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Mallett KE, Guarin Perez SF, Hooke AW, Tanner AM, Bland JT, Fitzsimmons JS, Taunton MJ, Sierra RJ. The Frank Stinchfield Award: Assembly and Dissociation Forces Differ Between Commonly Used Dual Mobility Implants: A Biomechanical Study. J Arthroplasty 2024; 39:S3-S8. [PMID: 38479635 DOI: 10.1016/j.arth.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intraprosthetic dissociation (IPD) is a complication unique to dual mobility (DM) implants where the outer polyethylene head dissociates from the inner femoral head. Increasing reports of IPD at the time of closed reduction of large head DM dislocations prompted this biomechanical study evaluating the assembly and dissociation forces of DM heads. METHODS We tested 17 polyethylene DM heads from 5 vendors. Of the heads, 12 were highly cross-linked polyethylene (4 vendors) and 5 were infused with vitamin E (2 vendors). Heads were between 46 and 47 mm in diameter, accepting a 28 mm-inner ceramic head. Implants were assembled and disassembled using a servohydraulic machine that recorded the forces and torques applied during testing. Dissociation was tested via both axial pull-out and lever-out techniques, where lever-out simulated stem-on-acetabular component impingement. RESULTS The initial maximum assembly force was significantly different between all vendors (P < .01) and decreased for all implants with subsequent assembly. Vendor 4-E (Link with vitamin E) heads required the highest assembly force (1,831.9 ± 81.95 N), followed by Vendor 3 (Smith & Nephew), Vendor 5 (DePuy Synthes), Vendor 1-E (Zimmer Biomet with vitamin E), Vendor 2 (Stryker), and Vendor 1 (Zimmer Biomet Arcom). Vendor 4-E implants showed the greatest dissociation resistance in both pull-out (2,059.89 N, n = 1) and lever-out (38.95 ± 2.79 Nm) tests. Vendor 1-E implants with vitamin E required higher assembly force, dissociation force, and energy than Vendor 1 heads without vitamin E. CONCLUSIONS There were notable differences in DM assembly and dissociation forces between implants. Diminishing force was required for assembly with each additional trial across vendors. Vendor 4-E DM heads required the highest assembly and dissociation forces. Vitamin E appeared to increase the assembly and dissociation forces. Based on these results, DM polyethylene heads should not be reimplanted after dissociation, and there may be a role for establishing a minimum dissociation energy standard to minimize IPD risk.
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Affiliation(s)
| | | | | | - Allison M Tanner
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | - Joshua T Bland
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | | | | | - Rafael J Sierra
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
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Inverardi N, Lekkala S, Serafim MF, Sekar A, Wannomae KK, Micheli B, Bedair H, Muratoglu OK, Oral E. Diffusion doping of analgesics into UHMWPE for prophylactic pain management. J Mater Chem B 2024. [PMID: 39192832 DOI: 10.1039/d4tb01050g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Pain management after total joint arthroplasty is often addressed by systemic delivery of opioids. Local delivery of non-opioid analgesic drugs directly in the joint space from the UHMWPE component of the prosthesis would be highly beneficial to increase the efficacy of the drugs, decreasing the overall side effects and the risk of opioid addiction. It has been shown that effective concentrations of local analgesics can be achieved by eluting from analgesic-blended UHMWPE; however, this approach is limited by the decrease in mechanical properties resulting from the extent of phase separation of the blended drugs from the polymeric matrix. Here we hypothesized that mechanical properties could be maintained by incorporating analgesics into solid form UHMWPE by diffusion as an alternative method. Lidocaine or bupivacaine were diffused in solid form UHMWPE with or without radiation crosslinking. The loaded drug content, the spatial distribution of the drugs and their chemical stability after doping were characterized by FTIR and NMR spectroscopy, respectively. Drug release kinetics, tensile mechanical properties and wear rates were assessed. The results showed that diffusion doping could be used as a promising method to obtain a therapeutic implant material without compromising its mechanical and structural integrity.
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Affiliation(s)
- Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Maria F Serafim
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Amita Sekar
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Keith K Wannomae
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Brad Micheli
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Hany Bedair
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Khan AZ, Maxwell MJ, Parrott RM, Bowler AR, Glass EA, Miller D, Vasconcellos D, Brownhill JR, Austin LS, Cuff DJ, Murthi AM, Smith MJ, Wiater JM, Jawa A. Effect of vitamin E-enhanced highly cross-linked polyethylene on wear rate and particle debris in anatomic total shoulder arthroplasty: a biomechanical comparison to ultrahigh-molecular-weight polyethylene. J Shoulder Elbow Surg 2024; 33:1465-1472. [PMID: 38182025 DOI: 10.1016/j.jse.2023.11.016] [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: 06/13/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce cross-linking, but reducing the resulting free radicals with melting or heat annealing can compromise the component's mechanical properties. Vitamin E has been introduced as an adjuvant to thermal treatments. Anatomic shoulder arthroplasty models with a ceramic head component have demonstrated that vitamin E-enhanced polyethylene show improved wear compared with highly cross-linked polyethylene (HXLPE). This study aimed to assess the biomechanical wear properties and particle size characteristics of a novel vitamin E-enhanced highly cross-linked polyethylene (VEXPE) glenoid compared to a conventional ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid against a cobalt chromium molybdenum (CoCrMo) head component. METHODS Biomechanical wear testing was performed to compare the VEXPE glenoid to UHMWPE glenoid with regard to pristine polyethylene wear and abrasive endurance against a polished CoCrMo alloy humeral head in an anatomic shoulder wear-simulation model. Cumulative mass loss (milligrams) was recorded, and wear rate calculated (milligrams per megacycle [Mc]). Under pristine wear conditions, particle analysis was performed, and functional biologic activity (FBA) was calculated to estimate particle debris osteolytic potential. In addition, 95% confidence intervals for all testing conditions were calculated. RESULTS The average pristine wear rate was statistically significantly lower for the VEXPE glenoid compared with the HXLPE glenoid (0.81 ± 0.64 mg/Mc vs. 7.00 ± 0.45 mg/Mc) (P < .05). Under abrasive wear conditions, the VEXPE glenoid had a statistically significant lower average wear rate compared with the UHMWPE glenoid comparator device (18.93 ± 5.80 mg/Mc vs. 40.47 ± 2.63 mg/Mc) (P < .05). The VEXPE glenoid demonstrated a statistically significant improvement in FBA compared with the HXLPE glenoid (0.21 ± 0.21 vs. 1.54 ± 0.49 (P < .05). CONCLUSIONS A new anatomic glenoid component with VEXPE demonstrated significantly improved pristine and abrasive wear properties with lower osteolytic particle debris potential compared with a conventional UHMWPE glenoid component. Vitamin E-enhanced polyethylene shows early promise in shoulder arthroplasty components. Long-term clinical and radiographic investigation needs to be performed to verify if these biomechanical wear properties translate to diminished long-term wear, osteolysis, and loosening.
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Affiliation(s)
- Adam Z Khan
- Northwest Permanente P.C., Portland, OR, USA
| | | | | | | | | | | | | | | | - Luke S Austin
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, USA
| | - Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA
| | | | - Matthew J Smith
- Department of Orthopedic Surgery, University of Missouri, Columbia, MO, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Andrew Jawa
- New England Baptist Hospital, Boston, MA, USA.
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Lekkala S, Inverardi N, Grindy SC, Hugard S, Muratoglu OK, Oral E. Irradiation Behavior of Analgesic and Nonsteroidal Anti-Inflammatory Drug-Loaded UHMWPE for Joint Replacement. Biomacromolecules 2024; 25:2312-2322. [PMID: 38456765 DOI: 10.1021/acs.biomac.3c01179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Local delivery of pain medication can be a beneficial strategy to address pain management after joint replacement, as it can decrease systemic opioid usage, leading to less side and long-term effects. In this study, we used ultrahigh molecular weight polyethylene (UHMWPE), commonly employed as a bearing material for joint implants, to deliver a wide set of analgesics and the nonsteroidal anti-inflammatory drug tolfenamic acid. We blended the drugs with UHMWPE and processed the blend by compression molding and sterilization by low-dose gamma irradiation. We studied the chemical stability of the eluted drugs, drug elution, tensile properties, and wear resistance of the polymer blends before and after sterilization. The incorporation of bupivacaine hydrochloride and tolfenamic acid in UHMWPE resulted in either single- or dual-drug loaded materials that can be sterilized by gamma irradiation. These compositions were found to be promising for the development of clinically relevant drug-eluting implants for joint replacement.
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Affiliation(s)
- Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Scott C Grindy
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Shannon Hugard
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
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From Basic Science to Clinical Perfection: What Defines the Orthopedic Biocompatible Implant? SURGERIES 2022. [DOI: 10.3390/surgeries4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The general improvement in life expectancy and standard of living makes it easier for patients to get access to routine medical exams and is anticipated to increase the prevalence of several degenerative joint illnesses. In addition, it is anticipated that their incidence will increase both nationally and internationally, which will raise the demand for novel and long-lasting implantable devices in the field of orthopedics. The current review’s goals are to define what constitutes a biocompatible orthopedic implant in terms of in vitro biocompatibility testing and to clarify important concepts and definitions that are already in use. The demand for materials and implants made of various tissues is now increasing, and the ongoing advancement of in vitro cell culture studies is a reliable practical tool for examining the biocompatibility of potential implantable materials. In vitro biocompatibility research has been reduced and, in most cases, diminished to laboratory studies that no longer or drastically reduce animal sacrifice as a response to the well-known three “Rs” (“reduction”, “refinement”, and “replacement”) introduced to literature by English academics in the 1960s. As technology advances at an astounding rate, a new generation of gene-activating biomaterials tailored for specific people and disease conditions might emerge in the near future.
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Bergvinsson H, Zampelis V, Sundberg M, Tjörnstrand J, Flivik G. Vitamin E infused highly cross-linked cemented cups in total hip arthroplasty show good wear pattern and stabilize satisfactorily: a randomized, controlled RSA trial with 5-year follow-up. Acta Orthop 2022; 93:249-255. [PMID: 35048993 PMCID: PMC8788680 DOI: 10.2340/17453674.2022.1517] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Vitamin E infused highly cross-linked polyethylene (VEPE) was introduced in order to enhance oxidative resistance in highly cross-linked polyethylene cups in total hip arthroplasty (THA). We have, with a follow-up of 5 years, evaluated wear characteristics of 2 identically designed cemented cups with the only difference being the material, VEPE or ultra-high molecular weight polyethylene (UHMWPE). Furthermore, we report cup migration and clinical outcome. Patients and methods - 48 patients with primary osteoarthritis were randomized to either UHMWPE or VEPE cups. Patients were followed with radiostereometric analysis (RSA) from the first postoperative day, at 3 months, 1, 2, and 5 years as well as with hip-specific outcome questionnaires. Results - At 3 months the mean proximal head penetration for UHMWPE was 0.07 mm (95% CI 0.03-0.11) and for VEPE 0.06 mm (-0.01 to 0.13). Thereafter, there was a continuous annual wear of 0.08 mm/year, up to 0.46 mm (0.36-0.57) at 5 years, for the UHMWPE cup. The VEPE cup showed low annual wear of 0.01 mm/year, up to 0.09 mm (0.02-0.16) at 5 years. In the first 3 months the UHMWPE cup migrated cranially 0.08 mm (0.03-0.13) whereas the VEPE cup migrated 0.17 mm (0.10-0.24), Thereafter, they showed similar migration patterns with stabilization between 2 and 5 years up to 0.21 mm (0.04-0.39) and 0.24 mm (0.13-0.36) respectively. The HOOS remained good up to 5 years, and no cup was revised. Interpretation - Compared with otherwise identical UHMWPE cups the cemented VEPE cup shows statistically significant reduction of wear up to 5 years and both cup types stabilize well with good clinical outcome.
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Affiliation(s)
- Halldor Bergvinsson
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Vasilis Zampelis
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Martin Sundberg
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Jon Tjörnstrand
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
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Gromov K, Sillesen NH, Kallemose T, Husted H, Malchau H, Troelsen A. Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases. Hip Int 2022; 32:56-61. [PMID: 33167730 DOI: 10.1177/1120700020969644] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3-7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. METHODS We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1-6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. RESULTS Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. CONCLUSION Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.
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Affiliation(s)
- Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Nanna H Sillesen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Husted
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Malchau
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3236679. [PMID: 34912888 PMCID: PMC8668289 DOI: 10.1155/2021/3236679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
Objective Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. Results From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate (odds ratio = 0.54; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE (mean difference = −0.10; 95% CI -0.17, -0.03; P = 0.007). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. Conclusion Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.
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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.
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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;
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Bistolfi A, Giustra F, Bosco F, Sabatini L, Aprato A, Bracco P, Bellare A. Ultra-high molecular weight polyethylene (UHMWPE) for hip and knee arthroplasty: The present and the future. J Orthop 2021; 25:98-106. [PMID: 33994706 PMCID: PMC8102204 DOI: 10.1016/j.jor.2021.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE to review advances and clinical performance of polyethylene in total joint arthroplasty, summing up historical problems and focusing on the latest innovations. METHODS search for medical grade Ultra-High-Molecular-Weight-Polyethylene (UHMWPE); Data Sources: PubMed, Scopus, Cochrane Library. RESULTS the increasing number of joint arthroplasties and high-activity patients led to progressive developments of bearing surfaces to improve performance and durability. Different strategies such as crosslinking UHMWPE (HXLPE) and the addition of vitamin-E (HXLPE) have been tested to improve wear and oxidation resistance. CONCLUSION Recent innovations about UHMWPE showed improvements either for hip and knee, with the potential of long-term survivorship.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Aprato
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Pierangiola Bracco
- Department of Chemistry and NIS (Nanostructured Interfaces and Surfaces) Center, University of Torino, 10125, Torino, Italy
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Han J, Duan W, Xia Q, Song D. Diffusion behavior of vitamin-E in irradiation cross-linked GO/UHMWPE composites. Polym Bull (Berl) 2021. [DOI: 10.1007/s00289-021-03652-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Rochcongar G, Remazeilles M, Bourroux E, Dunet J, Chapus V, Feron M, Praz C, Buia G, Hulet C. Reduced wear in vitamin E-infused highly cross-linked polyethylene cups: 5-year results of a randomized controlled trial. Acta Orthop 2021; 92:151-155. [PMID: 33263447 PMCID: PMC8158183 DOI: 10.1080/17453674.2020.1852785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Vitamin E-infused polyethylene is a relatively new material in joint arthroplasty; there are no long-term reports, and only few mid-term results. Using radiostereometric analysis (RSA), we primarily determined whether vitamin E-infused highly cross-linked polyethylene (HXLPE/VitE) acetabular cups show less wear than ultra-high molecular weight polyethylene (UHMWPE) acetabular cups at 5 years after total hip arthroplasty (THA). We also assessed whether wear rates correlate with increasing cup inclination angles or cup sizes.Patients and methods - This is a 5-year follow-up of our previously reported randomized controlled trial of 62 patients with 3 years' follow-up, who received THA with either an HXLPE/VitE or a UHMWPE acetabular cup. At 5 years, 40 patients were analyzed (22 in the HXLPE/VitE and 18 in the UHMWPE group).Results - HXLPE/VitE cups continued to show less cumulative femoral head penetration than UHMWPE cups (HXLPE/VitE: 0.24 mm, UHMWPE: 0.45 mm; p < 0.001). Distribution of wear was also more even with HXLPE/VitE cups than with UHMWPE cups (p = 0.002). Moreover, the difference in PE wear between 1 and 5 years in both groups showed no statistically significant correlation with increasing cup inclination angles or cup sizes. Finally, no osteolysis and implant loosening occurred, and no revision surgeries were required.Interpretation - Wear rates continue to be lower in HXLPE/VitE cups than in UHMWPE cups at 5 years of follow-up without correlation with increasing cup inclination angles or cup sizes. Finally, HXLPE/VitE cups may have the potential to prevent osteolysis and implant loosening.
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Affiliation(s)
- Goulven Rochcongar
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Remazeilles
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Emeline Bourroux
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Julien Dunet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Valentin Chapus
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Feron
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - César Praz
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France,Correspondence:
| | - Geoffrey Buia
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Christophe Hulet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
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Parekh A, Sood A, Monsef JB, Hamouda M, Hussain A, Gonzalez M. Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty. JBJS Rev 2021; 9:e20.00065. [PMID: 33982980 DOI: 10.2106/jbjs.rvw.20.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amit Parekh
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Jad Bou Monsef
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
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14
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Zaribaf FP, Hassuji TA, Cookson AN, Gill HS, Pegg EC. A practical model of the diffusion of oil‐based fluid into polyethylene. J Appl Polym Sci 2021. [DOI: 10.1002/app.50028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fedra P. Zaribaf
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Tahir A. Hassuji
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Andrew N. Cookson
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Harinderjit S. Gill
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Elise C. Pegg
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
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Vitamin E-blended highly cross-linked polyethylene liners in total hip arthroplasty: a randomized, multicenter trial using virtual CAD-based wear analysis at 5-year follow-up. Arch Orthop Trauma Surg 2020; 140:1859-1866. [PMID: 32048017 DOI: 10.1007/s00402-020-03358-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Progressive oxidation of highly cross-linked ultra-high molecular weight (UHMPWE-X) liners is considered to be a risk factor for material failure in THA. Antioxidants such as vitamin E (alpha-tocopherol) (UHMWPE-XE) were supplemented into the latest generation of polyethylene liners. To prevent inhomogenous vitamin E distribution within the polymer, blending was established as an alternative manufacturing process to diffusion. The purpose of the present study was to investigate the in vivo wear behavior of UHMWPE-XE in comparison with conventional UHMWPE-X liners using virtual CAD-based radiographs. METHODS Until now, 94 patients from a prospective, randomized, controlled, multicenter study were reviewed at 5-year follow-up. Of these, 51 (54%) received UHMWPE-XE and 43 (46%) UHMWPE-X liners. Anteroposterior pelvic radiographs were made immediately after surgery and at 1 and 5 years postoperatively. The radiographs were analyzed using the observer-independent analysis software RayMatch® (Raylytic GmbH, Leipzig, Germany). RESULTS The mean wear rate was measured to be 23.6 μm/year (SD 13.7; range 0.7-71.8 μm). There were no significant differences between the two cohorts (UHMWPE-X: 23.2 μm/year vs. UHMWPE-XE: 24.0 μm/year, p = 0.73). Cup anteversion significantly changed within the 1st year after implantation independent from the type of polyethylene liner [UHMWPE-X: 18.2-23.9° (p = 0.0001); UHMWPE-XE: 21.0-25.5° (p = 0.002)]. No further significant changes of cup anteversion in both groups were found between year 1 and 5 after implantation [UHMWPE-X (p = 0.46); UHMWPE-XE (p = 0.56)]. CONCLUSION The present study demonstrates that the addition of vitamin E does not adversely affect the midterm wear behavior of UHMWPE-X. The antioxidative benefit of vitamin E is expected to become evident in long-term follow-up. Cup anteversion increment by 5° within the 1st year is likely a result of the released hip flexion contracture resulting in an enhanced posterior pelvic tilt. Therefore, a reassessment of target values in acetabular cup placement might be considered.
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Duan W, Wu M, Han J, Ni Z. Research into the thermal stability and mechanical properties of vitamin E diffusion modified irradiation cross-linked graphene oxide/ultra-high molecular weight polyethylene composites. RSC Adv 2020; 10:4175-4188. [PMID: 35495271 PMCID: PMC9049050 DOI: 10.1039/c9ra09893c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/11/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
Recently, there has been increasing interest in modifying ultra-high molecular weight polyethylene (UHMWPE) due to glaring needs in the artificial joint replacement field. It is generally reported in the literature that irradiation cross-linking and adding graphene oxide (GO)/vitamin E (VE) can enhance the mechanical properties of UHMWPE, but this can sacrifice the oxidation stability and gel content. This paper examines how VE diffusion can influence irradiation cross-linked GO/UHMWPE composites and whether mechanical performance and oxidation resistance can be maintained simultaneously, which will provide new guidance for prolonging the longevity of UHMWPE implants. The GO/UHMWPE composites were fabricated by means of liquid ultrasonic dispersion, hot pressing and irradiation cross-linking, followed by VE diffusion and homogenization treatment. The results indicated that limited VE diffusion decreased the water absorption and wettability. The crystallinity, melting temperature, thermal stability, hardness and scratch resistance of the composites basically remain essentially the same, except in the case of pure UHMWPE. In addition, the oxidation resistance was improved significantly after incorporating VE. Furthermore, the diffusion and enhancement mechanisms were also demonstrated, respectively.
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Affiliation(s)
- Weipeng Duan
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Meiping Wu
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Jitai Han
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Zifeng Ni
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
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Zandi N, Lotfi R, Tamjid E, Shokrgozar MA, Simchi A. Core-sheath gelatin based electrospun nanofibers for dual delivery release of biomolecules and therapeutics. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 108:110432. [PMID: 31923974 DOI: 10.1016/j.msec.2019.110432] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/27/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023]
Abstract
Coaxial electrospinning with the ability to use simultaneously two separate solvents provides a promising strategy for drug delivery. Nevertheless, controlled release of hydrophilic and sensitive therapeutics from slow biodegradable polymers is still challenging. To address this gap, we fabricated core-sheath fibers for dual delivery of lysozyme, as a model protein, and phenytoin sodium as a small therapeutic molecule. The sheath was processed by a gelatin solution while the core fibers were fabricated from an aqueous gelatin/PVA solution. Microstructural studies by transmission and scanning electron microscopy reveal the formation of homogeneous core-sheath nanofibers with an outer and inner diameter of 180 ± 48 nm and 106 ± 30 nm, respectively. Thermal gravimetric analysis determines that the mass loss of the core-sheath fibers fall between the mass loss values of individual sheath and core fibers. Swelling studies indicate higher water absorption of the core-sheath mat compared to the separate sheath and core membranes. In vitro drug release studies in Phosphate Buffered Saline (PBS) determine sustained release of the therapeutics from the core-sheath structure. The release trails three stages including non-Fickian diffusion at the early stage followed by the Fickian diffusion mechanism. The present study shows a useful approach to design core-sheath nanofibrous membranes with controlled and programmable drug release profiles.
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Affiliation(s)
- Nooshin Zandi
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, P.O. Box 11365-11155, Tehran, Iran
| | - Roya Lotfi
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, P.O. Box 11365-11155, Tehran, Iran
| | - Elnaz Tamjid
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, P.O. Box 14115-175, Tehran, Iran
| | | | - Abdolreza Simchi
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, P.O. Box 11365-11155, Tehran, Iran; Department of Materials Science and Engineering, Sharif University of Technology, P.O. Box 11365-11155, Tehran, Iran.
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18
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Nasef SM, Khozemy EE, Kamoun EA, El-Gendi H. Gamma radiation-induced crosslinked composite membranes based on polyvinyl alcohol/chitosan/AgNO3/vitamin E for biomedical applications. Int J Biol Macromol 2019; 137:878-885. [DOI: 10.1016/j.ijbiomac.2019.07.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023]
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19
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Alendronate Release from UHMWPE-Based Biomaterials in Relation to Particle Size of the GUR Powder for Manufacturing. MATERIALS 2019; 12:ma12111832. [PMID: 31174252 PMCID: PMC6600958 DOI: 10.3390/ma12111832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) is widely used in endoprosthetics and has been the subject of countless studies. This project investigates the dependence of alendronate (AL) release on the molecular weight of the UHMWPE used (GUR1020 and GUR1050). A 0.5 wt% AL was added to the UHMWPE during the production of the moldings. In addition to the 14-day release tests, biocompatibility tests such as live dead assay, cell proliferation assay (WST) and Lactate dehydrogenase test (LDH) with MG-63 cells as well as a tensile test according to DIN EN ISO 527 were carried out. The released AL concentration was determined by HPLC. A continuous release of the AL was observed over the entire period of 2 weeks. In addition, a correlation between molar mass and AL release was demonstrated. The GUR1020 showed a release four times higher than the GUR1050. Both materials have no negative influence on the proliferation of MG-63 cells. This was also confirmed in the live/dead assay by the increase in cell count. No cytotoxicity was detected in the LDH test. The addition of 0.5 wt% AL increased the elongation at break for GUR1020 by 23% and for GUR1050 by 49%. It was demonstrated that the choice of UHMWPE has an influence on the release of AL. The particle size in particular has a strong influence on the release behavior.
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20
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Takemura S, Minoda Y, Sugama R, Ohta Y, Nakamura S, Ueyama H, Nakamura H. Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively. Bone Joint J 2019; 101-B:559-564. [PMID: 31039001 DOI: 10.1302/0301-620x.101b5.bjj-2018-1355.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA). PATIENTS AND METHODS The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively. RESULTS Differences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively. CONCLUSION Clinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559-564.
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Affiliation(s)
- S Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - R Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Wen S, Hu Y, Zhang Y, Huang S, Zuo Y, Min Y. Dual-functional core-shell electrospun mats with precisely controlled release of anti-inflammatory and anti-bacterial agents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 100:514-522. [PMID: 30948088 DOI: 10.1016/j.msec.2019.02.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 01/11/2023]
Abstract
Acute wounds are worldwide problems affecting millions of people and causing heavy economic burden to national healthcare systems. Herein, we describe novel wound dressing materials relying on core/shell electrospun mats incorporated with flurbiprofen and vancomycin for achieving programmable release of anti-inflammatory and anti-bacterial agents. The shell matrix of nanofibers consisted of polyethylene oxide while the core matrix was made from a blend of silk and collagen. Several optimal mat architectures were engineered with distinct configurations, of which release profiles displayed an exponential trend, which indicates a first-order process following Fickian diffusion behavior. The flurbiprofen release lasted from 2 to 6 days, which was much faster compared to the one of vancomycin prolonged up to about 20 days. Mechanical data indicated tensile modulus, tensile strength, elongation before break of core/shell electrospun mats became enhanced or comparable to those for human skin after methanol vapor treatment. Desirable release kinetics and mechanical characteristics achieved by novel core/shell electrospun mats were attributable to induced enrichment of β-sheet phase in silk via methanol vapor treatment as well as water annealing process with time and judicious selections for matrix materials and mat configurations. The design principles considered in this study successfully addressed a range of inflammation and infection requirements in wound healing, potentially guiding construction of other biomedical coatings and devices.
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Affiliation(s)
- Shihao Wen
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA
| | - Yupeng Hu
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA
| | - Yuanzhong Zhang
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA
| | - Shifeng Huang
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA
| | - Yuchen Zuo
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA
| | - Younjin Min
- Department of Polymer Engineering, University of Akron, Akron, OH 44325, USA.
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22
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Ren Y, Zhang ZY, Lan RT, Xu L, Gao Y, Zhao B, Xu JZ, Gul RM, Li ZM. Enhanced oxidation stability of highly cross-linked ultrahigh molecular weight polyethylene by tea polyphenols for total joint implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 94:211-219. [DOI: 10.1016/j.msec.2018.09.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/23/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
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23
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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.
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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
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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.
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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
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Ponzio DY, Weitzler L, deMeireles A, Esposito CI, Wright TM, Padgett DE. Antioxidant-stabilized highly crosslinked polyethylene in total knee arthroplasty. Bone Joint J 2018; 100-B:1330-1335. [DOI: 10.1302/0301-620x.100b10.bjj-2018-0061.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to evaluate the surface damage, the density of crosslinking, and oxidation in retrieved antioxidant-stabilized highly crosslinked polyethylene (A-XLPE) tibial inserts from total knee arthroplasty (TKA), and to compare the results with a matched cohort of standard remelted highly crosslinked polyethylene (XLPE) inserts. Materials and Methods A total of 19 A-XLPE tibial inserts were retrieved during revision TKA and matched to 18 retrieved XLPE inserts according to the demographics of the patients, with a mean length of implantation of 15 months (1 to 42). The percentage areas of PE damage on the articular surfaces and the modes of damage were measured. The density of crosslinking of the PE and oxidation were measured at loaded and unloaded regions on these surfaces. Results A-XLPE inserts had higher rates of burnishing and lower rates of pitting and scratching compared with XLPE. There were no differences in the density of crosslinking at loaded and unloaded regions. A-XLPE showed higher oxidation indices in the unloaded surface region compared with XLPE. There were no differences in the levels of oxidation in the loaded regions. Conclusion Retrieval analysis of A-XLPE did not reflect a clinically relevant difference in surface damage, density of crosslinking, or oxidation compared with XLPE tibial inserts at short-term evaluation. Cite this article: Bone Joint J 2018;100-B:1330–5.
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Bonutti PM, Mesko JW, Ramakrishnan R. Long-term Wear Data From a Prospective Multicenter Study of Second-Generation Highly Cross-linked Polyethylene Inserts in Total Hip Arthroplasty. Orthopedics 2018; 41:e529-e533. [PMID: 29771397 DOI: 10.3928/01477447-20180511-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/26/2018] [Indexed: 02/03/2023]
Abstract
In a prospective multicenter trial on highly cross-linked polyethylene inserts in patients undergoing total hip arthroplasty, 118 patients consented to 10-year follow-up. Medium-term follow-up results showed low wear at 5 and 7 years after surgery. The current study focuses on long-term data at 10 years. Patients were followed up by either phone or office visit to collect long-term clinical data including Harris hip score and adverse events. There were 2 deaths and 2 revisions, 1 at 6.5 years for pelvic cyst and severe pain and another at 8.0 years for recurrent dislocation. For wear analysis, suitable radiographic images for 48 patients (52 hips) at minimum 10-year follow-up were available. Mean age of the cohort was 62.5 years (62% female). Femoral head penetration was measured using Martell's method from the radiographic images between the 6-week and the subsequent follow-ups. Polyethylene wear rate was calculated from the penetration data. Descriptive statistics were performed. There was no evidence of significant oxidation or locking mechanism failure. Mean Harris hip score of the group was 94.3. No osteolysis was noted by an independent radiographic reviewer. The slope of the bestfit regression line to the femoral head penetration data, which represents the overall linear wear rate of the polyethylene, was 0.014 mm/y. The wear rate was significantly below the 0.100 mm/y critical threshold for development of osteolysis. Volumetric wear rate was calculated to be 11.6 mm3/y. The second-generation highly cross-linked polyethylene acetabular inserts had low wear in the long term (10.3 years) with no incidence of osteolysis. [Orthopedics. 2018; 41(4):e529-e533.].
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27
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Xu JZ, Wannomae KK, Muratoglu OK, Oral E. Increased oxidative protection by high active vitamin E content and partial radiation crosslinking of UHMWPE. J Orthop Res 2018; 36:1860-1867. [PMID: 29232007 DOI: 10.1002/jor.23835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023]
Abstract
Vitamin E stabilization successfully improved long-term oxidation resistance of wear-resistant ultra-high-molecular-weight polyethylene (UHMWPE) used for joint implants. Stabilization can be achieved by blending an antioxidant into the UHMWPE resin powder before consolidation and irradiation. Balancing the wear resistance and vitamin E content in the blend is the current challenge with this approach, because vitamin E hinders crosslinking of UHMWPE during irradiation, which decreases wear resistance. The vitamin E concentration in the blend is generally limited to less than 0.3 wt%. Wear- and oxidation-resistant UHMWPE has been obtained previously by consolidating blends of pre-irradiated UHMWPE powders (XPE) into an unmodified polyethylene matrix (PE), where the improvement in wear rate depended on the radiation dose and fraction of XPE. We hypothesized that increasing the vitamin E content in the unirradiated matrix would not compromise wear and would further improve the oxidative stability of XPE/PE blends. Pin-on-disk wear testing showed that the XPE/PE blends containing 0.1-1.0 wt% vitamin E in the matrix had comparable wear rates. We used an aggressive accelerated aging test in the presence of the pro-oxidant squalene and oxidation induction time (OIT) test and found that higher amounts of vitamin E resulted in stronger oxidation resistance for XPE/PE blends. The mechanical strength and toughness of the blends were not affected by changing the vitamin E content in the matrix. Stabilizing UHMWPE with higher vitamin E content may extend the service life of UHMWPE implants. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1860-1867, 2018.
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Affiliation(s)
- Jia-Zhuang Xu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114.,Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Keith K Wannomae
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Du Z, Wang S, Wang Y. Preferential CD8 rather than CD4 T-cell response to wear particles of polyether-ether-ketone and highly cross-linked polyethylene. RSC Adv 2018; 8:1866-1874. [PMID: 35542597 PMCID: PMC9077207 DOI: 10.1039/c7ra10589d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/26/2017] [Indexed: 11/21/2022] Open
Abstract
The efficacy of polyether-ether-ketone (PEEK) as a bearing material in knee components, a potential alternative to the currently used highly cross-linked polyethylene (HXLPE), has attracted a lot of attention recently. This study aimed to systematically assess the effect of particulate wear debris on CD4 and CD8 T-cell responses. HXLPE and PEEK particles (96% less than 5 μm) were generated by custom cryo-milling and pulverization in liquid nitrogen, and then incubated with blood collected from 25 donors. The phenotypes of the T-cells were systematically analyzed by immunostaining and flow cytometry. For the in vivo study, 0.1 mL of each particle suspension (about 1.0 × 108 wear particles) was injected into murine knee joints; the synovium and spleen were collected one week later for histological examination and immunofluorescence staining. PEEK and HXLPE particles did not induce CD4+ T-cell responses; however, CD8+ T-cells might be involved in mediating particle-induced reactions. The T-cell and inflammatory responses induced by PEEK and HXLPE particles were comparable. Further investigations into the frictional properties of materials should be performed to expand on our results. Enriching the understanding of the effects of the particles on the adaptive immune response.![]()
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Affiliation(s)
- Zhe Du
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
| | - Shujun Wang
- Department of Immunology
- Shanghai Institute of Immunology
- Shanghai Jiaotong University School of Medicine
- Shanghai
- China
| | - You Wang
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
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29
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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
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30
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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]
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31
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Shareghi B, Johanson PE, Kärrholm J. Wear of Vitamin E-Infused Highly Cross-Linked Polyethylene at Five Years. J Bone Joint Surg Am 2017; 99:1447-1452. [PMID: 28872526 DOI: 10.2106/jbjs.16.00691] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In an earlier study with a 2-year follow-up of uncemented cups, we had reported low femoral-head penetration of vitamin E-infused highly cross-linked polyethylene liners (E1) compared with highly cross-linked liners without vitamin E (ArComXL). We studied the penetration rate of E1 compared with that of ArComXL, with a focus on changes occurring between 2 and 5 years after total hip arthroplasty. METHODS In this randomized controlled study, we performed radiostereometric analysis of the penetration rate up to 5 years in 63 hips. RESULTS During the total period of observation, the median proximal penetration for E1, 0.13 mm (mean, 0.11 mm [95% confidence interval (CI), 0.08 to 0.14 mm]), was lower than that for ArComXL, 0.20 mm (mean, 0.22 mm [95% CI, 0.17 to 0.26 mm]). The median proximal penetration rate between 2 and 5 years was 0.02 mm/yr (mean, 0.01 mm/yr [95% CI, 0.01 to 0.02 mm/yr]) for E1 and 0.04 mm/yr (mean, 0.04 mm/yr [95% CI, 0.03 to 0.05 mm/yr) for ArComXL. The corresponding median total (i.e., 3-dimensional resultant) penetration rates were 0.04 mm/yr (mean, 0.04 mm/yr [95% CI, 0.03 to 0.05 mm/yr]) for E1 and 0.07 mm/yr (mean, 0.08 mm/yr [95% CI, 0.06 to 0.10 mm/yr]) for ArComXL. CONCLUSIONS From years 2 to 5, we observed increased penetration in both groups. The penetration rate was higher for ArComXL, resulting in more proximal and total penetration at 5 years than for E1. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bita Shareghi
- 1Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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32
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Kayandan S, Doshi BN, Oral E, Muratoglu OK. Surface cross-linked ultra high molecular weight polyethylene by emulsified diffusion of dicumyl peroxide. J Biomed Mater Res B Appl Biomater 2017; 106:1517-1523. [PMID: 28741857 DOI: 10.1002/jbm.b.33957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/13/2017] [Accepted: 07/04/2017] [Indexed: 11/06/2022]
Abstract
Cross-linking improves the wear resistance of ultrahigh molecular weight polyethylene (UHMWPE) used in hip and knee implants. Free radicals, generated by ionizing radiation or chemically, react to form cross-links. Limiting cross-linking to the articulating surface of the implant is desirable to enable high wear resistance on the surface and higher strength and toughness in the bulk. We investigated the diffusion of emulsified dicumyl peroxide (DCP) into vitamin E-blended UHMWPE (0.1 and 0.3 wt. % vitamin-E) with subsequent thermal decomposition in situ to obtain surface cross-linking with the objective of achieving surface wear rate equivalent or lower than that of current clinically available materials. We diffused emulsified DCP at 100°C followed by in situ decomposition at 150°C. We also assessed the effect of having vitamin-E in the DCP emulsion. The oxidative stability of the treated samples increased with increasing vitamin E concentration in the blend and by incorporating vitamin E into the peroxide emulsion. The impact strength of a surface cross-linked, 0.3 wt% vitamin E blended UHMWPE prepared using this method was superior to a clinically available irradiated and melted highly cross-linked UHMWPE while the wear resistance was comparable. These results showed the feasibility of surface cross-linking using emulsified peroxide diffusion as a method of making tough and wear resistant joint implant bearing surfaces. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1517-1523, 2018.
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Affiliation(s)
- Sanem Kayandan
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Brinda N Doshi
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
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33
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Bracco P, Bellare A, Bistolfi A, Affatato S. Ultra-High Molecular Weight Polyethylene: Influence of the Chemical, Physical and Mechanical Properties on the Wear Behavior. A Review. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E791. [PMID: 28773153 PMCID: PMC5551834 DOI: 10.3390/ma10070791] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 01/03/2023]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) is the most common bearing material in total joint arthroplasty due to its unique combination of superior mechanical properties and wear resistance over other polymers. A great deal of research in recent decades has focused on further improving its performances, in order to provide durable implants in young and active patients. From "historical", gamma-air sterilized polyethylenes, to the so-called first and second generation of highly crosslinked materials, a variety of different formulations have progressively appeared in the market. This paper reviews the structure-properties relationship of these materials, with a particular emphasis on the in vitro and in vivo wear performances, through an analysis of the existing literature.
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Affiliation(s)
- Pierangiola Bracco
- Department of Chemistry and NIS (Nanostructured Interfaces and Surfaces) Center, University of Torino, 10125 Torino, Italy.
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | | - Saverio Affatato
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, 40136 Bologna, Italy.
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Oral E, O'Brien C, Doshi B, Muratoglu OK. High temperature homogenization improves impact toughness of vitamin E-diffused, irradiated UHMWPE. J Orthop Res 2017; 35:1343-1347. [PMID: 27487014 DOI: 10.1002/jor.23380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/29/2016] [Indexed: 02/04/2023]
Abstract
Diffusion of vitamin E into radiation cross-linked ultrahigh molecular weight polyethylene (UHMWPE) is used to increase stability against oxidation of total joint implant components. The dispersion of vitamin E throughout implant preforms has been optimized by a two-step process of doping and homogenization. Both of these steps are performed below the peak melting point of the cross-linked polymer (<140°C) to avoid loss of crystallinity and strength. Recently, it was discovered that the exposure of UHMWPE to elevated temperatures, around 300°C, for a limited amount of time in nitrogen, could improve the toughness without sacrificing wear resistance. We hypothesized that high temperature homogenization of antioxidant-doped, radiation cross-linked UHMWPE could improve its toughness. We found that homogenization at 300°C for 8 h resulted in an increase in the impact toughness (74 kJ/m2 compared to 67 kJ/m2 ), the ultimate tensile strength (50 MPa compared to 43 MPa) and elongation at break (271% compared to 236%). The high temperature treatment did not compromise the wear resistance or the oxidative stability as measured by oxidation induction time. In addition, the desired homogeneity was achieved at a much shorter duration (8 h compared to >240 h) by using high temperature homogenization. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1343-1347, 2017.
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Affiliation(s)
- Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1260, Boston, Massachusetts 02114.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Caitlin O'Brien
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1260, Boston, Massachusetts 02114
| | - Brinda Doshi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1260, Boston, Massachusetts 02114
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1260, Boston, Massachusetts 02114.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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35
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Currier BH, Van Citters DW. A Novel Technique for Assessing Antioxidant Concentration in Retrieved UHMWPE. Clin Orthop Relat Res 2017; 475:1356-1365. [PMID: 27334326 PMCID: PMC5384904 DOI: 10.1007/s11999-016-4939-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Antioxidants added to UHMWPE to prevent in vivo oxidation are important to the long-term performance of hip and knee arthroplasty. Diffused vitamin E antioxidant polyethylene raised questions about potential in vivo elution that could cause inflammatory reactions in periprosthetic tissues and also potentially leave the implant once again prone to oxidation. Currently, there is no information on the elution, if any, of antioxidants from implant polyethylene materials in vivo. QUESTIONS/PURPOSES (1) Do antioxidants, especially diffused vitamin E, elute from antioxidant polyethylene in vivo? (2) Can extraction of the retrieved antioxidant polyethylene (to remove absorbed species from the in vivo environment near the articular and nonarticular surfaces) improve the identification of antioxidant content? (3) Can actual antioxidant content be estimated from calculated antioxidant indices by accounting for ester content (from absorbed species) near the articular and nonarticular surfaces? METHODS An institutional review board-approved retrieval laboratory received 39 antioxidant polyethylene hip and knee retrievals at revision from 25 surgeons with in vivo time of 0.02 to 3.6 years (median, 1.3 years). These consecutive antioxidant polyethylene retrievals, received between May 2010 and February 2016, were made from three different antioxidant highly crosslinked polyethylene materials: diffused vitamin E, blended vitamin E, and hindered phenol antioxidant pentaerythritol tetrakis[3-(3,5-di-tert-butyl-4-hydroxyphenyl)] propionate (here and after referred to as PBHP). Retrievals were analyzed using Fourier transform infrared (FTIR) spectroscopy. Absorbed ester index (1725-1740 cm-1 normalized to 1365-1371 cm-1), and vitamin E index (1245-1275 cm-1) and PBHP index (1125-1150 cm-1), normalized to 1850-1985 cm-1, were defined. Microtomed thin sections of PBHP and vitamin E retrievals were hexane-extracted to remove absorbed species from the in vivo environment in an effort to improve identification of antioxidant content. Paired Student's t-tests were used to compare as-retrieved articular antioxidant index with expected antioxidant index (the bulk value for blended antioxidants where constant antioxidant content is expected throughout and the extrapolated original vitamin E concentration at the articular surface based on the as-manufactured vitamin E concentration gradient). Linear regression was used for each of the retrievals to evaluate the correlation of antioxidant index to ester content with the goal of extrapolation to the antioxidant index at zero ester content. RESULTS On average, vitamin E index at the articular surface (0.04 ± 0.03) was reduced compared with expected vitamin E index (0.09 ± 0.04; 95% confidence interval [CI] of the difference, 0.04-0.07; p < 0.001), and PBHP index at the articular surface (0.06 ± 0.02) was elevated compared with the average PBHP index from the bulk (0.03 ± 0.00; 95% CI of the difference, 0.03-0.05; p < 0.001). Extraction returned the PBHP index at the articular surface (0.03 ± 0.00) to bulk values (95% CI of the difference, -0.001 to 0.004; p = 0.326); diffused vitamin E was removed by extraction. Crossplots of vitamin E index and PBHP index with ester index showed significant (p < 0.001 for 32 of the 35 retrievals with sufficient data) linear trends (r ≥ 0.89) that allowed extrapolation of the articular surface antioxidant indices at zero absorbed ester index. CONCLUSIONS Absorbed esters from time in vivo caused erroneous values of antioxidant index to be calculated. However, hexane extraction to remove absorbed species also removed diffused vitamin E. Correlating antioxidant indices with ester content, measured by FTIR in unextracted antioxidant retrievals, provides a nonaltered method for estimating actual articular surface vitamin E index and demonstrates that there was no measurable elution in these short-term retrievals. CLINICAL RELEVANCE Assessing antioxidant content in retrieved polyethylene inserts is important to determine how much of the antioxidant remains in place to prevent oxidation of the polyethylene over time in vivo. Retrieval analyses reporting antioxidant content must account for absorbed species to be valid. Because standard hexane extraction removes both absorbed species and vitamin E from diffused vitamin E retrievals, the correlation method presented in this study is the recommended analysis alternative.
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Affiliation(s)
- Barbara H. Currier
- grid.254880.3Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755 USA
| | - Douglas W. Van Citters
- grid.254880.3Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755 USA
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36
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Neuerburg C, Loer T, Mittlmeier L, Polan C, Farkas Z, Holdt LM, Utzschneider S, Schwiesau J, Grupp TM, Böcker W, Aszodi A, Wedemeyer C, Kammerlander C. Impact of vitamin E-blended UHMWPE wear particles on the osseous microenvironment in polyethylene particle-induced osteolysis. Int J Mol Med 2016; 38:1652-1660. [PMID: 27779642 PMCID: PMC5117748 DOI: 10.3892/ijmm.2016.2780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022] Open
Abstract
Aseptic loosening mediated by wear particle-induced osteolysis (PIO) remains the major cause of implant loosening in endoprosthetic surgery. The development of new vitamin E (α-tocopherol)-blended ultra-high molecular weight polyethylene (VE-UHMWPE) with increased oxidation resistance and improved mechanical properties has raised hopes. Furthermore, regenerative approaches may be opened, as vitamin E supplementation has shown neuroprotective characteristics mediated via calcitonin gene-related peptide (CGRP), which is known to affect bone remodeling in PIO. Therefore, the present study aimed to further clarify the impact of VE-UHMWPE wear particles on the osseous microenvironment and to identify the potential modulatory pathways involved. Using an established murine calvaria model, mice were subjected to sham operation (SHAM group), or treated with UHMWPE or VE-UHMWPE particles for different experimental durations (7, 14 and 28 days; n=6/group). Morphometric analysis by micro-computed tomography detected significant (p<0.01) and comparable signs of PIO in all particle-treated groups, whereas markers of inflammation [tumor necrosis factor (TNF)-α/tartrate resistant acid phosphatase (TRAP) staining] and bone remodeling [Dickkopf-related protein 1 (DKK-1)/osteoprotegerin (OPG)] were most affected in the early stages following surgery. Taking the present data into account, VE-UHMWPE appears to have a promising biocompatibility and increased ageing resistance. According to the α-CGRP serum levels and immunohistochemistry, the impact of vitamin E on neuropeptidergic signaling and its chance for regenerative approaches requires further investigation.
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Affiliation(s)
- Carl Neuerburg
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Theresa Loer
- Department of Orthopedics and Trauma Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Lena Mittlmeier
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Christina Polan
- Department of Orthopedics and Trauma Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Zsuzsanna Farkas
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Lesca Miriam Holdt
- Institute of Laboratory Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sandra Utzschneider
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Jens Schwiesau
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Wolfgang Böcker
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Attila Aszodi
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Christian Wedemeyer
- KKEL St. Barbara Hospital, Department of Orthopedics and Trauma Surgery, Gladbeck, Germany
| | - Christian Kammerlander
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
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Doshi B, Ward JS, Oral E, Muratoglu OK. Fatigue toughness of irradiated vitamin E/UHMWPE blends. J Orthop Res 2016; 34:1514-20. [PMID: 26773556 DOI: 10.1002/jor.23168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
Radiation cross-linked ultrahigh molecular weight polyethylenes (UHMWPEs) have become the standard-of-care in total joint replacements (TJR) in the last decade because of their superior wear resistance in comparison with previously used "conventional" gamma sterilized UHMWPE. Some first generation radiation cross-linked UHMWPEs were stabilized against oxidation by post-irradiation melting, which significantly reduced their fatigue crack propagation resistance or fatigue toughness. Second generation cross-linked UHMWPEs incorporated instead an antioxidant such as vitamin E, eliminating the need for melting. In this study, we investigated the fatigue crack propagation resistance and the impact toughness of vitamin E-blended and radiation cross-linked UHMWPEs as a function of vitamin E concentration and radiation dose. Both properties were strongly dependent on the cross-link density and they showed a good correlation with each other (R(2) = 0.89). © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1514-1520, 2016.
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Affiliation(s)
- Brinda Doshi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts
| | - Jerel S Ward
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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38
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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.
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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
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Oral E, Doshi BN, Gul RM, Neils AL, Kayandan S, Muratoglu OK. Peroxide cross-linked UHMWPE blended with vitamin E. J Biomed Mater Res B Appl Biomater 2016; 105:1379-1389. [DOI: 10.1002/jbm.b.33662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/10/2015] [Accepted: 03/10/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ebru Oral
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Brinda N. Doshi
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
| | - Rizwan M. Gul
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
- Department of Mechanical Engineering; University of Engineering and Technology; Peshawar Pakistan
| | - Andrew L. Neils
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
| | - Sanem Kayandan
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun K. Muratoglu
- Harris Orthopedic Laboratory; Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School; Boston Massachusetts
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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]
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41
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D’Antonio JA. CORR Insights(®): Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size. Clin Orthop Relat Res 2016; 474:372-3. [PMID: 26024579 PMCID: PMC4709322 DOI: 10.1007/s11999-015-4365-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/18/2015] [Indexed: 01/31/2023]
Affiliation(s)
- James A. D’Antonio
- Greater Pittsburgh Orthopaedic Associates, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108 USA
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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.
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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.
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43
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Three Year RSA Evaluation of Vitamin E Diffused Highly Cross-linked Polyethylene Liners and Cup Stability. J Arthroplasty 2015; 30:1260-4. [PMID: 25754257 DOI: 10.1016/j.arth.2015.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/06/2015] [Indexed: 02/01/2023] Open
Abstract
Vitamin E diffusion into highly cross-linked polyethylene (E-XLPE) is a method for enhancing oxidative stability of acetabular liners. The purpose of this study was to evaluate in vivo penetration of E-XLPE using radiostereometric analysis (RSA). Eighty-four hips were recruited into a prospective 10-year RSA. This is the first evaluation of the multicenter cohort after 3-years. All patients received E-XLPE liners (E1, Biomet) and porous-titanium coated cups (Regenerex, Biomet). There was no difference (P=0.450) in median femoral head penetration into the E-XLPE liners at 3-years comparing cobalt-chrome heads (-0.028mm; inter-quartile range (IQR) - 0.065 to 0.047) with ceramic heads (-0.043mm, IQR - 0.143to0.042). The 3-year follow-up indicates minimal E-XLPE liner penetration regardless of head material and minimal early cup movement.
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44
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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]
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45
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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.
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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
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46
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Hope N, Bellare A. A comparison of the efficacy of various antioxidants on the oxidative stability of irradiated polyethylene. Clin Orthop Relat Res 2015; 473:936-41. [PMID: 25238806 PMCID: PMC4317412 DOI: 10.1007/s11999-014-3946-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrahigh-molecular-weight polyethylene (UHMWPE) is subjected to radiation crosslinking to form highly crosslinked polyethylene (HXLPE), which has improved wear resistance. First-generation HXLPE was subjected to thermal treatment to reduce or quench free radicals that can induce long-term oxidative degeneration. Most recently, antioxidants have been added to HXLPE to induce oxidative resistance rather than by thermal treatment. However, antioxidants can interfere with the efficiency of radiation crosslinking. QUESTIONS/PURPOSES We sought to identify (1) which antioxidant from among those tested (vitamin E, β-carotene, butylated hydroxytoluene, or pentaerythritol tetrakis [methylene-3-(3,5-di-tert-butyl-4-hydroxyphenyl) propionate]) causes the least reduction of crosslinking; (2) which promotes the greatest oxidative stability; and (3) which had the lowest ratio of oxidation index to crosslink density. METHODS Medical-grade polyethylene (PE) resin was blended with 0.1 weight % of the following stabilizers: alpha tocopherol (vitamin E), β-carotene, butylated hydroxytoluene (BHT), and pentaerythritol tetrakis [methylene-3-(3,5-di-tert-butyl-4-hydroxyphenyl) propionate] (a hindered phenol antioxidant [HPAO]). These blends were compression-molded into sheets and subjected to electron beam irradiation to a dose of 100 kGy. Equilibrium swelling experiments were conducted to calculate crosslink density. Each PE was subjected to accelerated aging for a period of 2 weeks and Fourier transform infrared spectroscopy was used to measure the maximum oxidation. Statistical analysis was conducted using analysis of variance with Fisher's protected least significant difference in which a p value of < 0.05 was used to define a significant difference. RESULTS The least reduction of crosslinking in antioxidant-containing HXLPE was observed with HPAO, which had a crosslink density (n = 6) of 0.167 (effect size [ES] = 0.87; 95% confidence interval [CI], 0.162-0.173) mol/dm(3) compared with 0.139 (ES = 1.57; 95% CI, 0.132-0.146) mol/dm(3) (p = 0.020) for BHT, 0.131 (ES = 1.77; 95% CI, 0.123-0.139) mol/dm(3) (p = 0.004) for β-carotene, and 0.130 (ES = 1.79; 95% CI, 0.124-0.136) mol/dm(3) (p = 0.003) for vitamin E, whereas pure HXLPE had a crosslink density of 0.203 (95% CI, 0.170-0.235) mol/dm(3) (p = 0.005). BHT-PE had an oxidation index of 0.21 (ES = 13.14; 95% CI, 0.19-0.22) followed by HPAO-PE, vitamin E-PE and β-carotene-PE, which had oxidation indices of 0.28 (ES = 9.68; 95% CI, 0.28-0.29), 0.29 (ES = 9.59; 95% CI, 0.27-0.30), and 0.35 (ES = 6.68; 95% CI, 0.34-0.37), respectively (p < 0.001 for all groups). BHT-PE had the lowest ratio of oxidation index to crosslink density of the materials tested (1.49, ES = 1.94; 95% CI, 1.32-1.66) followed by HPAO-PE (1.70, ES = 1.52; 95% CI, 1.61-1.80), vitamin E-PE (2.21, ES = 0.52; 95% CI, 2.05-2.38), and β-carotene-PE (2.69, ES = -0.43; 95% CI, 2.46-2.93) compared with control PE (2.47, 95% CI, 2.07-2.88) with β-carotene (p = 0.208) and vitamin E (p = 0.129) not being different from the control. CONCLUSIONS BHT-modified HXLPE was found in this study to have the lowest oxidation index as well as the lowest ratio of oxidation index to crosslink density compared with vitamin E, HPAO, and β-carotene-modified HXLPEs. More comprehensive studies are required such as wear testing using joint simulators as well as biocompatibility studies before BHT-modified HXLPE can be considered for clinical use. CLINICAL RELEVANCE BHT is a synthetic antioxidant commonly used in the polymer industry to prevent long-term oxidative degradation and has been approved by the FDA for use in cosmetics and foodstuffs. It may be an attractive potential stabilizer for HXLPE in total joint replacements.
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Affiliation(s)
- Natalie Hope
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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[Possibilities and limits of modern polyethylenes. With respect to the application profile]. DER ORTHOPADE 2015; 43:515-21. [PMID: 24832377 DOI: 10.1007/s00132-014-2297-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Polyethylene is still one of the most important materials in the field of hip and knee arthroplasty. The clinical results of the last decades have helped to further develop polyethylene into a high-tech material. Progress in the development of new materials must be compared with the tried and tested ones to provide optimal and most individual patient care. OBJECTIVES This article gives an overview of the history and current application profile of the material ultra-high molecular weight polyethylene (UHMWPE) in hip and knee arthroplasty. MATERIAL AND METHODS With the aid of the current literature, new developments in the field of the material UHMWPE, also with respect to the biological activity of wear, the particular biomechanics of the knee joint as well as alternative hard-hard bearing surfaces in the hip, are represented in terms of implant safety. RESULTS The problems concerning polyethylene are now well recognized. The disadvantages of the material UHMWPE could be consistently reduced based on material research so that modern polyethylenes have gradually been shown in clinical trials that they can be reliably used. CONCLUSION Despite this the potential for improvement has still not yet been fully exploited. Any further development must be extensively tested both biomechanically and biologically before the material can be used in vivo. Long-term results are still necessary before a material can be accepted as being clinically safe.
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48
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TURNER AC, SUGIMOTO T, UETSUKI K, HYON SH, TOMITA N. Mechanical and oxidative performance of high-dose electron-beam irradiated, dl- α-tocopherol (vitamin E) blended UHMWPE. ACTA ACUST UNITED AC 2015. [DOI: 10.1299/jbse.14-00238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Alexander C. TURNER
- Department of Mechanical Engineering, Graduate School of Engineering, Kyoto University
| | | | | | - Suong-Hyu HYON
- Faculty of Textile Science, Kyoto Institute of Technology
| | - Naohide TOMITA
- Department of Mechanical Engineering, Graduate School of Engineering, Kyoto University
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49
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Effect of squalene absorption on oxidative stability of highly crosslinked UHMWPE stabilized with natural polyphenols. Polym Degrad Stab 2014. [DOI: 10.1016/j.polymdegradstab.2014.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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Novel active stabilization technology in highly crosslinked UHMWPEs for superior stability. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2014.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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