1
|
Nepple CM, Blackburn AZ, Feder OI, Prasad AK, Bedair HS. Minimum 10-Year Follow-Up of Vitamin-E Diffused Highly Crosslinked Polyethylene Liners in Total Hip Arthroplasty: Comparative Evaluation from a Prospective, International, Multicenter Cohort Study. J Arthroplasty 2024:S0883-5403(24)00939-2. [PMID: 39303910 DOI: 10.1016/j.arth.2024.09.002] [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: 04/15/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a proven, effective treatment for end-stage osteoarthritis. The success of THA is due in part to highly crosslinked (XL) polyethylene implants. In 2007, a new generation of polyethylene liners entered clinical use. The new liners infused polyethylene with vitamin E (EP). The EP liner was hypothesized to prevent the loss of mechanical properties caused by oxidation, extending the lifetime of the implant. This international prospective study aimed to quantify the clinical outcomes of a 977-patient cohort receiving EP and XL liners 10 years after surgery. METHODS The prospective cohort study began in 2007, including eight countries and seventeen centers. The final cohort included 977 patients (EP liner: n = 520; XL liner: n = 457). Patients were followed preoperatively, postoperatively, and at 1, 3, 5, 7, and 10 years. Each follow-up visit involved clinical evaluation, radiography, and survey collection. Demographics and revisions were also recorded. Mann-Whitney U tests were used to evaluate statistical differences. RESULTS At ten years following surgery, 534 patients were eligible for follow-up. Of those eligible, 352 patients returned for clinical evaluation (65.9% eligible; 36.0% overall). No statistical differences were found (P > 0.05) in the demographics of the followed-up cohort. The linear wear rates were 0.00338 mm/year for XL liners and 0.0236 mm/year for EP liners using individual regression (P < 0.0001). No significant difference was observed in wear rates using cohort regression. Similarly, surveys suggested no significant outcomes between the EP and XL liner cohorts. The overall incidence of revision was 2.3% for EP and 2.0% for XL liners. CONCLUSION The EP liner demonstrated significantly lower wear than its XL counterparts at 10-years after implantation. Results are promising, as vitamin E polyethylene may improve the lifetime performance of THA implants and ensure arthroplasty innovations reflect the changing patient population.
Collapse
Affiliation(s)
- Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, 55 Fruit St. Boston, MA
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St. Boston, MA
| | - Oren I Feder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St. Boston, MA; Harvard Medical School, Department of Orthopaedic Surgery, 25 Shattuck St., Boston, MA
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St. Boston, MA; Harvard Medical School, Department of Orthopaedic Surgery, 25 Shattuck St., Boston, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St. Boston, MA; Harvard Medical School, Department of Orthopaedic Surgery, 25 Shattuck St., Boston, MA.
| |
Collapse
|
2
|
Migliorini F, Betsch M, Maffulli N, Schäfer L, Hildebrand F, Kubach J, Pasurka M. Rate of revision and wear penetration in different polyethylene liner compositions in total hip arthroplasty: a Bayesian network meta-analysis. Sci Rep 2024; 14:21162. [PMID: 39256531 PMCID: PMC11387631 DOI: 10.1038/s41598-024-71326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
The present Bayesian network meta-analysis compared different types of polyethylene liners in total hip arthroplasty (THA) in terms of wear penetration (mm/year) and rate of revision. The type of liners compared were the crosslinked ultra-high molecular weight polyethylene (CPE/UHMWPE), Vitamin E infused highly cross-linked polyethylene (HXLPE-VEPE), modified cross-linked polyethylene (MXLPE), highly cross-linked polyethylene (HXLPE), Cross-linked polyethylene (XLPE). This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In June 2024, PubMed, Scopus, Embase, Google Scholar, and Cochrane databases were accessed. A time constraint was set from January 2000. All investigations which compared two or more types of polyethylene liners for THA were accessed. Only studies that clearly stated the nature of the liner were included. Data from 60 studies (37,352 THAs) were collected. 56% of patients were women. The mean age of patients was 60.0 ± 6.6 years, the mean BMI was 27.5 ± 2.0 kg/m2. The mean length of follow-up was 81.6 ± 44.4 months. Comparability was found at baseline between groups. XLPE and HXLPE liners in THA are associated with the lowest wear penetration (mm/year) and the lowest revision rate at approximately 7 years of follow-up.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy.
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Joshua Kubach
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Mario Pasurka
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
| |
Collapse
|
3
|
Muratoglu OK, Asik MD, Nepple CM, Wannomae KK, Micheli BR, Connolly RL, Oral E. Di-cumyl peroxide cross-linked UHMWPE/vitamin-E blend for total joint arthroplasty implants. J Orthop Res 2024; 42:306-316. [PMID: 37593816 DOI: 10.1002/jor.25679] [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: 01/30/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Majority of ultrahigh molecular weight polyethylene (UHMWPE) medical devices used in total joint arthroplasty are cross-linked using gamma radiation to improve wear resistance. Alternative methods of cross-linking are urgently needed to replace gamma radiation due to rapid decline in its supply. Peroxide cross-linking is a candidate method with widespread industrial applications. Oxidative stability and biocompatibility, which are critical requirements for medical device applications, can be achieved using vitamin-E as an additive and by removing peroxide by-products through high-temperature melting, respectively. We investigated compression molded UHMWPE/vitamin-E/di-cumyl peroxide blends followed by high-temperature melting in inert gas as a material candidate for tibial knee inserts. Wear resistance increased and mechanical properties remained largely unchanged. Oxidation induction time was higher than most of the other clinically available formulations. The material passed the local-end point biocompatibility tests per ISO 10993. Compounds found in exhaustive extraction were of no concern with margin-of-safety values well above the accepted level, indicating a desirable toxicological risk profile. Statement of Clinical Significance: Peroxide cross-linked, vitamin-E stabilized, and high-temperature melted UHMWPE has recently been cleared for clinical use in tibial knee inserts. With all the salient characteristics needed in a material that can provide superior long-term performance in total joint patients, peroxide cross-linking can replace the gamma radiation cross-linking of UHMWPE.
Collapse
Affiliation(s)
- Orhun K Muratoglu
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mehmet D Asik
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith K Wannomae
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brad R Micheli
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel L Connolly
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ebru Oral
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Meng Z, Zhang T, Zhang C, Shang Y, Lei Q, Chi Q. Advances in Polymer Dielectrics with High Energy Storage Performance by Designing Electric Charge Trap Structures. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023:e2310272. [PMID: 38109702 DOI: 10.1002/adma.202310272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/06/2023] [Indexed: 12/20/2023]
Abstract
Dielectric capacitors have been developed for nearly a century, and all-polymer film capacitors are currently the most popular. Much effort has been devoted to studying polymer dielectric capacitors and improving their capacitive performance, but their high conductivity and capacitance losses under high electric fields or elevated temperatures are still significant challenges. Although many review articles have reported various strategies to address these problems, to the best of current knowledge, no review article has summarized the recent progress in the high-energy storage performance of polymer-based dielectric films with electric charge trap structures. Therefore, this paper first reviews the charge trap characterization methods for polymeric dielectrics and discusses their strengths and weaknesses. The research progress on the design of charge trap structures in polymer dielectric films, including molecular chain optimization, organic doping, blending modification, inorganic doping, multilayered structures, and the mechanisms of the charge trap-induced enhancement of the capacitive performance of polymers are systematically reviewed. Finally, a summary and outlook on the fundamental theory of charge trap regulation, performance characterization, numerical calculations, and engineering applications are presented. This review provides a valuable reference for improving the insulation and energy storage performance of dielectric capacitive films.
Collapse
Affiliation(s)
- Zhaotong Meng
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
| | - Tiandong Zhang
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
| | - Changhai Zhang
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
| | - Yanan Shang
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
| | - Qingquan Lei
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
| | - Qingguo Chi
- Key Laboratory of Engineering Dielectrics and Its Application, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical and Electronic Engineering, Harbin University of Science and Technology, Harbin, 150080, P. R. China
- School of Electrical Engineering, Dalian University of Technology, Dalian, 116024, P. R. China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
El-Sahoury JAN, Kjærgaard K, Ovesen O, Hofbauer C, Overgaard S, Ding M. Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial. Bone Joint J 2023; 105-B:1052-1059. [PMID: 37777211 DOI: 10.1302/0301-620x.105b10.bjj-2023-0115.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA). Methods A single-blinded, multi-arm, 2 × 2 factorial randomized controlled trial was undertaken. Patients were recruited between May 2009 and April 2011. Radiostereometric analyses (RSAs) were performed from baseline to ten years. Of the 220 eligible patients, 116 underwent randomization, and 82 remained at the ten-year follow-up. Eligible patients were randomized into one of four interventions: vE-PE acetabular liner with either 32 or 36 mm femoral head, and XLPE acetabular liner with either 32 or 36 mm femoral head. Parameters were otherwise identical except for acetabular liner material and femoral head size. Results A total of 116 patients participated, of whom 77 were male. The median ages of the vE-PE 32 mm and 36 mm groups were 65 (interquartile range (IQR) 57 to 67) and 63 years (IQR 56 to 66), respectively, and of the XLPE 32 mm and 36 mm groups were 64 (IQR 58 to 66) and 61 years (IQR 54 to 66), respectively. Mean total head penetration was significantly lower into vE-PE acetabular liner groups than into XLPE acetabular liner groups (-0.219 mm (95% confidence interval -0.348 to -0.090); p = 0.001). There were no differences in wear according to head size, acetabular component migration, or PROMs, except for UCLA. There were no cases of aseptic loosening or failures requiring revision at long-term follow-up. Conclusion Significantly lower wear was observed in vE-PE acetabular liners than in XLPE acetabular liners. No difference in wear was observed between different head size or PROMs except for the UCLA at ten years.
Collapse
Affiliation(s)
- Joseph A N El-Sahoury
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kristian Kjærgaard
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Søren Overgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopaedic Surgery & Traumatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ming Ding
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
A Review of Biomaterials and Associated Performance Metrics Analysis in Pre-Clinical Finite Element Model and in Implementation Stages for Total Hip Implant System. Polymers (Basel) 2022; 14:polym14204308. [PMID: 36297885 PMCID: PMC9607025 DOI: 10.3390/polym14204308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Total hip replacement (THR) is a common orthopedic surgery technique that helps thousands of individuals to live normal lives each year. A hip replacement replaces the shattered cartilage and bone with an implant. Most hip implants fail after 10–15 years. The material selection for the total hip implant systems is a major research field since it affects the mechanical and clinical performance of it. Stress shielding due to excessive contact stress, implant dislocation due to a large deformation, aseptic implant loosening due to the particle propagation of wear debris, decreased bone remodeling density due to the stress shielding, and adverse tissue responses due to material wear debris all contribute to the failure of hip implants. Recent research shows that pre-clinical computational finite element analysis (FEA) can be used to estimate four mechanical performance parameters of hip implants which are connected with distinct biomaterials: von Mises stress and deformation, micromotion, wear estimates, and implant fatigue. In vitro, in vivo, and clinical stages are utilized to determine the hip implant biocompatibility and the unfavorable local tissue reactions to different biomaterials during the implementation phase. This research summarizes and analyses the performance of the different biomaterials that are employed in total hip implant systems in the pre-clinical stage using FEA, as well as their performances in in vitro, in vivo, and in clinical studies, which will help researchers in gaining a better understanding of the prospects and challenges in this field.
Collapse
|
8
|
Ahmad H, Rodrigue D. Crosslinked polyethylene: A review on the crosslinking techniques, manufacturing methods, applications, and recycling. POLYM ENG SCI 2022. [DOI: 10.1002/pen.26049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hibal Ahmad
- Department of Chemical Engineering Université Laval Quebec City Quebec Canada
| | - Denis Rodrigue
- Department of Chemical Engineering Université Laval Quebec City Quebec Canada
| |
Collapse
|
9
|
Nielson T, Owens G, Miller B, Meneghini E, Deckard ER, Meneghini RM. Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene. J Arthroplasty 2022; 37:S685-S691. [PMID: 35227535 DOI: 10.1016/j.arth.2022.01.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold: (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm. METHODS One hundred forty-two consecutive primary total hip arthroplasties using ceramic femoral heads (n = 84 VE-HXLPE; n = 58 HXLPE) in a single implant system were retrospectively reviewed. FHP was measured radiographically utilizing Martell method at 4-week, 1-year, and latest radiographs. FHP, cup position, and demographic variables were compared between VE-HXLPE and HXLPE liners. RESULTS Median linear FHP was lower for VE-HXLPE compared to HXLPE during the initial "bedding-in" period between 4-week and 1-year (0.383 vs 0.551 mm, P = .650) and between 1-year and latest follow-up (0.131 vs 0.270 mm/y, P = .636) although without statistical significance. Acetabular cup inclination and anteversion did not influence linear or volumetric FHP (P ≥ .204). Large femoral heads (≥40 mm) were predictive of higher FHP during the early bedding-in period (P ≤ .025) but did not have an effect beyond 1 year in multivariate regression with numbers available. No radiographic osteolysis was observed in any case. CONCLUSION These findings support others that VE-HXLPE is the optimal polyethylene bearing surface to minimize FHP during the bedding-in period and beyond. Surprisingly, large ceramic femoral heads appear to influence FHP during the initial bedding-in period but do not increase FHP beyond 1 year. Further longer term follow-up remains warranted. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Trent Nielson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Garrett Owens
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Brandon Miller
- Department of Mechanical Engineering, Tennessee Tech University, Cookeville, TN
| | - Ethan Meneghini
- IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
| |
Collapse
|
10
|
Zhang H, Guo Y, Tian F, Qiao Y, Tang Z, Zhu C, Xu J. Discussion of Orientation and Performance of Crosslinked Ultrahigh-Molecular-Weight Polyethylene Used for Artificial Joints. ACS APPLIED MATERIALS & INTERFACES 2022; 14:29230-29237. [PMID: 35700194 DOI: 10.1021/acsami.2c05549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Previously, the orientation structure of ultrahigh-molecular-weight polyethylene (UHMWPE) for artificial joints was considered to be unchanged after irradiation crosslinking. Therefore, much of the research related to the long-term failure of artificial joints has focused on material improvements. In this study, ultrasmall-angle X-ray scattering (USAXS) and the small/wide-angle X-ray scattering (SAXS-WAXS) combined technique reveal that the orientation structures of UHMWPE materials at all scales (nanoscale to microscale) are responsible for the long-term failure of artificial joints. To further illustrate the formation of these hierarchical oriented structures, a simple model is presented. In this model, first, the migration of free radicals plays a vital role, and the different steric hindrances in different directions directly lead to uneven migration behavior of free radicals. Second, the uneven migration of free radicals contributes to an inhomogeneous concentration of free radicals, thus resulting in observable crosslinking nonuniformities. Finally, all the hierarchical structural nonuniformities promote long-term failure of artificial joints after long-term wear.
Collapse
Affiliation(s)
- Hao Zhang
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Yuhai Guo
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Feng Tian
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China
| | - Yongna Qiao
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Zheng Tang
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Caizhen Zhu
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Jian Xu
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| |
Collapse
|
11
|
Revision Risk of Total Hip Arthroplasty With Vitamin E Doped Liners: Results From the Danish Hip Arthroplasty Register. J Arthroplasty 2022; 37:1136-1142. [PMID: 35149169 DOI: 10.1016/j.arth.2022.02.007] [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: 11/04/2021] [Revised: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Vitamin E-doped cross-linked polyethylene (VEPE) liners were introduced in total hip arthroplasty (THA) to reduce wear and risk of aseptic loosening and liner fracture. We report this nationwide population-based study to investigate the safety of VEPE liners for THA compared to cross-linked annealed or remelted polyethylene (XLPE). METHODS We included THAs from The Danish Hip Arthroplasty Register from January 1, 2008 to June 30, 2019, with uncemented cup, VEPE or XLPE liner, and metal or ceramic head. The outcome was revision due to (1) polyethylene-related endpoints (aseptic loosening, granuloma, osteolysis, or liner fractures) and (2) other endpoints. RESULTS A total of 110,803 THAs were assessed for eligibility and 53,842 THAs (46,645 patients) were included in the study: 5069 (9.4%) THAs with a VEPE liner and 48,773 (91.6%) with a XLPE liner. Median observation time was 5.48 (interquartile range 3.80-7.15) years for VEPE and 4.85 (interquartile range 2.68-7.76) for XLPE. VEPE had a lower risk of revision for polyethylene-related endpoints compared to XLPE (hazard ratio [HR] 0.60, 95% confidence interval 0.36-0.98) during complete follow-up. THAs with VEPE liners were associated with increased risk of any revision within the first 3 months (HR 1.62, 1.36-1.94), revision recorded as aseptic loosening within 3 months (HR 4.46, 2.26-8.80), and periprosthetic fracture within 3 months (HR 2.57, 1.98, 3.33). CONCLUSION VEPE liners had a lower risk of revision due to polyethylene-related endpoints, but a higher risk of all-cause revision within 3 months.
Collapse
|
12
|
Matsumoto K, Tokuhashi Y, Sawada H, Saito S, Suzuki S, Ozaki R, Nakanishi K. Fatigue wear test comparing vitamin-E-blended crosslinked polyethylene and conventional polyethylene in a Posterior Dynamic Stabilization System of the spine in the laboratory. J Orthop Sci 2022; 27:558-562. [PMID: 33865669 DOI: 10.1016/j.jos.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although artificial joints using polyethylene have been developed for various joints, the development of Posterior Dynamic Stabilization system of the spine using polyethylene has proceeded at a much slower pace. There are no studies which compare the abrasion resistance of vitamin-E-blended crosslinked polyethylene (VE) and conventional polyethylene (Virgin) in the spinal region. The purpose of this study was to compare the wear resistance of VE and Virgin in a Posterior Dynamic Stabilization System of the spine. METHODS Posterior Dynamic Stabilization System of the spine uses a polyethylene ball as a sliding surface. A fatigue wear test was repeated up to 1 million cycles at a speed of ±5°, 1 Hz while the rod was being pulled at a load of 50 N. Balls were compared using VE and Virgin in 6 samples each. Ti-6AL-4 V (Ti 64) and Co-Cr-Mo (CoCr) rods were used. Abrasion loss and shape change of the polyethylene balls were compared. RESULTS When Ti 64 was used as the rod, the average wear amount was -0.01 mg (0.02 mg, 0.01 mg, -0.06 mg) for VE, and 0.23 mg (0.18 mg, 0.13 mg, 0.38 mg) for Virgin. When CoCr was used as the rod, the average wear amount was 0.42 mg (0.71 mg, -0.06 mg, 0.61 mg) for VE, and 0.73 mg (0.72 mg, 0.70 mg, 0.76 mg) for Virgin. Most polyethylene samples showed indentations of 0.1 m or less at the contact point with the set screw. In the combination of Virgin and CoCr, a white patch was observed on the inner side of the polyethylene samples, with a maximum depression of 0.1 mm. CONCLUSIONS A fatigue wear test showed VE to be more efficient in abrasion resistance than Virgin in a Posterior Dynamic Stabilization System of the spine in the laboratory.
Collapse
Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan.
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| | - Sosuke Saito
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| | - Ryo Ozaki
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati Itabashi-ku, Tokyo 173-8610, Japan
| |
Collapse
|
13
|
Surjit Singh CK, Lim HP, Yen-Pin Khoo J, Tey BT, Chan ES. Effects of high-energy emulsification methods and environmental stresses on emulsion stability and retention of tocotrienols encapsulated in Pickering emulsions. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2022.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Liu S, Li Q, Wang J, Lu M, Zhang W, Wang K, Liu W, Wang M. Study on the post-irradiation oxidation of polyethylenes using EPR and FTIR technique. Polym Degrad Stab 2022. [DOI: 10.1016/j.polymdegradstab.2022.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Synergy between vitamin E and D-sorbitol in enhancing oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene. Acta Biomater 2021; 134:302-312. [PMID: 34311104 DOI: 10.1016/j.actbio.2021.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
Oxidative stability of radiation crosslinked ultrahigh molecular weight polyethylene (UHMWPE) artificial joints is significantly improved by vitamin E (VE), but there is a dilemma that VE hinders crosslinking and thus jeopardizes the wear of UHMWPE. In this effort, we proposed an efficient strategy to stabilize UHMWPE under limited antioxidant contents, where VE and D-sorbitol (DS) were used as the primary antioxidant and the secondary antioxidant respectively. For non-irradiated blends with fixed antioxidant contents, oxidative stability accessed by oxidation induction time (OIT) of VE/DS/UHMWPE blends was superior to that of VE/UHMWPE blends, while DS/UHMWPE blends showed no increase in OIT. The cooperation between DS and VE exhibited a synergistic effect on enhancing the oxidative stability of UHMWPE. Interestingly, the irradiated VE/DS/UHMWPE blends showed comparable OIT but a significantly higher crosslink density than the irradiated VE/UHMWPE blends. The crystallinity, melting point, and in vitro biocompatibility of the blends were not affected by VE and DS. The quantitative relationships of mechanical properties, oxidation stability, crystallinity and crosslink density were established to unveil the correlation of these key factors. The overall properties of VE/UHMWPE and VE/DS/UHMWPE blends were compared to elucidate the superiority of the antioxidant compounding strategy. These findings provide a paradigm to break the trade-off between oxidative stability, crosslink density and mechanical properties, which is constructive to develop UHMWPE bearings with upgraded performance for total joint replacements. STATEMENT OF SIGNIFICANCE: VE-stabilized UHMWPE is the most commonly used material in total joint replacements at present. However, oxidation and wear resistance of VE/UHMWPE implants cannot be unified since VE reduces the efficiency of radiation crosslinking. It limits the use of VE. Herein, we proposed a compounding stabilization by the synergy between VE and DS. The antioxidation capability of VE was revived by DS, thus enhancing the oxidation stability of unirradiated UHMWPE. The irradiated VE/DS/UHMWPE exhibited similar oxidation stability but higher crosslink density than irradiated VE/UHMWPE, which is beneficial to combat wear of UHMWPE and to inhibit the occurrence of osteolysis. This synergistic antioxidation strategy endows the UHMWPE joint material with good overall performance, which is of clinical significance.
Collapse
|
16
|
Elbardesy H, Yadav H, Rabea M, Guerin S, Harty J. Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials. SICOT J 2021; 7:47. [PMID: 34515633 PMCID: PMC8436949 DOI: 10.1051/sicotj/2021045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear? PATIENTS AND METHODS We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty. RESULTS We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group. CONCLUSIONS In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.
Collapse
Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Himanshu Yadav
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Mohamed Rabea
- Faculty of Pharmacy, Mansoura University, Mansoura 32216, Egypt
| | - Shane Guerin
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - James Harty
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| |
Collapse
|
17
|
Abstract
AbstractThe success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.
Collapse
|
18
|
Hemmilä M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Pamilo K, Mäkelä KT. Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register. Acta Orthop 2021; 92:316-322. [PMID: 33517823 PMCID: PMC8231410 DOI: 10.1080/17453674.2021.1879513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA.Patients and methods - We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups.Results - The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9-94.9] and 93% [CI 91.9-93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4-1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6-99.4) and for the reference group 99% (CI 98.7-99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7-2.5]).Interpretation - After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners.
Collapse
Affiliation(s)
- Matias Hemmilä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku; ,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | - Markus Matilainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu;
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| |
Collapse
|
19
|
Mahmood FF, Beck M, de Gast A, Rehbein P, French GJ, Becker R, Dominkus M, Helmy N, Hollmann L, Baines J. Survivorship and Patient-Reported Outcomes of an Uncemented Vitamin E-Infused Monoblock Acetabular Cup: A Multicenter Prospective Cohort Study. J Arthroplasty 2021; 36:1700-1706. [PMID: 33516632 DOI: 10.1016/j.arth.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Addition of vitamin E to polyethylene is theorized to reduce the potential for oxidative wear in acetabular components. This paper presents a multicenter prospective cohort study that reports on outcomes from use of a Vitamin E-infused highly cross-linked polyethylene acetabular cup. METHODS Patients were recruited across nine medical institutions. Clinical outcome measures recorded were the Harris Hip Score, visual analogue score for pain and satisfaction. Evidence of implant loosening or osteolysis was collected radiologically. Cup survival and reasons for revision in relevant cases were also recorded. Data collection was undertaken preoperatively, at 6-12 weeks, 6 months, 1 year, 2 years, and 5 years. A total of 675 patients were recruited, with 450 cases available at final review. Data regarding cup survival was available to 8 years and 9 months postoperatively. RESULTS Improvements in both the Harris Hip Score and visual analogue score for pain and satisfaction were recorded at all time points, with these being maintained through the length of follow-up. In total, 89% of cups were implanted within the Lewinnek safe zone. A lucent line was identified in one case, with no evidence of acetabular osteolysis observed throughout the follow-up period. Cup survival was 98.9% at 8 years and 9 months. No revisions for aseptic loosening were observed. CONCLUSIONS The use of a vitamin E-infused polyethylene acetabular cup demonstrates reassuring patient-reported outcomes, radiological measures, and cup survival at medium to long-term follow-up.
Collapse
Affiliation(s)
- Fahd F Mahmood
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Martin Beck
- Luzerner Kantonsspital, Luzern, Switzerland; Orthopaedic Clinic Lucerne, Hirslanden Clinic St. Anna, Lucerne
| | - Arthur de Gast
- Diakonessenhuis Utrecht, Utrecht, the Netherlands; Clinical Orthopedic Research Center Midden-Nederland, Diakonessenhuis Zeist, Zeist, the Netherlands
| | - Philipp Rehbein
- Department of Orthopaedics, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | | | - Roland Becker
- Dept. of Orthopedics and Traumatology, Brandenburg Medical School, Brandenburg, Germany
| | - Martin Dominkus
- Orthopaedic Department, Orthopädisches Spital Speising, Wien, Austria; Sigmund Freud University, Campus Prater Freudplatz 1, Wien, Austria
| | - Naeder Helmy
- Department of Orthopaedics, Nurgerspital Solothurn, Solothurn, Switzerland
| | - Lutz Hollmann
- Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands
| | - Joe Baines
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| |
Collapse
|
20
|
Huang CH, Lu YC, Hsu LI, Liau JJ, Chang TK, Huang CH. Effect of material selection on tibial post stresses in posterior-stabilized knee prosthesis. Bone Joint Res 2020; 9:768-777. [PMID: 33135462 PMCID: PMC7649505 DOI: 10.1302/2046-3758.911.bjr-2020-0019.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims The material and design of knee components can have a considerable effect on the contact characteristics of the tibial post. This study aimed to analyze the stress distribution on the tibial post when using different grades of polyethylene for the tibial inserts. In addition, the contact properties of fixed-bearing and mobile-bearing inserts were evaluated. Methods Three different grades of polyethylene were compared in this study; conventional ultra high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (HXLPE), and vitamin E-stabilized polyethylene (VEPE). In addition, tibial baseplates with a fixed-bearing and a mobile-bearing insert were evaluated to understand differences in the contact properties. The inserts were implanted in neutral alignment and with a 10° internal malrotation. The contact stress, von Mises stress, and equivalent plastic strain (PEEQ) on the tibial posts were extracted for comparison. Results The stress and strain on the tibial post for the three polyethylenes greatly increased when the insert was placed in malrotation, showing a 38% to 56% increase in von Mises stress and a 335% to 434% increase in PEEQ. The VEPE insert had the lowest PEEQ among the three materials. The mobile-bearing design exhibited a lower increase in stress and strain around the tibial posts than the fixed-bearing design. Conclusion Using VEPE for the tibial component potentially eliminates the risk of material permanent deformation. The mobile-bearing insert can help to avoid a dramatic increase in plastic strain around the tibial post in cases of malrotation. The mobility allows the pressure to be distributed on the tibial post and demonstrated lower stresses with all three polyethylenes simulated. Cite this article: Bone Joint Res 2020;9(11):768–777.
Collapse
Affiliation(s)
- Chang-Hung Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Institute of Geriatric Welfare Technology and Science, MacKay Medical College, New Taipei City, Taiwan
| | - Yung-Chang Lu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Lin-I Hsu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jiann-Jong Liau
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ting-Kuo Chang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Hsiung Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Orthopaedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
21
|
Kjærgaard K, Ding M, Jensen C, Bragdon C, Malchau H, Andreasen CM, Ovesen O, Hofbauer C, Overgaard S. Vitamin E-doped total hip arthroplasty liners show similar head penetration to highly cross-linked polyethylene at five years: a multi-arm randomized controlled trial. Bone Joint J 2020; 102-B:1303-1310. [PMID: 32993343 PMCID: PMC7517722 DOI: 10.1302/0301-620x.102b10.bjj-2020-0138.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm). Methods Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and acetabular component migration were measured using radiostereometric analysis at baseline, three, 12, 24, and 60 months postoperatively. The Harris Hip Score, University of California, Los Angeles (UCLA) Activity Score, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey questionnaire (SF-36) were assessed at baseline, three, 12, 36, and 60 months. Results Of 220 screened patients, 127 were included in this study. In all, 116 received the allocated intervention, and 94 had their results analyzed at five years. Head penetration was similar between liner materials and head sizes at five years, vE-PE versus XLPE was -0.084 mm (95% confidence interval (CI) -0.173 to 0.005; p = 0.064), and 32 mm versus 36 mm was -0.020 mm (95% CI -0.110 to 0.071; p = 0.671), respectively. No differences were found in acetabular component migration or in the patient-reported outcome measures. Conclusion No significant difference in head penetration was found at five years between vE-PE and XLPE liners, nor between 32 mm and 36 mm heads. Cite this article: Bone Joint J 2020;102-B(10):1303–1310.
Collapse
Affiliation(s)
- Kristian Kjærgaard
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ming Ding
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, Kolding Hospital, Kolding, Denmark
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina M Andreasen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Ovesen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | | | - Søren Overgaard
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
22
|
Wyatt MC, Roberton A, Foxall-Smi M, Beswick AD, Kunutsor SK, Whitehouse MR. Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis. Hip Int 2020; 30:598-608. [PMID: 31213083 DOI: 10.1177/1120700019858335] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Vitamin E highly cross-linked polyethylene (HXLPE) was developed to reduce wear in total hip replacement (THR). This formal systematic review and meta-analysis aimed to provide independent synthesis of wear characteristics of Vitamin E treated HXLPE compared to HXPLE/UHMWPE. Secondary outcome measures were differences in revision rates and functional scores. METHODS We performed a formal systematic review as per PRISMA guidelines; literature searches were conducted on 14 November 2017 (MEDLINE, Embase on Ovid, and the Cochrane Library). We included randomised controlled trials, analyses of joint registries, and case-controlled studies of primary THR comparing cups with a vitamin E HXLPE bearing with bearing surfaces made from other types of polyethylene. Initial screening was performed by 2 independent assessors; disagreement resolved in discussion with a third reviewer. Studies were evaluated using the Cochrane risk of bias tool. Data extraction permitted meta-analysis. RESULTS 372 studies were identified on initial screening, 5 studies met the eligibility criteria. There was no significant heterogeneity between studies. There was variable risk of bias. At a mean of 35 (range 20-60) months, Vitamin E HXLPE had significant advantages over highly cross-linked polyethylene with regards total femoral head penetration (p = 0.004). Given the RSA measurement errors this may not be clinically significant.There were neither significant differences in revision rates nor Harris Hip Scores (p = 0.06). CONCLUSION At a minimum of 3 years follow-up there was reduced total femoral head penetration for vitamin E HXLPE over HXLPE. This bearing surface does not, as yet, have clinically significant advantages in terms of revision rates or patient function over HXLPE.
Collapse
Affiliation(s)
- Michael C Wyatt
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrew Roberton
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Michael Foxall-Smi
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| |
Collapse
|
23
|
Influence of Irradiation Temperature on Oxidative and Network Properties of X-Ray Cross-Linked Vitamin E Stabilized UHMWPE for Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2568428. [PMID: 32280683 PMCID: PMC7125449 DOI: 10.1155/2020/2568428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Previous studies have shown that increased cross-link density, reduced free radicals, and increased antioxidant grafting resulting from electron-beam irradiation at elevated temperatures improved the wear performance and the oxidative stability of vitamin E blended UHMWPE. The current study explores the impact of elevated irradiation temperature on vitamin E blended UHMWPE using X-ray. We hypothesize that the effects of temperature would be similar to those observed after electron-beam irradiation due to the relatively high dose rate of X-rays. Two X-ray doses of 80 and 100 kGy and two irradiation temperatures, that is, room temperature and 100°C were considered. The reference was Vitelene®, a vitamin E stabilized polyethylene cross-linked with 80 kGy by e-beam at 100°C. Oxidation index and oxidation induction time, as well as cross-link density, gel fraction, and trans-vinylene index, were determined, as the oxidative and network properties are decisive for the long-term implant performance. Gel fraction and oxidation induction time were significantly improved subsequently to warm irradiation in comparison with the material irradiated at room temperature. In conclusion, X-ray irradiation at elevated temperatures resulted in an increase of cross-linking and oxidative resistance of vitamin E stabilized polyethylene comparable to those of e-beam irradiated UHMWPE.
Collapse
|
24
|
Lindalen E, Thoen PS, Nordsletten L, Høvik Ø, Röhrl SM. Low wear rate at 6-year follow-up of vitamin E-infused cross-linked polyethylene: a randomised trial using 32- and 36-mm heads. Hip Int 2019; 29:355-362. [PMID: 30227721 DOI: 10.1177/1120700018798790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Free radicals formed in the cross-linking process may over time alter the mechanical properties of highly cross-linked polyethylene. Vitamin E-infused highly cross-linked polyethylene was therefore developed to achieve low wear-rate and good mechanical properties in the long term. AIM To present 6-year results from the initial randomised controlled trial. PATIENTS AND METHODS We measured wear and periacetabular bone remodelling in cementless total hip arthroplasty; 32- or 36-mm Biolox Delta heads and vitamin E-infused highly cross-linked polyethylene (E-Poly) were used. Markerless radiosterometric analysis measured the in vivo wear and dual energy x-ray absorptiometry was used to analyse bone remodelling in 40 hips at 6-year follow-up. RESULTS In the proximal direction the wear for 32- and 36-mm heads was 0.15 mm (95% confidence interval [CI], 0.08-0.21) and 0.06 mm (95% CI, -0.002-0.12), respectively (p = 0. 015). However, between 3 months and 6 years (excluding the period of "bedding in"), the proximal wear for 32- and 36-mm heads was 0.10 mm (95% CI, 0.05-0.15) and 0.05 mm (95% CI, -0.01-0.11), respectively (p = 0.12). The annual proximal wear rate for 32- and 36-mm heads from 3 months to 6 years was 0.02 mm and 0.01 mm, respectively. There was no difference in bone remodelling around the cup from baseline to 6 years for the total material and no differences between study groups. CONCLUSION Wear of this vitamin E-infused highly cross-linked polyethylene is still low at 6-year follow-up, with no significant difference in wear from 3 months to 6 years between 32- and 36-mm heads.
Collapse
Affiliation(s)
- Einar Lindalen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Peder S Thoen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Lars Nordsletten
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øystein Høvik
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Stephan M Röhrl
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
25
|
Materials for Hip Prostheses: A Review of Wear and Loading Considerations. MATERIALS 2019; 12:ma12030495. [PMID: 30764574 PMCID: PMC6384837 DOI: 10.3390/ma12030495] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/15/2022]
Abstract
Replacement surgery of hip joint consists of the substitution of the joint with an implant able to recreate the articulation functionality. This article aims to review the current state of the art of the biomaterials used for hip implants. Hip implants can be realized with different combination of materials, such as metals, ceramics and polymers. In this review, we analyze, from international literature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e., being biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a low wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We analyzed the scientific literature, collecting information on the material behavior and the human-body response to it. Particular attention has been given to the tribological behavior of the biomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After more than 50 years of evolution, in term of designs and materials, the actual wear rate of the most common implants is low, allowing us to sensibly reduce the risk related to the widespread debris distribution in the human body.
Collapse
|
26
|
Galea VP, Connelly JW, Shareghi B, Kärrholm J, Sköldenberg O, Salemyr M, Laursen MB, Muratoglu O, Bragdon C, Malchau H. Evaluation of in vivo wear of vitamin E-diffused highly crosslinked polyethylene at five years. Bone Joint J 2018; 100-B:1592-1599. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0371.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims The primary aim of this study was to compare the wear properties of vitamin E-diffused, highly crosslinked polyethylene (VEPE) and one formulation of moderately crosslinked and mechanically annealed ultra-high molecular weight polyethylene (ModXLPE) in patients five years after primary total hip arthroplasty (THA). The secondary aim was to assess the clinical results of patients treated with VEPE by evaluating patient-reported outcome measures (PROMs), radiological evidence of fixation, and the incidence of mechanical failure. Patients and Methods A total of 208 patients (221 THAs) from four international centres were recruited into a prospective study involving radiostereometric analysis (RSA) and the assessment of clinical outcomes. A total of 193 hips (87%) were reviewed at the five-year follow-up. Of these, 136 (70%) received VEPE (vs ModXLPE) liners and 68 (35%) received ceramic (vs metal) femoral heads. PROMs and radiographs were collected preoperatively and at one, two, and five years postoperatively. In addition, RSA images were collected to measure PE wear postoperatively and at one, two, and five years after surgery. Results We observed similar bedding in one year postoperatively and wear two years postoperatively between the two types of liner. However, there was significantly more penetration of the femoral head in the ModXLPE cohort compared with the VEPE cohort five years postoperatively (p < 0.001). The only variables independently predictive of increased wear were ModXLPE (vs VEPE) liner type (β = 0.22, p = 0.010) and metal (vs ceramic) femoral head (β = 0.21, p = 0.013). There was no association between increased wear and the development of radiolucency (p = 0.866) or PROMs. No patient had evidence of osteolysis. Conclusion Five years postoperatively, patients with VEPE (vs ModXLPE) and ceramic (vs metal) femoral heads had decreased wear. The rates of wear for both liners were very low and have not led to any osteolysis or implant failure due to aseptic loosening.
Collapse
Affiliation(s)
- V. P. Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J. W. Connelly
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B. Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O. Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. Salemyr
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. B. Laursen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - O. Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - H. Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Lambert B, Neut D, van der Veen HC, Bulstra SK. Effects of vitamin E incorporation in polyethylene on oxidative degradation, wear rates, immune response, and infections in total joint arthroplasty: a review of the current literature. INTERNATIONAL ORTHOPAEDICS 2018; 43:1549-1557. [PMID: 30470866 DOI: 10.1007/s00264-018-4237-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this review summarizes the first clinical results of total hip and knee arthroplasties with vitamin E incorporated highly cross-linked polyethylene. Based on in vitro studies, incorporation of vitamin E in polyethylene provides good oxidative protection and preserves low wear rates. Incorporation of vitamin E may have the beneficial effect of reduced inflammatory response to its wear particles. Some microorganisms showed reduced adherence to vitamin E-incorporated UHMWPE; however, clinical relevance is doubtful. Short-term clinical studies of total hip and knee arthroplasties with vitamin E-incorporated highly cross-linked UHMWPE reported good clinical results and wear rates similar to highly cross-linked UHMWPE without vitamin E.
Collapse
Affiliation(s)
- Bart Lambert
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
28
|
Ludwig KB, Chandrasekar V, Saylor DM, Van Citters DW, Reinitz SD, Forrey C, McDermott MK, Wickramasekara S, Janes DW. Characterizing the free volume of ultrahigh molecular weight polyethylene to predict diffusion coefficients in orthopedic liners. J Biomed Mater Res B Appl Biomater 2017; 106:2393-2402. [DOI: 10.1002/jbm.b.34045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/21/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Kyle B. Ludwig
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | - Vaishnavi Chandrasekar
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | - David M. Saylor
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | | | - Steven D. Reinitz
- Thayer School of Engineering; Dartmouth College; Hanover New Hampshire 03755
| | - Christopher Forrey
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | - Martin K. McDermott
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | - Samanthi Wickramasekara
- Center for Devices and Radiological Health, U.S. Food and Drug Administration; Silver Spring Maryland 20993
| | | |
Collapse
|
29
|
Chen W, Bichara DA, Suhardi J, Sheng P, Muratoglu OK. Effects of vitamin E-diffused highly cross-linked UHMWPE particles on inflammation, apoptosis and immune response against S. aureus. Biomaterials 2017; 143:46-56. [DOI: 10.1016/j.biomaterials.2017.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/31/2023]
|
30
|
Pro-oxidant activity of α-tocopherol during photooxidative degradation of polyolefins. ESRI and IR microspectroscopy studies. Polym Degrad Stab 2017. [DOI: 10.1016/j.polymdegradstab.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
31
|
Currier BH, Currier JH, Holdcroft LA, Van Citters DW. Effectiveness of anti-oxidant polyethylene: What early retrievals can tell us. J Biomed Mater Res B Appl Biomater 2017; 106:353-359. [DOI: 10.1002/jbm.b.33840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Barbara H. Currier
- Thayer School of Engineering; Dartmouth College; Hanover New Hampshire 03755
| | - John H. Currier
- Thayer School of Engineering; Dartmouth College; Hanover New Hampshire 03755
| | | | | |
Collapse
|
32
|
Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial. INTERNATIONAL ORTHOPAEDICS 2016; 41:1113-1118. [DOI: 10.1007/s00264-016-3320-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
|
33
|
Nebergall AK, Troelsen A, Rubash HE, Malchau H, Rolfson O, Greene ME. Five-Year Experience of Vitamin E-Diffused Highly Cross-Linked Polyethylene Wear in Total Hip Arthroplasty Assessed by Radiostereometric Analysis. J Arthroplasty 2016; 31:1251-1255. [PMID: 26777551 DOI: 10.1016/j.arth.2015.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (VEPE) was developed to reduce oxidation without compromising mechanical strength. The purpose of this study was to evaluate VEPE in vivo using radiostereometric analysis (RSA) and patient-reported outcome measures (PROMs). METHODS Fifty-one hips were enrolled. Each patient received a VEPE liner, a porous titanium shell, and an uncemented stem with a 32-mm cobalt-chrome femoral head. Tantalum beads were inserted into the VEPE to measure femoral head penetration using RSA. RSA radiographs and PROMs were obtained preoperatively immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. RESULTS Forty-seven hips returned at 3 years, and 42 hip at 5 years. The mean ± standard error of the mean proximal head penetration into the polyethylene was 0.06 ± 0.01 at 5 years. The amount of head penetration did not change significantly with increasing time in vivo. The mean ± standard error of the mean Harris Hip Score was 58 ± 2 preoperatively, which improved significantly to 93 ± 2 at 5 years (P < .001). CONCLUSION The head penetration into VEPE liners was low compared with non-VEPE at 5 years. After settling of the liners in the early period, no significant head penetration occurred from 2- to 5-year follow-up. All PROMs improved significantly from preoperative to postoperative and remained very favorable at 5 years. This study documents the longest-term evaluation of in vivo wear performance of VEPE.
Collapse
Affiliation(s)
- Audrey K Nebergall
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Anders Troelsen
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Copenhagen University Hvidovre Hospital, Hvidovre, Denmark
| | - Harry E Rubash
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Henrik Malchau
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Ola Rolfson
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meridith E Greene
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
34
|
Doudin K, Al-Malaika S. Vitamin E-stabilised UHMWPE for surgical orthopaedic implants: Quantification of vitamin E and characterisation of its transformation products. Polym Degrad Stab 2016. [DOI: 10.1016/j.polymdegradstab.2015.11.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
Jahan MS, Walters BM, Riahinasab T, Gnawali R, Adhikari D, Trieu H. A comparative study of radiation effects in medical-grade polymers: UHMWPE, PCU and PEEK. Radiat Phys Chem Oxf Engl 1993 2016. [DOI: 10.1016/j.radphyschem.2015.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
36
|
E-vitamin infused highly cross-linked polyethylene: RSA results from a randomised controlled trial using 32 mm and 36 mm ceramic heads. Hip Int 2015; 25:50-5. [PMID: 25633755 DOI: 10.5301/hipint.5000195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Polyethylene wear has been a major cause of revision of cementless total hip replacements. Highly cross-linked polyethylene has been developed to increase mechanical resistance to wear. However, cross-linking from irradiation of the polyethylene generates free radicals and these can oxidise in vivo and might over time alter the initial mechanical properties. Vitamin-E infused highly cross-linked polyethylene has been developed to reduce the amount of free radicals without compromising the mechanical properties. PURPOSE To measure wear of vitamin E infused highly cross-linked polyethylene and compare wear between 2 different head sizes. METHODS In a prospective randomised study between 32 mm and 36 mm Biolox® delta heads in 50 hips we analysed the in vivo wear of the E-poly™ with markerless radiostereometry. RESULTS Mean (95% CI) wear for the total material was 0.041 mm (0.015-0.066) in the vertical direction and 0.177 mm (0.155-0.200) in the total 3D direction. After the anticipated period of bedding-in we found no statistically significant differences in wear from three months to 2 years in vertical and total 3D directions. Although statistical significant differences between 32 mm and 36 mm heads were found in the total 3D direction we cannot conclude that there are significant clinical important differences in wear comparing these head sizes. CONCLUSIONS This study shows promising early results with very low wear, even for 36 mm heads, but long term follow-up is necessary to evaluate if this polyethylene will provide low wear and good mechanical properties in the long-term.
Collapse
|
37
|
Gigante A, Bottegoni C, Ragone V, Banci L. Effectiveness of Vitamin-E-Doped Polyethylene in Joint Replacement: A Literature Review. J Funct Biomater 2015; 6:889-900. [PMID: 26371052 PMCID: PMC4598683 DOI: 10.3390/jfb6030889] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/24/2015] [Accepted: 08/08/2015] [Indexed: 12/25/2022] Open
Abstract
Since polyethylene is one of the most frequently used biomaterials, such as in bearing components in joint arthroplasty, strong efforts have been made to improve the design and material properties over the last decades. Antioxidants, such as vitamin-E, seem to be a promising alternative to further increase durability and reduce polyethylene wear and degradation in the long-term. Nevertheless, even if several promising in vitro results are available, there is yet no clinical evidence that vitamin-E polyethylenes show these advantages in vivo. The aim of this paper was to provide a comprehensive overview on the current knowledge regarding the biological and mechanical proprieties of this biomaterial, underlying the in vitro and in vivo evidence for effectiveness of vitamin-E-doped polyethylene in joint arthroplasty.
Collapse
Affiliation(s)
- Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Carlo Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Vincenza Ragone
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
| | - Lorenzo Banci
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
| |
Collapse
|
38
|
de Villiers D, Traynor A, Collins SN, Shelton JC. The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives. Proc Inst Mech Eng H 2015; 229:611-8. [PMID: 26183804 PMCID: PMC4626785 DOI: 10.1177/0954411915595433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/06/2015] [Indexed: 12/12/2022]
Abstract
Hypersensitivity reactions in patients receiving metal-on-metal hip replacements have been attributed to corrosion products as observed by elevated cobalt and chromium ions in the blood. Although the majority of cases are reported in metal-on-metal, incidences of these reactions have been reported in the metal-on-polyethylene patient population. To date, no in vitro study has considered cobalt release for this bearing combination. This study considered four 28 mm and seven 52 mm diameter metal-on-polyethylene bearings tested following ISO standard hip simulator conditions as well as under established abrasive conditions. These tests showed measurable cobalt in all bearings under standard conditions. Cobalt release, as well as polyethylene wear, increased with diameter, increasing from 52 to 255 ppb. The introduction of bone cement particles into the articulation doubled polyethylene wear and cobalt release while alumina particles produced significant damage on the heads demonstrated by cobalt levels of 70,700 ppb and an increased polyethylene wear from a mean value of 9–160 mm3/mc. Cobalt release was indicative of head damage and correlated with polyethylene wear at the next gravimetric interval. The removal of third body particles resulted in continued elevated cobalt levels in the 52 mm diameter bearings tested with alumina compared to standard conditions but the bearings tested with bone cement particles returned to standard levels. The polyethylene wear in the bone cement tested bearings also recovered to standard levels, although the alumina tested bearings continued to wear at a higher rate of 475 mm3/mc. Cobalt release was shown to occur in metal-on-polyethylene bearings indicating damage to the metal head resulting in increased polyethylene wear. While large diameter metal-on-polyethylene bearings may provide an increased range of motion and a reduced dislocation risk, increased levels of cobalt are likely to be released and this needs to be fully considered before being widely adopted.
Collapse
Affiliation(s)
- Danielle de Villiers
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | | | | | - Julia C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| |
Collapse
|
39
|
A comprehensive study of ultra-high molecular weight polyethylene modified by α-tocopherol after exposure to extremely high temperatures. Russ Chem Bull 2015. [DOI: 10.1007/s11172-014-0771-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Rowell SL, Muratoglu OK. Investigation of surgically retrieved, vitamin E-stabilized, crosslinked UHMWPE implants after short-termin vivoservice. J Biomed Mater Res B Appl Biomater 2015; 104:1132-40. [DOI: 10.1002/jbm.b.33465] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 01/30/2015] [Accepted: 05/07/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Shannon L. Rowell
- Harris Orthopaedics Laboratory; Massachusetts General Hospital; Boston MA
| | - Orhun K. Muratoglu
- Harris Orthopaedics Laboratory; Massachusetts General Hospital; Boston MA
- Department of Orthopaedic Surgery; Harvard Medical School; Boston MA
| |
Collapse
|
41
|
Wear Performance of UHMWPE and Reinforced UHMWPE Composites in Arthroplasty Applications: A Review. LUBRICANTS 2015. [DOI: 10.3390/lubricants3020413] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
42
|
Huang CH, Lu YC, Chang TK, Hsiao IL, Su YC, Yeh ST, Fang HW, Huang CH. In vivo biological response to highly cross-linked and vitamin e-doped polyethylene--a particle-Induced osteolysis animal study. J Biomed Mater Res B Appl Biomater 2015; 104:561-7. [PMID: 25952769 DOI: 10.1002/jbm.b.33426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 03/06/2015] [Accepted: 03/27/2015] [Indexed: 01/13/2023]
Abstract
Polyethylene particle-induced osteolysis is the primary limitation in the long-term success of total joint replacement with conventional ultra high molecular weight polyethylene (UHMWPE). Highly cross-linked polyethylene (HXLPE) and vitamin E-doped cross-linked polyethylene (VE-HXLPE) have been developed to increase the wear resistance of joint surfaces. However, very few studies have reported on the incidence of particle-induced osteolysis for these novel materials. The aim of this study was to use a particle-induced osteolysis animal model to compare the in vivo biological response to different polymer particles. Three commercially available polymers (UHMWPE, HXLPE, and VE-HXLPE) were compared. Osseous properties including the bone volume relative to the tissue volume (BV/TV), trabecular thickness (Tb. Th), and bone mineral density (BMD) were examined using micro computed tomography. Histological analysis was used to observe tissue inflammation in each group. This study demonstrated that the osseous properties and noticeable inflammatory reactions were obviously decreased in the HXLPE group. When compared with the sham group, a decrease of 12.7% was found in BV/TV, 9.6% in BMD and 8.3% in Tb.Th for the HXLPE group. The heightened inflammatory response in the HXLPE group could be due to its smaller size and greater amount of implanted particles. Vitamin E diffused in vivo may not affect the inflammatory and osteolytic responses in this model. The morphological size and total cumulative amount of implanted particles could be critical factors in determining the biological response.
Collapse
Affiliation(s)
- Chang-Hung Huang
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Chang Lu
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan.,Department of Cosmetic Application and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Ting-Kuo Chang
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan
| | - I-Lin Hsiao
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan
| | - Yi-Ching Su
- Department of Chemical Engineering and Biotechnology and Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Shu-Ting Yeh
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology and Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Hsiung Huang
- Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan
| |
Collapse
|
43
|
Spectroscopic and chromatographic quantification of an antioxidant-stabilized ultrahigh-molecular-weight polyethylene. Clin Orthop Relat Res 2015; 473:952-9. [PMID: 25524430 PMCID: PMC4317457 DOI: 10.1007/s11999-014-4108-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The oxidative stability of various antioxidant-containing ultrahigh-molecular-weight polyethylene (UHMWPE) formulations has been widely reported. Depending on which specific antioxidant is used, the process by which it is incorporated into UHMWPE, and the amount of the antioxidant incorporated, there could be substantial differences in the material and toxicological properties of the UHMWPE formulation. Pentaerythritol tetrakis (3-[3,5-di tertiary butyl-4-hydroxyphenyl] propionate) (PBHP) has been extensively used as an efficient antioxidant in various applications. However, it has not thus far been used to stabilize UHMWPE in orthopaedic implants. It is therefore important to characterize and verify the concentration and homogeneity of distribution of PBHP in the composition, the chemical consequence of exposure of the antioxidant to gamma irradiation, and to assess the toxicological risk of use by the identification and quantification of leachables before the use of PBHP-containing UHMWPE in implantable devices. QUESTIONS/PURPOSES (1) Can the concentration and uniformity of distribution of the antioxidant PBHP in UHMWPE powder and in the consolidated, preirradiated formulation be verified? (2) Can the leachable compounds in the gamma radiation crosslinked PBHP/UHMWPE formulation be identified and quantified? METHODS PBHP in GUR 1020 UHMWPE was quantified by Fourier transform infrared (FTIR) and ultraviolet-visible (UV-Vis) spectroscopy. The chemical byproducts generated by gamma irradiation of PBHP were identified using gas chromatography in conjunction with mass spectrometry followed by a second-stage mass spectrometry (GC-MS/MS). When GC-MS/MS was coupled with Stir Bar Sorptive extraction, leachable components in the UHMWPE formulation were identified and quantified. RESULTS The percent concentration of PBHP in UHMWPE powder was confirmed by UV-Vis spectroscopy and the concentration and uniform distribution of PBHP in UHMWPE after consolidation and before radiation crosslinking was verified through FTIR spectroscopy. GC-MS/MS analysis enabled the identification and quantification of 16 gamma irradiation byproducts of PBHP. These 16 compounds were verified as potentially leachable compounds in PBHP-stabilized UHMWPE and were found to be well below the safety threshold concern of 150 ng/device in orthopaedic knee inserts made from PBHP-stabilized UHMWPE. CONCLUSIONS Spectroscopic analysis has been successfully used to demonstrate the ability to reliably quantify the amount as well as the distribution of PBHP in UHMWPE in orthopaedic bearings. State-of-the-art chemical extraction and analytical techniques have enabled the identification of the gamma radiation-induced byproducts of PBHP and the quantification of these components as leachables from the PBHP-stabilized UHMWPE formulation. CLINICAL RELEVANCE Antioxidant-stabilized UHMWPE materials being considered for orthopaedic bearings must be fully characterized for composition before use because it is apparent that exposure to high doses of gamma radiation would cause the formation of new chemical entities. It is important to verify the identities and quantities of chemical species that could leach out of implanted devices in the long term to enable their toxicological risk assessment.
Collapse
|
44
|
Kolanthai E, Bose S, Bhagyashree KS, Bhat SV, Asokan K, Kanjilal D, Chatterjee K. Graphene scavenges free radicals to synergistically enhance structural properties in a gamma-irradiated polyethylene composite through enhanced interfacial interactions. Phys Chem Chem Phys 2015; 17:22900-10. [DOI: 10.1039/c5cp02609a] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A unique strategy for scavenging free radicals in situ on exposure to gamma irradiation in polyethylene (PE) nanocomposites is presented.
Collapse
Affiliation(s)
- Elayaraja Kolanthai
- Department of Materials Engineering
- Indian Institute of Science
- Bangalore 560012
- India
| | - Suryasarathi Bose
- Department of Materials Engineering
- Indian Institute of Science
- Bangalore 560012
- India
| | - K. S. Bhagyashree
- Department of Physics
- Indian Institute of Science
- Bangalore 560012
- India
| | - S. V. Bhat
- Department of Physics
- Indian Institute of Science
- Bangalore 560012
- India
| | - K. Asokan
- Inter University Accelerator Centre
- Aruna Asaf Ali Marg
- New Delhi 110067
- India
| | - D. Kanjilal
- Inter University Accelerator Centre
- Aruna Asaf Ali Marg
- New Delhi 110067
- India
| | - Kaushik Chatterjee
- Department of Materials Engineering
- Indian Institute of Science
- Bangalore 560012
- India
| |
Collapse
|
45
|
Oral E, Neils A, Muratoglu OK. High vitamin E content, impact resistant UHMWPE blend without loss of wear resistance. J Biomed Mater Res B Appl Biomater 2014; 103:790-7. [DOI: 10.1002/jbm.b.33256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Ebru Oral
- Harris Orthopaedic Laboratory; Massachusetts General Hospital; Boston Massachusetts
- Department of Orthopaedic Surgery; Harvard Medical School; Boston Massachusetts
| | - Andrew Neils
- Harris Orthopaedic Laboratory; Massachusetts General Hospital; Boston Massachusetts
| | - Orhun K. Muratoglu
- Harris Orthopaedic Laboratory; Massachusetts General Hospital; Boston Massachusetts
- Department of Orthopaedic Surgery; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
46
|
Oral E, Neils A, Yabannavar P, Muratoglu OK. The effect of an additional phosphite stabilizer on the properties of radiation cross-linked vitamin E blends of UHMWPE. J Orthop Res 2014; 32:757-61. [PMID: 24536024 DOI: 10.1002/jor.22597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/20/2014] [Indexed: 02/04/2023]
Abstract
Antioxidant stabilization of radiation cross-linked ultrahigh molecular weight polyethylene (UHMWPE) has been introduced to improve the oxidative stability of total joint implant bearing surfaces. Blending of an antioxidant with UHMWPE resin powder followed by consolidation and radiation cross-linking has been cleared by the FDA for use in both total hips and total knees for designs incorporating two antioxidants, namely vitamin E and Covernox™ (a medical grade version of Irganox™ 1010). The antioxidants in the polymer are expected to protect the polymer during consolidation, during radiation cross-linking, on the shelf before implantation, and in vivo after implantation. To maximize the protection of the polymer afforded by the antioxidant in vivo, a novel approach may be the use of multiple antioxidants, especially to protect the primary antioxidant for a longer period of time. We hypothesized that the addition of a phosphite stabilizer (Irgafos 168™) commonly used in conjunction with hindered phenolic antioxidants in polymer processing could improve the oxidative stability of radiation cross-linked blends of vitamin E. To test our hypothesis, we prepared UHMWPE blends with 0.05 wt% Irgafos and 0.05 wt% vitamin E and compared its cross-link density, wear resistance, tensile properties, and impact strength to control blends containing only vitamin E. Our hypothesis was not supported; the cross-link density of UHMWPE was significantly decreased by the additive without additional benefit to oxidative stability. To our knowledge, this was the first attempt at using multiple stabilizers in medical grade UHMWPE.
Collapse
Affiliation(s)
- Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | | | | |
Collapse
|
47
|
Xia XC, Zhang QP, Wang L, He S, Feng JM, Yang MB. Extension of the orientation region of high density polyethylene molded by gas-assisted injection molding: control of the thermal field. POLYM INT 2014. [DOI: 10.1002/pi.4743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Xiao-Chao Xia
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| | - Quan-Ping Zhang
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| | - Long Wang
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| | - Shan He
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| | - Jian-Ming Feng
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| | - Ming-Bo Yang
- College of Polymer Science and Engineering and the State Key Laboratory of Polymer Materials Engineering; Sichuan University; Chengdu 610065 Sichuan PR China
| |
Collapse
|
48
|
Heuer EG, Braithwaite GJC, Miller BL, Spiegelberg SH, Gsell RA, Rufner AS, Stark N. Oxidative-induction time as a measure of vitamin E concentration in ultra-high molecular weight polyethylene. J Biomed Mater Res B Appl Biomater 2014; 103:106-15. [PMID: 24771508 DOI: 10.1002/jbm.b.33175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 03/19/2014] [Accepted: 03/30/2014] [Indexed: 11/09/2022]
Abstract
A novel, sensitive method for quantifying an equivalent antioxidant concentration, specifically vitamin E (VE), in postprocessed ultra-high molecular weight polyethylene (UHMWPE) for orthopedic implants is presented. This method correlates oxidative-induction time (OIT) determined from differential scanning calorimetry with starting VE weight percent in solvent blended samples using a nonlinear power law fit. The generated calibration curve reliably determined the equivalent VE concentration down to blended concentrations lower than 0.007 wt %, with a measurement uncertainty of 0.0009 wt %. This measurement uncertainty implies a detection limit that is significantly lower than currently achievable with the established method using Fourier transform infrared spectroscopy to calculate a VE index. However, exact processes that are influencing the OIT in irradiated materials are unclear at this time. UHMWPE blended with VE in powder, consolidated and irradiated form were investigated. In addition, intralaboratory results give support that this technique may lend itself to standardization in quality control and verification.
Collapse
|
49
|
Mehmood MS, Walters BM, Yasin T, Ahmad M, Jahan MS, Mishra SR, Ikram M. Correlation of residual radical’s with three phase morphology of UHMWPE: Analysis for the dependence on heat involved during vitamin E diffusion. Eur Polym J 2014. [DOI: 10.1016/j.eurpolymj.2014.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
50
|
Visco AM, Campo N, Brancato V, Trimarchi M. Influence of α-Tocopherol Load and Annealing Treatment on the Wear Resistance of Biomedical UHMWPE Irradiated with Electron Beam. INTERNATIONAL JOURNAL OF POLYMER ANALYSIS AND CHARACTERIZATION 2013. [DOI: 10.1080/1023666x.2013.819545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|