developed for the formation of the uniform grafting thickness of the zwitterionic polymers on the curved cross-linked polyethylene (CLPE) surface used in artificial hip-joint. This method yielded zwitterionized CLPE surfaces with similar hydrophilicities and friction coefficient to those prepared via the UV grafting method which has been widely used process to modify the implant surfaces. Furthermore, the thermally grafted CLPE surface showed geometry-independent uniform grafting thickness on the curved CLPE surface while UV-grafted one showed uneven grafting thickness. This grafting method could help the development of complex, personalized, and biocompatible artificial liner surfaces.

A surface graft polymerization process on chemically stable medical ePTFE for suppressing platelet adhesion and activation

An effective surface grafting method for chemically inert and elaborately porous medical expanded-polytetrafluoroethylene (ePTFE) was developed. Although surface graft polymerization onto basic polymeric biomaterials has been widely studied, successful modification of the ePTFE surface has been lacking due to its high chemical resistance. Herein, we succeeded in surface graft polymerization onto ePTFE through glycidyl methacrylate (GMA) as a bridge linkage following argon (Ar) plasma treatment. The epoxy group of GMA was expected to react with the peroxide groups produced on ePTFE by Ar plasma exposure, and its methacrylic groups can copolymerize with various monomers. In the present study, we selected 2-methacryloyloxyethyl phosphorylcholine (MPC) as a model monomer and the blood compatibility of modified ePTFE was evaluated. Two sequences of surface grafting were compared. In a two-step graft polymerization, GMA was first immobilized onto Ar plasma treated ePTFE, and then MPC was polymerized. In a one-step graft copolymerization, MPC and GMA were mixed and copolymerized simultaneously onto Ar plasma treated ePTFE, resulting in a poly(MPC-co-GMA) (PMG) graft surface. The roughness of the node-and-fibril structure of ePTFE was reduced by the uniform polymer layer, and the modified ePTFE had a good hydrophilic nature even after being stored in an aqueous environment for 30 days. The indispensable GMA in graft polymerization improved the surface grafting on ePTFE. The one-step and two-step graft polymerization methods could decrease the number of adhered platelets, and almost inhibit platelet activation. We concluded that graft polymerization with the GMA linker provides a novel strategy to modify the chemically inert ePTFE surfaces for functionalizing as new medical devices.

Examination of 2-methacryloyloxyethyl phosphorylcholine polymer coated acrylic resin denture base material: surface characteristics and Candida albicans adhesion

The aim of this study is to evaluate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer coating with various concentrations onto acrylic resin denture base material on surface characteristics such as contact angle and surface roughness and on Candida albicans adhesion which is the major factor of denture stomatitis. Specimens, prepared from heat-polymerized acrylic denture base material, were divided into control and three test groups, randomly. Surfaces of the specimens in test groups were coated with poly(MPC) (PMPC) by graft polymerization of MPC in different concentrations (0.25 mol/L; 0.50 mol/L and 0.75 mol/L), while no surface treatment was applied to the control group. Contact angles and surface roughness were examined, and chemical composition of the surfaces was analyzed by Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (FTIR) to verify the presence of PMPC coatings. Then, specimens were incubated with C. albicans for 18 h and the number of adhered cells was determined. Upon PMPC coating, the contact angle values statistically decreased, but no difference was found in surface roughness values. A statistically significant decrease was observed in C. albicans adhesion in parallel with the increase in the MPC polymer concentration. There was no significant difference between 0.50 mol/L and 0.75 mol/L groups in terms of adhesion. These findings indicated that graft polymerization of MPC on acrylic denture base material reduces the adhesion of C. albicans, and may be evaluated as a coating for prevention of denture stomatitis.

A phospholipid polymer graft layer affords high resistance for wear and oxidation under load bearing conditions

Manipulating the surface and substrate of cross-linked polyethylene (CLPE) is an essential approach for obtaining life-long orthopedic bearings. We therefore proposed a bearing material comprised of an antioxidative substrate generated by vitamin E blending (HD-CLPE[VE]) with a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted surface, and investigated its wear resistance and oxidative stability under accelerated aging and load bearing conditions. Neither the hydration nor friction kinetics of the molecular network structure of the PMPC-grafted surface or the HD-CLPE(VE) substrate were influenced by accelerated aging but rather exhibited high stability even under high oxidation conditions. The characteristics of the PMPC-grafted surface improved the wear and impact fatigue resistance of the HD-CLPE(VE) liner regardless of accelerated aging. Notably, the PMPC-grafted surface was found to affect the potential oxidative stability at the rim part of the acetabular liner. PMPC chains serve several important functions on the surface regardless of load bearing, such as high lubricity or low lipophilicity attributed to phosphorylcholine groups and/or surrounding water-fluid film, and suppression of lipid diffusion attributed to methacrylate main chains on the surface. Together, these results provide preliminary evidence that the PMPC graft layer and vitamin E-blended substrate might positively affect the extent of orthopedic implant durability.

A hydrated phospholipid polymer-grafted layer prevents lipid-related oxidative degradation of cross-linked polyethylene

The surface and substrate of a cross-linked polyethylene (CLPE) liner are designed to achieve resistance against oxidative degradation in the construction of hip joint replacements. In this study, we aimed to evaluate the oxidative degradation caused by lipid absorption of a highly hydrophilic nanometer-scaled thickness layer prepared by grafting a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) layer and a high-dose gamma-ray irradiated CLPE with vitamin E blending (HD-CLPE[VE]). The HD-CLPE(VE) and PMPC-grafted HD-CLPE(VE) exhibited extremely high oxidation resistance regardless of lipid absorption, even though residual-free radical levels were detectable. The water wettability of the PMPC-grafted CLPE and PMPC-grafted HD-CLPE(VE) surfaces was considerably greater than that of untreated surfaces. The hydrated PMPC-grafted layer also exhibited extremely low solubility for squalene. Lipids such as squalene and cholesterol esters diminished the oxidation resistance of CLPE despite the vitamin E improvement. Notably, the PMPC-grafted surface was resistant to lipid absorption and diffusion as well as subsequent lipid-related oxidative degradation, likely because of the presence of the hydrated PMPC-grafted layer. Together, these results provide preliminary evidence that the resistance against lipid absorption and diffusion of a hydrated PMPC-grafted layer might positively affect the extent of resistance to the in vivo oxidation of orthopedic implants.

Prevention of bacterial adhesion and biofilm formation on a vitamin E-blended, cross-linked polyethylene surface with a poly(2-methacryloyloxyethyl phosphorylcholine) layer

In the construction of artificial hip joint replacements, the surface and substrate of a cross-linked polyethylene (CLPE) liner are designed to achieve high wear resistance and prevent infection by bacteria. In this study, we fabricated a highly hydrophilic and antibiofouling poly(2-methacryloyloxyethyl phosphorylcholine [MPC]) (PMPC)-graft layer on the vitamin E-blended CLPE (HD-CLPE(VE)) surface. The 100-nm-thick, smooth, and electrically neutral PMPC layer was successfully fabricated on the HD-CLPE(VE) surface using photoinduced graft polymerization. The PMPC-grafted HD-CLPE(VE) was found to prevent bacterial adherence and biofilm formation on the surface because of the formation of a highly hydrophilic polyzwitterionic layer on the surface of HD-CLPE(VE), which can serve as an extremely efficient antibiofouling layer. The number of bacterial adhered on the PMPC-grafted HD-CLPE(VE) surface was reduced by 100-fold or more by PMPC grafting, regardless of the biofilm-production characteristics of the strains. In contrast, vitamin E blending did not affect bacterial adhesion. Moreover, the number of planktonic bacteria did not differ significantly, regardless of PMPC grafting and vitamin E blending. In conclusion, the PMPC-grafted HD-CLPE(VE) provided bacteriostatic effects associated with smooth, highly hydrophilic surfaces with a neutral electrostatic charge owing to the zwitterionic structure of the MPC unit. Thus, this modification may prove useful for the production of artificial hip joint replacement materials.

STATEMENT OF SIGNIFICANCE

Our preliminary in vitro findings suggest that improved bacteriostatic performance of the HD-CLPE(VE) surface in orthopedic implants is possible via PMPC grafting. The results also indicate that surface modifications affect the anti-infection properties of the orthopedic implants and demonstrate that the application of a PMPC-grafted HD-CLPE(VE) surface may be a promising approach to extend the longevity and clinical outcomes of total hip arthroplasty. Further research is needed to evaluate the resistance to infection of PMPC-grafted HD-CLPE(VE) in terms of the varieties of biofilm formation tests including fluid flow conditions and animal experiments, which may offer useful clues to the possible performance of these materials in vivo.

Effects of extra irradiation on surface and bulk properties of PMPC-grafted cross-linked polyethylene

Sterilization using high-energy irradiation is an important aspect of implementing an ultra-high molecular weight polyethylene acetabular liner in total hip arthroplasty (THA). In this study, we evaluate the effects of extra irradiations such as gamma-ray or plasma irradiation during sterilization of the poly(2-methacryloyloxyethyl phosphorylcholine [MPC]) (PMPC) surface and cross-linked polyethylene (CLPE) substrate of a PMPC-grafted CLPE acetabular liner. The PMPC-grafted surface yielded high wettability and low friction properties regardless of the extra irradiations as compared with untreated CLPE. During a hip simulator test, wear resistance of the PMPC-grafted CLPE liner was maintained after extra irradiation, which is due to the high wettability characteristics of the PMPC surface. In particular, the PMPC-grafted CLPE liner treated with plasma irradiation showed greater wettability and wear resistance than that with gamma-ray irradiation. However, we could not clearly observe the changes in chemical properties and morphology of the PMPC surface after both extra irradiations. The physical and mechanical properties attributed to CLPE substrate performance were also unchanged. In contrast, PMPC-grafted CLPE treated with plasma irradiation showed improved oxidation resistance as compared to that treated with gamma-ray irradiation after accelerated aging. Thus, we conclude that PMPC-grafted CLPE with plasma irradiation has promise as a lifelong solution for bearing in THA.

Multidirectional wear and impact-to-wear tests of phospholipid-polymer-grafted and vitamin E-blended crosslinked polyethylene: a pilot study

BACKGROUND

Modifying the surface and substrate of a crosslinked polyethylene (CLPE) liner may be beneficial for high wear resistance as well as high oxidative stability and excellent mechanical properties, which would be useful in contributing to the long-term performance of orthopaedic bearings. A grafted poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) layer on a vitamin E-blended crosslinked PE (HD-CLPE[VE]) surface may provide hydrophilicity and lubricity without compromising the oxidative stability or mechanical properties.

QUESTIONS/PURPOSES

(1) Will the modifications (PMPC grafting and vitamin E blending) affect the lubrication characteristics of the CLPE surface? (2) Will the modifications affect wear resistance? (3) Will the modifications affect fatigue resistance?

METHODS

We investigated the effects of surface and substrate modifications (PMPC grafting and vitamin E blending) on the wear and fatigue fracture of thin CLPE samples. For each of the untreated and PMPC-grafted CLPE surfaces with and without vitamin E blended (four groups), wettability and lubricity surface analyses were conducted as well as multidirectional wear and impact-to-wear tests using a pin-on-disk testing machine.

RESULTS

The water wettability and lubricity (CLPE [mean ± 95% confidence interval]: 23.2° ± 1.8°, 0.005 ± 0.001; HD-CLPE[VE]: 26.0° ± 2.3°, 0.009 ± 0.003) of the PMPC-grafted surfaces were greater (p < 0.001) than that (CLPE: 90.3° ± 1.2°, 0.067 ± 0.015; HD-CLPE[VE]: 90.8° ± 2.0°, 0.063 ± 0.008) of the untreated surface regardless of vitamin E additives. It was observed that the PMPC grafting (CLPE: 0.23 ± 0.06 mg; HD-CLPE[VE]: 0.05 ± 0.10 mg) was associated with reduced gravimetric wear (CLPE: 0.53 ± 0.08 mg, p = 0.004 HD-CLPE[VE]: 0.23 ± 0.07 mg, p = 0.038) in the multidirectional wear test. The PMPC-grafted surface characteristics did not appear to affect the impact fatigue resistance regardless of vitamin E blending.

CONCLUSIONS

PMPC grafting improved the surface hydrophilicity and lubricity, and it reduced the gravimetric wear in terms of multidirectional sliding. It did not result in differences in terms of the impact-to-unidirectional sliding regardless of vitamin E blending. Further research is needed to evaluate the wear resistance of PMPC-grafted HD-CLPE(VE) in long-term hip simulator tests under normal and severe conditions, which may offer useful clues to the possible performance of these materials in vivo.

CLINICAL RELEVANCE

Our preliminary in vitro findings suggest that some improvement in the wear performance of crosslinked polyethylene acetabular liners in total hip arthroplasty could be obtained using PMPC grafting. Further research is needed to evaluate the wear resistance of PMPC-grafted HD-CLPE(VE) in long-term hip simulator tests under normal and severe conditions, which may offer useful clues to the possible performance of these materials in vivo.

Synthesis and characterization of Fatty acid/amino Acid self-assemblies

In this paper, we discuss the synthesis and self-assembling behavior of new copolymers derived from fatty acid/amino acid components, namely dimers of linoleic acid (DLA) and tyrosine derived diphenols containing alkyl ester pendent chains, designated as "R" (DTR). Specific pendent chains were ethyl (E) and hexyl (H). These poly(aliphatic/aromatic-ester-amide)s were further reacted with poly(ethylene glycol) (PEG) and poly(ethylene glycol methyl ether) of different molecular masses, thus resulting in ABA type (hydrophilic-hydrophobic-hydrophilic) triblock copolymers. We used Fourier transform infrared (FTIR) and nuclear magnetic resonance (NMR) spectroscopies to evaluate the chemical structure of the final materials. The molecular masses were estimated by gel permeation chromatography (GPC) measurements. The self-organization of these new polymeric systems into micellar/nanospheric structures in aqueous environment was evaluated using ultraviolet/visible (UV-VIS) spectroscopy, dynamic light scattering (DLS) and transmission electron microscopy (TEM). The polymers were found to spontaneously self-assemble into nanoparticles with sizes in the range 196-239 nm and critical micelle concentration (CMC) of 0.125-0.250 mg/mL. The results are quite promising and these materials are capable of self-organizing into well-defined micelles/nanospheres encapsulating bioactive molecules, e.g., vitamins or antibacterial peptides for antibacterial coatings on medical devices.

The mechanical properties of the ultra high molecular weight polyethylene grafted with 3-dimethy (3-(N-methacryamido) propyl) ammonium propane sulfonate

Ultra-high molecular weight polyethylene (UHMWPE) powder was modified with a zwitterion monomer with good biocompatibility of MPDSAH (3-dimethy (3-(N-methacryamido) propyl) ammonium propane sulfonate) by UV irradiation and then hot pressed. The microstructure and mechanical properties of modified UHMWPE are investigated. The results show that the structure of powder and bulk materials has been changed. The modified powders have more filaments than that of untreated. The surface of modified bulk materials is more rough and displays the granular protuberances which have the random loose arrangement compared with untreated UHMWPE. The crystallinity, uniaxial tensile and compressive properties decreased after grafting. Ultimate elongations decrease with the increase of the monomer concentration and are higher than 300% which is recommended by ASTM and ISO except the sample with 0.45mol/L MPDSAH. The friction coefficient of modified UHMWPE is lower than that of the untreated UHMWPE and it decreases gradually with the increase of monomer concentration. The wear rates have been decreased and the wear resistance has been improved under saline and distilled water lubrication.

Effect of UV-irradiation intensity on graft polymerization of 2-methacryloyloxyethyl phosphorylcholine on orthopedic bearing substrate

Photoinduced grafting of 2-methacryloyloxyethyl phosphorylcholine (MPC) onto cross-linked polyethylene (CLPE) was investigated for its ability to reduce the wear of orthopedic bearings. We investigated the effect of UV-irradiation intensity on the extent of poly(MPC) (PMPC) grafting, and found that it increased with increasing intensity up to 7.5 mW/cm(2), and the remained fairly constant. It was found to be extremely important to carefully control the UV intensity, as at higher values, a PMPC gel formed via homopolymerization of the MPC, resulting in the formation of cracks at the interface of the PMPC layer and the CLPE substrate. When the CLPE was exposed to UV-irradiation during the graft polymerization process, some of its physical and mechanical properties were slightly changed due to cross-linking and scission effects in the surface region; however, the results of all of the tests exceed the lower limits of the ASTM standards. Modification of the CLPE surface with the hydrophilic PMPC layer increased lubrication to levels that match articular cartilage. The highly hydrated thin PMPC films mimicked the native cartilage extracellular matrix that covers synovial joint surface, acting as an extremely efficient lubricant, and providing high-wear resistance.

Biotribological properties of UHMWPE grafted with AA under lubrication as artificial joint

Osteolysis caused by wear particles from polyethylene in the artificial hip joints is a serious issue. In order to endow the low friction and wear of the bearing surface of ultra-high molecular weight polyethylene (UHMWPE) artificial joint for a longer term, hydrophilic acrylic acid (AA) was grafted on UHMWPE powders with the method of ultraviolet irradiation and then the modified powders were hot pressed. The tribological properties of modified UHMWPE sliding against CoCrMo metallic plate on reciprocating tribometer under calf serum, saline and distilled water lubrication during a long-term friction were investigated. The measurement of Fourier-transform infrared spectroscopy indicates that AA is successfully grafted on the surface of UHMWPE powders by photo-induced graft polymerization. Contact angles of UHMWPE are decreased from 83° to 35° by grafting and the surface wettability is effectively improved. The tensile strength of modified sample decreases. The friction coefficient and wear rate of UHMWPE-g-PAA under calf serum, saline and distilled water lubrication are lower than that of untreated UHMWPE. With the increase of grafting ratio, the wear rate of UHMWPE-g-PAA decreases firstly and then increases. The modified UHMWPE with grafting ratio of 3.5 % has the lowest wear rate, which is just quarter of the untreated UHMWPE. The hydrated PAA polymer brushes enclosed in the UHMWPE bulk material provide continuous lubrication during long term sliding.

Study on biotribological properties of UHMWPE grafted with MPDSAH

In order to prolong the service life of artificial joints, a zwitterion monomer of MPDSAH ((3-(methacryloylamino)propyl)dimethyl (3-sulfopropyl)ammonium hydroxide) was grafted onto ultra-high molecular weight polyethylene (UHMWPE) powders to construct a brush-like structure by UV irradiation, and then the grafted UHMWPE powders were hot pressed as the bulk materials. The wettability of bulk materials surface with different monomer concentrations was analyzed. The tribological properties of modified UHMWPE bulk materials were investigated under distilled water and saline by sliding against stainless steel ball. The measurement of Fourier-transform infrared (FT-IR) spectroscopy indicates that MPDSAH is successfully grafted onto the surface of UHMWPE powders by UV irradiation. The contact angles of modified UHMWPE are decreased and the surface wettability is effectively improved. The friction coefficient of the modified sample is lower than that of untreated UHMWPE in aqueous lubricants during a long-term friction. With the increase of monomer concentration, the wear rate of grafted UHMWPE decreases gradually in distilled water. The grafting hydrophilic macromolecule polymer is helpful to form a lubricating film of water, which leads to the improvement of the lubricity of UHMWPE.

Biomimetic hydration lubrication with various polyelectrolyte layers on cross-linked polyethylene orthopedic bearing materials

Natural joints rely on fluid thin-film lubrication by the hydrated polyelectrolyte layer of cartilage. However, current artificial joints with polyethylene (PE) surfaces have considerably less efficient lubrication and thus much greater wear, leading to osteolysis and aseptic loosening. This is considered a common factor limiting prosthetic longevity in total hip arthroplasty (THA). However, such wear could be mitigated by surface modification to mimic the role of cartilage. Here we report the development of nanometer-scale hydrophilic layers with varying charge (nonionic, cationic, anionic, or zwitterionic) on cross-linked PE (CLPE) surfaces, which could fully mimic the hydrophilicity and lubricity of the natural joint surface. We present evidence to support two lubrication mechanisms: the primary mechanism is due to the high level of hydration in the grafted layer, where water molecules act as very efficient lubricants; and the secondary mechanism is repulsion of protein molecules and positively charged inorganic ions by the grafted polyelectrolyte layer. Thus, such nanometer-scaled hydrophilic polymers or polyelectrolyte layers on the CLPE surface of acetabular cup bearings could confer high durability to THA prosthetics.

Cartilage-mimicking, high-density brush structure improves wear resistance of crosslinked polyethylene: a pilot study

BACKGROUND

In natural synovial joints under physiologic conditions, fluid thin-film lubrication by a hydrated layer of the cartilage is essential for the smooth motion of the joints. The considerably less efficient lubrication of artificial joints of polyethylene is prone to wear, leading to osteolysis and aseptic loosening and limiting the longevity of THA. A nanometer-scale layer of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) with cartilage-mimicking brushlike structures on a crosslinked polyethylene (CLPE) surface may provide hydrophilicity and lubricity resembling the physiologic joint surface.

QUESTIONS/PURPOSES

We asked whether the photoirradiation time during graft polymerization would affect the density and stability of the PMPC layer and the PMPC-grafted surface would enhance the durability of artificial joints. We investigated the effect of photoirradiation time and the resultant characteristics of the PMPC layer on the durability of the CLPE.

METHODS

For each of the PMPC-grafted CLPE surfaces with various photoirradiation times (six groups: 0 [untreated CLPE], 11, 23, 45, 90, and 180 minutes), 18 sample pieces (total of 108 samples) were evaluated in surface analyses, and four cups (total of 24 samples) were evaluated in a hip simulator test.

RESULTS

The density of the PMPC layer increased with an increase in the photoirradiation time. The hip simulator test confirmed the PMPC-grafted CLPE with a high density of the PMPC layer exhibited minimal wear as compared with the untreated CLPE. High-density PMPC grafting appears essential for maintaining the high wear resistance of the PMPC-grafted CLPE. To obtain a high-density PMPC layer, the photoirradiation time must be greater than 45 minutes.

CONCLUSIONS

The cartilage-mimicking, density brushlike structure of the PMPC-grafted CLPE could extend high durability to acetabular cups in THA.

CLINICAL RELEVANCE

Our in vitro findings suggest the wear performance of CLPE acetabular cups in THA can be improved by this approach.

Lubricity and stability of poly(2-methacryloyloxyethyl phosphorylcholine) polymer layer on Co-Cr-Mo surface for hemi-arthroplasty to prevent degeneration of articular cartilage

Migration of the artificial femoral head to the inside of the pelvis due to the degeneration of acetabular cartilage has emerged as a serious issue in resurfacing or bipolar hemi-arthroplasty. Surface modification of cobalt-chromium-molybdenum alloy (Co-Cr-Mo) is one of the promising means of improving lubrication for preventing the migration of the artificial femoral head. In this study, we systematically investigated the surface properties, such as lubricity, biocompatibility, and stability of the various modification layers formed on the Co-Cr-Mo with the biocompatible 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer by dip coating or grafting. The cartilage/poly(MPC) (PMPC)-grafted Co-Cr-Mo interface, which mimicked a natural joint, showed an extremely low friction coefficient of <0.01, as low as that of a natural cartilage interface. Moreover, the long-term stability in water was confirmed for the PMPC-grafted layer; no hydrolysis of the siloxane bond was observed throughout soaking in phosphate-buffered saline for 12 weeks. The PMPC-grafted Co-Cr-Mo femoral head for hemi-arthroplasty is a promising option for preserving acetabular cartilage and extending the duration before total hip arthroplasty.

Effects of mobility/immobility of surface modification by 2-methacryloyloxyethyl phosphorylcholine polymer on the durability of polyethylene for artificial joints

Surface modification is important for the improvement in medical device materials. 2-Methacryloyloxyethyl phosphorylcholine (MPC) polymers have attracted considerable attention as surface modifiable polymers for several medical devices. In this study, we hypothesize that the structure of the surface modification layers might affect the long-term stability, hydration kinetics, wear resistance, and so forth, of medical devices such as artificial joints, and the poly(MPC) (PMPC) grafted surface might assure the long-term performance of such devices. Therefore, we investigate the surface properties of various surface modifications by using dip coatings of MPC-co-n-butyl methacrylate (PMB30) and MPC-co-3-methacryloxypropyl trimethoxysilane (PMSi90) polymers, or photoinduced radical grafting of PMPC and also the effects of the surface properties on the durability of cross-linked polyethylene (CLPE) for artificial joints. The PMPC-grafted CLPE has an extremely low and stable coefficient of dynamic friction and volumetric wear as compared to the untreated CLPE, PMB30-coated CLPE, and PMSi90-coated CLPE. It is concluded that the photoinduced radical graft polymerization of MPC is the best method to retain the benefits of the MPC polymer used in artificial joints under variable and multidirectional loads for long periods with strong bonding between the MPC polymer and the CLPE surface, and also to retain the high mobility of the MPC polymer.

Wear resistance of artificial hip joints with poly(2-methacryloyloxyethyl phosphorylcholine) grafted polyethylene: comparisons with the effect of polyethylene cross-linking and ceramic femoral heads

Aseptic loosening of artificial hip joints induced by wear particles from the polyethylene (PE) liner remains the ruinous problem limiting their longevity. We reported here that grafting with a polymer, poly(2-methacryloyloxyethyl phosphorylcholine (MPC)) (PMPC), on the PE liner surface dramatically decreased the wear production under a hip joint simulator condition. We examined that the effect of properties of both PE by cross-linking and femoral head by changing the materials on wearing properties of PE. The PMPC grafting on the liners increased hydrophilicity and decreased friction torque, regardless of the cross-linking of the PE liner or the difference in the femoral head materials. During the hip joint simulator experiments (5 x 10(6) cycles of loading), cross-linking caused a decrease of wear amount and a reduction of the particle size, while the femoral head materials did not affect it. The PMPC grafting abrogated the wear production, confirmed by almost no wear of the liner surface, independently of the liner cross-linking or the femoral head material. We concluded that the PMPC grafting on the PE liner surpasses the liner cross-linking or the change of femoral head materials for extending longevity of artificial hip joints.

Self-initiated surface graft polymerization of 2-methacryloyloxyethyl phosphorylcholine on poly(ether ether ketone) by photoirradiation

In the present paper, we reported the fabrication of a highly hydrophilic nanometer-scale modified surface on a poly(ether ether ketone) (PEEK) substrate by photoinduced graft polymerization of 2-methacryloyloxyethyl phosphorylcholine (MPC) in the absence of photoinitiators. Photoirradiation results in the generation of semibenzopinacol-containing radicals of benzophenone units in the PEEK molecular structure, which acts as a photoinitiator during graft polymerization. The poly(MPC)-grafted PEEK surface fabricated by a novel and simple polymerization system exhibited unique characteristics such as high wettability and high antiprotein adsorption, which makes it highly suitable for medical applications.