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Derr T, MacDonald DW, Malkani AL, Mont MA, Piuzzi NS, Kurtz SM. Oxidation and Damage Mechanisms of Second-Generation Highly Cross-Linked Polyethylene Tibial Inserts. J Arthroplasty 2024:S0883-5403(24)00631-4. [PMID: 38906197 DOI: 10.1016/j.arth.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND After clinical introduction in 2005, sequentially annealed, highly cross-linked polyethylene (SA HXLPE) was studied for retrievals with short implantation times; however, long-term follow-ups are lacking. The objective of this study was to examine and compare the revision reasons, damage mechanisms, and oxidation indices of SA HXLPE and conventional gamma inert-sterilized (Gamma Inert) ultra-high-molecular-weight polyethylene tibial inserts implanted for >5 years. METHODS There were 74 total knee arthroplasty tibial inserts (46 SA HXLPEs, 28 Gamma Inerts) implanted for >5 years (mean 7 ± 2 years) retrieved as part of a multicenter retrieval program. Cruciate-retaining implants comprised 44% of the SA HXLPEs and 14% of the Gamma Inerts. Patient factors and revision reasons were collected from revision operating notes. A semiquantitative scoring method was used to assess surface damage mechanisms. Oxidation was measured using Fourier transform infrared microscopy according to American Society for Testing and Materials 2102. Differences between cohorts were assessed with Mann-Whitney U-tests. RESULTS Loosening (Gamma Inert: 17 of 28, SA HXLPE: 15 of 46) and instability (Gamma Inert: 6 of 28, SA HXLPE: 15 of 46) were the most common revision reasons for both cohorts. The most prevalent surface damage mechanisms were burnishing, pitting, and scratching, with burnishing of the condyles being higher in Gamma Inert components (P = .022). Mean oxidation was higher in the SA HXLPE inserts at the articulating surface (P = .002) and anterior-posterior faces (P = .023). No difference was observed at the backside surface (P = .060). CONCLUSIONS Revision reasons and surface damage mechanisms were comparable in the Gamma Inert and SA cohorts. Further studies are needed to continue to assess the in vivo damage and clinical relevance, if any, of oxidation in SA HXLPE over longer implantation times, particularly for implants implanted for more than 10 years.
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Affiliation(s)
- Tabitha Derr
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Michael A Mont
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Kurtz
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
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2
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Maier K, Selig M, Haddouche A, Haunschild M, Hauschild O, Khalili I, Kirschberg J, Lutter C, Menges M, Mertl P, Niemeier A, Rubens-Duval B, Mittelmeier W. Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial. Trials 2024; 25:27. [PMID: 38183062 PMCID: PMC10768156 DOI: 10.1186/s13063-023-07811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design. METHODS This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile. DISCUSSION The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses. TRIAL REGISTRATION ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1 . All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.
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Affiliation(s)
- Kristin Maier
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany.
| | - Marius Selig
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Andréa Haddouche
- Hopital Sud - CHU Grenoble, Avenue Kimberley, 38130, Echirolles, France
| | - Martin Haunschild
- Klinik Für Allgemeine Orthopädie, Endoprothetik Und Kinderorthopädie, Katholisches Klinikum Koblenz-Montabaur, Kardinal-Krementz-Str. 1-5, Koblenz-Montabaur, 56073, Germany
| | - Oliver Hauschild
- Department for Orthopedic and Trauma Surgery, Park-Klinik Weissensee, Schönstraße 80, Berlin, 13086, Germany
| | - Iman Khalili
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | - Julia Kirschberg
- Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Christoph Lutter
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
| | - Michael Menges
- Lukas Krankenhaus, Hindenburgstraße 56, 32257, Bünde, Germany
| | - Patrice Mertl
- CHU Amiens-Picardie, 1 Rond Point du Professeur Christian Cabrol, 80054, CEDEX 1, Amiens, France
| | - Andreas Niemeier
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | | | - Wolfram Mittelmeier
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
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3
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Minimum 7-year results of cementless total hip arthroplasty with vitamin E-diffused and 2-methacryloyloxyethyl phosphorylcholine-grafted highly cross-linked polyethylene. Medicine (Baltimore) 2023; 102:e36257. [PMID: 38050300 PMCID: PMC10695485 DOI: 10.1097/md.0000000000036257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
The purpose of this study was to evaluate the mid-term clinical results and polyethylene wear of vitamin E-diffused highly cross-linked polyethylene (HXLPE) and 2-methacryloyloxyethyl phosphorylcholine (MPC)-grafted HXLPE in cementless total hip arthroplasty (THA). Thirty-four THAs with vitamin E-diffused HXLPE (VEPE) and 32-mm cobalt-chromium head, and 116 THAs with MPC-grafted HXLPE and 32-mm alumina head were evaluated. The Merle d'Aubigné and Postel scores were administered. Kaplan-Meier survivorship was analyzed. Annual radiographs were analyzed using computerized method and linear steady-state wear rate was measured. The mean duration of follow-up was 9 years (range, 7-11 years) in VEPE group and 8 years (range, 7-10 years) in MPC group. The mean Merle d'Aubigné and Postel scores improved postoperatively in both groups. Kaplan-Meier survivorship with endpoint of revision was 100% (95% confidence interval, 100%-100%) in VEPE group and 98.3% (95% confidence interval, 93.4%-99.6%) in MPC group at 10 years (P = .44). The mean steady-state wear rate was 0.007 mm/year in VEPE group and 0.006 mm/year in MPC group (P = .60). The clinical results of both groups were good and wear rates of both liners were very low.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Spece H, Yarbrough RV, Kurtz SM. A Review of Early In Vivo Performance of Antioxidant Stabilized Polyethylene for Total Knee Arthroplasty. J Arthroplasty 2023; 38:1885-1891. [PMID: 36813217 DOI: 10.1016/j.arth.2023.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The incorporation of antioxidants into highly cross-linked polyethylene (HXLPE) has emerged as an alternative to postirradiation thermal treatments for improving oxidation resistance. Currently, use of antioxidant stabilized HXLPE (AO-XLPE) in total knee arthroplasty (TKA) is increasing. In this literature review, we asked: (1) How does the clinical performance of AO-XLPE compare to conventional ultra-high molecular weight polyethylene (UHMWPE) or HXLPE for TKA? (2) What material changes occur in vivo for AO-XLPE in TKA? and (3) What is the risk of revision for AO-XLPE in TKA? METHODS We performed a search of the literature according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines using PubMed and Embase. Included studies reported the in vivo behavior of vitamin E-doped polyethylene in TKA. We reviewed 13 studies. RESULTS Across the studies, clinical results including revision rates, patient-reported outcome measurement scores, and the occurrence of osteolysis or radiolucent lines tended to be similar for AO-XLPE as compared to conventional UHMWPE or HXLPE controls. In retrieval analyses, AO-XLPE exhibited excellent resistance to oxidation and typical surface damage. Survival rates were positive and not significantly different from conventional UHMWPE or HXLPE. There were no cases of osteolysis for AO-XLPE and no revision due to polyethylene wear reported. CONCLUSION The purpose of this review was to provide a comprehensive overview of the literature regarding the clinical effectiveness of AO-XLPE in TKA. Overall, the results of our review indicated positive early-to mid-term clinical performance for AO-XLPE in TKA and similar outcomes as compared to conventional UHMWPE and HXLPE.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | | | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
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5
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Hasegawa M, Tone S, Naito Y, Sudo A. Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2140. [PMID: 36984020 PMCID: PMC10054334 DOI: 10.3390/ma16062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.
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Slouf M, Gajdosova V, Dybal J, Sticha R, Fulin P, Pokorny D, Mateo J, Panisello JJ, Canales V, Medel F, Bistolfi A, Bracco P. European Database of Explanted UHMWPE Liners from Total Joint Replacements: Correlations among Polymer Modifications, Structure, Oxidation, Mechanical Properties and Lifetime In Vivo. Polymers (Basel) 2023; 15:polym15030568. [PMID: 36771869 PMCID: PMC9921464 DOI: 10.3390/polym15030568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
This contribution lays the foundation for the European database of explanted UHMWPE liners from total joint replacements. Three EU countries (Czech Republic, Italy and Spain) have joined their datasets containing anonymized patient data (such as age and BMI), manufacturer data (such as information on UHMWPE crosslinking, thermal treatment and sterilization), orthopedic evaluation (such as total duration of the implant in vivo and reasons for its revision) and material characterization (such as oxidative degradation and micromechanical properties). The joined database contains more than 500 entries, exhibiting gradual growth, and it is beginning to show interesting trends, which are discussed in our contribution, including (i) strong correlations between UHMWPE oxidative degradation, degree of crystallinity and microhardness; (ii) statistically significant differences between UHMWPE liners with different types of sterilization; (iii) realistic correlations between the extent of oxidative degradation and the observed reasons for total joint replacement failures. Our final objective and task for the future is to continuously expand the database, involving researchers from other European countries, in order to create a robust tool that will contribute to the better understanding of structure-properties-performance relationships in the field of arthroplasty implants.
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Affiliation(s)
- Miroslav Slouf
- Institute of Macromolecular Chemistry of the Czech Academy of Sciences, 16206 Prague, Czech Republic
- Correspondence: (M.S.); (F.M.); (P.B.)
| | - Veronika Gajdosova
- Institute of Macromolecular Chemistry of the Czech Academy of Sciences, 16206 Prague, Czech Republic
| | - Jiri Dybal
- Institute of Macromolecular Chemistry of the Czech Academy of Sciences, 16206 Prague, Czech Republic
| | - Roman Sticha
- 1st Orthopedics Clinic of the 1st Faculty of Medicine of Charles University and Motol University Hospital, 15006 Prague, Czech Republic
| | - Petr Fulin
- 1st Orthopedics Clinic of the 1st Faculty of Medicine of Charles University and Motol University Hospital, 15006 Prague, Czech Republic
| | - David Pokorny
- 1st Orthopedics Clinic of the 1st Faculty of Medicine of Charles University and Motol University Hospital, 15006 Prague, Czech Republic
| | - Jesús Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, Medicine School, University of Zaragoza, 50009 Zaragoza, Spain
| | - Juan José Panisello
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Department of Surgery, Medicine School, University of Zaragoza, 50009 Zaragoza, Spain
| | - Vicente Canales
- Department of Orthopaedic Surgery and Traumatology, Royo Villanova Hospital, 50015 Zaragoza, Spain
| | - Francisco Medel
- Department of Mechanical Engineering-Institute of Engineering Research of Aragon, University of Zaragoza, 50018 Zaragoza, Spain
- Correspondence: (M.S.); (F.M.); (P.B.)
| | - Alessandro Bistolfi
- Department of Surgery, Orthopedics and Traumatology, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Pierangiola Bracco
- Chemistry Department and NIS Centre, University of Torino, 10125 Torino, Italy
- Correspondence: (M.S.); (F.M.); (P.B.)
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7
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Shah NA, Lan RT, Dai R, Jiang K, Shen HY, Hong R, Xu JZ, Li L, Li ZM. Improved oxidation stability and crosslink density of chemically crosslinked ultrahigh molecular weight polyethylene using the antioxidant synergy for artificial joints. J Biomed Mater Res B Appl Biomater 2023; 111:26-37. [PMID: 35809250 DOI: 10.1002/jbm.b.35129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023]
Abstract
Vitamin E (VE) is currently an approved antioxidant to improve the oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene (UHMWPE) insert used commercially in total joint arthroplasty. However, the decrease in crosslink density caused by VE reduces wear resistance of UHMWPE, showing an uncoordinated challenge. In this work, we hypothesized that D-sorbitol (DS) as a secondary antioxidant can improve the antioxidant efficacy of VE on chemically crosslinked UHMWPE. The combined effect of VE and DS on oxidation stability of UHMWPE was investigated at a set of controlled hybrid antioxidant content. The hybrid antioxidant strategy showed significantly synergistic enhancement on the oxidation stability of chemically crosslinked UHMWPE compared with the single VE strategy. More strikingly, the crosslink density of the blends with hybrid antioxidants stayed at a high level since DS is not sensitive to crosslinking. The relationships between oxidation stability, mechanical properties, crosslink density, and crystallinity were investigated, by which the clinically relevant overall performance of UHMWPE was optimized. This work provides a leading-edge design mean for the development of joint bearings.
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Affiliation(s)
- Nouman Ali Shah
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Ri-Tong Lan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Rui Dai
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Kai Jiang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Hui-Yuan Shen
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Rui Hong
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Jia-Zhuang Xu
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Lingli Li
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Ming Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
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8
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No Reduction in Revision Risk Associated With Highly Cross-linked Polyethylene With or Without Antioxidants Over Conventional Polyetheylene in TKA: An Analysis From the American Joint Replacement Registry. Clin Orthop Relat Res 2022; 480:1929-1936. [PMID: 35994277 PMCID: PMC9473776 DOI: 10.1097/corr.0000000000002338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) can improve wear properties in TKA, but it can also lead to decreased mechanical properties. Antioxidants were added to HXLPE to improve its mechanical properties while retaining the improved wear characteristics. However, it remains unclear whether these modifications to conventional polytheylene used in TKA have resulted in a change in the revision risk. QUESTIONS/PURPOSES We used American Joint Replacement Registry data to ask: (1) Is there a difference in all-cause revision in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene? (2) Is there a difference in revision for aseptic failure in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene? METHODS We analyzed American Joint Replacement Registry data from 2012 to 2019. We identified 339,366 primary TKAs over the study period in patients older than 65 years and linked procedures to supplemental Centers for Medicare & Medicaid data where available. Patient total number of reported comorbidities, gender, age, region, polyethylene characteristics, procedure dates, and indication for revision were recorded. Median follow-up was 34 months. We compared HXLPE with or without antioxidants to conventional polyethylene. Event-free percent survival curves and Cox proportional hazard regression modeling was used for all-cause revision and revision for aseptic failure. RESULTS Compared with conventional polyethylene, there was no difference in all-cause revision with HXLPE with an antioxidant (HR 1.06 [95% CI 0.98 to 1.14]; p = 0.13) or HXLPE without an antioxidant (HR 1.04 [95% CI 0.97 to 1.11]; p = 0.28). Compared with conventional polyethylene, there was no difference in revision for aseptic failure with HXLPE with an antioxidant (HR 1.07 [95% CI 0.99 to 1.14]; p = 0.08) or HXLPE without an antioxidant (HR 1.03 [95% CI 0.97 to 1.01]; p = 0.30). CONCLUSION We found no difference in revision risk between HXLPE with or without an antioxidant and conventional polyethylene during this time frame. HXLPE polyethylene, with or without an antioxidant, should not be widely adopted until or unless it is shown to be superior to conventional polyethylene in TKA. LEVEL OF EVIDENCE Level III, therapeutic study.
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9
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Palumbo BT, Salomon K, Sullivan A, Simon P, Lyons S, Bernasek TL. Total Hip Arthroplasty With Subtrochanteric Osteotomy for Developmental Hip Dysplasia: A Long-term Follow-up Study. Arthroplast Today 2022; 17:101-106. [PMID: 36046067 PMCID: PMC9421178 DOI: 10.1016/j.artd.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Total hip arthroplasty (THA) for developmental hip dysplasia (DDH) often requires a subtrochanteric shortening derotational osteotomy (SDO) to limit leg lengthening, mitigate risk of peripheral nerve palsy, and reduce excessive femoral anteversion. Few studies exist detailing long-term clinical outcomes and survivorship. The aim of this study is to analyze the long-term outcomes and survivorship of an SDO-THA cohort. Methods We retrospectively reviewed all patients who underwent cementless THA with femoral osteotomy due to Crowe I-IV DDH between 1991 and 2001. Primary outcome measures included revision surgery for any reason and functional outcome measures using modified Harris Hip scores. Secondary outcome measures included mode of implant failure and radiographic assessment for osteotomy union, polyethylene wear, osteolysis, and implant loosening. Results Our review resulted in 24 SDO-THA cases in 20 patients with a mean follow-up of 19 years (range, 8-27 years). Overall survivorship was 67%. All 8 failures were treated with acetabular revision at a mean time to revision of 11 years (range, 1-25 years). Of the failures, there were 5 cases due to polyethylene wear (62.5%), 2 cases due to acetabular loosening (25%), and 1 case due to recurrent instability (12.5%). The mean postoperative modified Harris Hip score was 76 (range, 52-91) with long-term improvement of 43 points maintained (P < .001). Conclusions THA with SDO can produce durable long-term outcomes for the patient with DDH. It is important to consider some common reasons for revision, namely polyethylene wear and osteolysis, acetabular loosening, and recurrent acetabular dislocations.
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Affiliation(s)
- Brian T. Palumbo
- Florida Orthopaedic Institute, Temple Terrace, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Kevin Salomon
- University of South Florida, Tampa, FL, USA
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Alex Sullivan
- Florida Orthopaedic Institute, Temple Terrace, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Peter Simon
- University of South Florida, Tampa, FL, USA
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Steven Lyons
- Florida Orthopaedic Institute, Temple Terrace, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Thomas L. Bernasek
- Florida Orthopaedic Institute, Temple Terrace, FL, USA
- University of South Florida, Tampa, FL, USA
- Corresponding author. Florida Orthopaedic Institute, 13020 Telecom Parkway N, Temple Terrace, FL 33637 USA. Tel.: +1 813 220 8338.
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10
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Lombardi AV, Byrd ZO, Berend KR, Morris MJ, Adams JB, Crawford DA. Mid-Term Survival of Total Hip Arthroplasty in Patients Younger Than 55-year-old. J Arthroplasty 2022; 37:S517-S523. [PMID: 35240281 DOI: 10.1016/j.arth.2022.02.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Survivorship of total hip arthroplasty (THA) in younger patients is concerning given the inverse relationship between age and lifetime risk for revision. The purpose of this study is to determine if risk of revision has improved for patients aged 55 years or younger who undergo primary THA using modern polyethylene liners. METHODS A retrospective review identified 2,461 consented patients (2,814 hips) with minimum 2-year follow-up who underwent primary THA at our institution between September 2007 and August 2014 using components from a single manufacturer (Zimmer Biomet), all with vitamin E-infused highly crosslinked polyethylene acetabular inserts. There were 561 patients (643 THA; 23%) aged 55 or younger and 1,900 (2,171 THA; 77%) older than 55. RESULTS Mean follow-up was 5.0 years for both groups. There were more male patients in the younger (55%) than older (41%) group. Body mass index (BMI) was higher in younger patients independent of gender. Improvement in Harris hip score (HHS) was similar between groups. Kaplan-Meier survival to endpoint of all cause revision was similar between groups at 12 years (P = .8808) with 97.5% (95% CI: ±0.7%) for younger versus 97.1% (95% CI: ±0.6%) for older patients. Most frequent reason for revision overall was periprosthetic femoral fracture (21; 0.75%); univariate analysis revealed risk factors were female gender (P = .28) and age ≥65 years (P = .012). CONCLUSION Use of modern polyethylene, such as vitamin E-stabilized highly cross-linked, liners during THA may improve survivorship in younger patients undergoing THA. Younger patients undergoing primary THA with highly cross-linked polyethylene liners had no increased rate of revision at mid-term follow-up.
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Affiliation(s)
- Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH
| | - Zackary O Byrd
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | | | - David A Crawford
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
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11
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Hiranaka T, Suda Y, Saitoh A, Tanaka A, Arimoto A, Koide M, Fujishiro T, Okamoto K. Current concept of kinematic alignment total knee arthroplasty and its derivatives. Bone Jt Open 2022; 3:390-397. [PMID: 35532356 PMCID: PMC9134837 DOI: 10.1302/2633-1462.35.bjo-2022-0021.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA, the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Akira Saitoh
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Atsuki Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Akihiko Arimoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
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12
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Kendall J, Pelt CE, Yep P, Mullen K, Kagan R. Trends in Polyethylene Design and Manufacturing Characteristics for Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry. J Arthroplasty 2022; 37:659-667. [PMID: 34826567 DOI: 10.1016/j.arth.2021.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Advances in polyethylene bearing characteristics have led to various options for total knee arthroplasty. We examine trends in use of polyethylene in the United States. METHODS An analysis of American Joint Replacement Registry data from 2012 to 2019 for primary total knee arthroplasty procedures was conducted. Design and manufacturing characteristics were obtained and validated in the American Joint Replacement Registry dataset. Polyethylene bearing design and manufacturing use characteristics were compared by year, gender, age group, and geographic region of the procedure. Descriptive analysis was performed. RESULTS We identified 993,292 cases over the study period. In total, 791,233 (80%) cases had complete device data available and were included in analysis. In addition, 366,280 (49.4%) cases utilized minimally stabilized bearings compared to 374,809 (50.6%) for posterior-stabilized bearings. Posterior-stabilized use was stable over the study period and highest in the Northeast (64.5%; P < .0001). Cruciate-retaining use decreased from 29.7% to 20.2% and anterior-stabilized use increased from 17.4% to 25.2%. Conventional polyethylene use decreased from 42.8% to 21.9%, and was highest in the 81+ age group (37.8%; P < .0001) and Northeast (43.0%; P < .0001). Highly cross-linked polyethylene (HXLPE) with antioxidant use increased from 9.08% to 31.8%, while HXLPE without antioxidant use remained constant. CONCLUSION There was an increase in use of anterior-stabilized and pivot bearings and an increase in use of HXLPE with antioxidant. Additionally, there were noted age group and regional differences in the use of various bearings. Further study should evaluate if these changing utilization trends are related to clinical outcomes, or due to regional training, preferences, or manufacturer pressures. LEVEL OF EVIDENCE Level III, retrospective.
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Affiliation(s)
- Jamil Kendall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT
| | - Patrick Yep
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, IL
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, IL
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
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13
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Schwiesau J, Fritz B, Bergmann G, Puente Reyna AL, Schilling C, Grupp TM. Influence of radiation conditions on the wear behaviour of Vitamin E treated UHMWPE gliding components for total knee arthroplasty after extended artificial aging and simulated daily patient activities. J Mech Behav Biomed Mater 2021; 122:104652. [PMID: 34246078 DOI: 10.1016/j.jmbbm.2021.104652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
The long term performance of total knee arthroplasty (TKA) with regards to the bearing materials is related to the aging behaviour of these materials. The use of highly crosslinked materials in hip arthroplasty improved the clinical outcome. Nevertheless, the outcome for these materials compared to conventional UHMWPE (ultra-high molecular weight polyethylene) remains controversial in TKA and alternative bearing materials may be advantageous to improve its outcome in the second and third decade. The aim of this study is the evaluation of the influence of radiation conditions on the wear behaviour of Vitamin E blended UHMWPE gliding components for TKA by simulation of extended aging and high demanding daily patient activities. For a medium radiation dose (30 kGy), the influence of the irradiation type (E-beam or Gamma radiation) and the thermal conditions (room temperature (RT) or heated to 115 °C) are evaluated in comparison to non-irradiated material. Significant influences on the wear behaviour were found for the radiation source and temperature during irradiation. Furthermore, no relevant degradation of the tested materials was observed after extended artificial aging. There was a good correspondence between the wear pattern in this study and retrievals.
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Affiliation(s)
- Jens Schwiesau
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany.
| | | | - Georg Bergmann
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Thomas M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany
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14
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Shah NA, Ren Y, Lan R, Lv J, Gul RM, Tan P, Huang S, Tan L, Xu J, Li Z. Ultrahigh molecular weight polyethylene with improved crosslink density, oxidation stability, and microbial inhibition by chemical crosslinking and tea polyphenols for total joint replacements. J Appl Polym Sci 2021. [DOI: 10.1002/app.51261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Nouman Ali Shah
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Yue Ren
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Ri‐Tong Lan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Jia‐Cheng Lv
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Rizwan M. Gul
- Department of Mechanical Engineering University of Engineering and Technology Peshawar Pakistan
| | - Peng‐Fei Tan
- College of Biomass Science and Engineering Sichuan University Chengdu China
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine Sichuan University Chengdu China
| | - Lin Tan
- College of Biomass Science and Engineering Sichuan University Chengdu China
| | - Jia‐Zhuang Xu
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Zhong‐Ming Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
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15
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16
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Raman spectroscopy reveals creep and wear rate of e-beam-sterilized conventional UHMWPE tibial inserts. J Mech Behav Biomed Mater 2020; 110:103902. [DOI: 10.1016/j.jmbbm.2020.103902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/01/2020] [Accepted: 05/30/2020] [Indexed: 11/19/2022]
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