Variation of mechanical properties and oxidation with radiation dose and source in highly crosslinked remelted UHMWPE

Identifying differences in the tribological performance of GUR 1020 and GUR 1050 UHMWPE resins associated to pressure × velocity conditions in linear reciprocating sliding tests

In this work, two commercial UHMWPE (ultra-high molecular weight polyethylene) resins used in orthopedics, GUR 1050 and GUR 1020, were evaluated through linear reciprocating dry friction tests. Average contact pressures (P) of 34 MPa and 50 MPa and sliding velocities (V) of 0.02 m/s and 0.10 m/s were selected to perform tests in four PV conditions. The friction coefficient (COF) with both resins was around 0.18 in average, without significant distinctions by PV; however, a distinction was seen in COF dispersion; it was in the range of 5%-19%, in dependence of the PV condition and resin type. COF with GUR 1020 was more disperse, and it was related to the vulnerability of the resin to undergoing dynamic changes in the intensity of adhesive (higher COF) or abrasive (lower COF) wear mechanisms. Both wear mechanisms are displayed simultaneously, but random changes in intensity may occur during the friction process. Such randomness was associated to the susceptibility to have the structure modified by friction, higher in GUR 1020 than GUR 1050. Concerning wear amount, contact pressure was the most influencing parameter on it. GUR 1020 performed more than 30% inferior than GUR 1050 under contact pressure higher than the yield strength of the material. Under pressures near the material strength, the wear level was in the range of surface roughness and both resins performed equal in average; however, in this case, the dispersion was systematically lower for GUR 1050, evidencing its better tribological stability. It was concluded that analyses on the dispersion of the tribological responses disclosed relevant information on stability related performance. Also, when procedural dependent properties, as such friction and wear, are considered as evaluation parameters, care must be taken to compare results from different tribosystems.

Influence of plane-strain compression on the microstructure and tribological behavior of GUR 1050 UHMWPE

Ultra-high molecular weight polyethylene (UHMWPE) has been used as a bearing surface in orthopedic implants due to its outstanding physical and mechanical properties. Modifications in the structure of the polymer have a direct effect on its wear. In this work, plane-strain compression in a channel die was applied to induce microstructural changes in specimens of UHMWPE GUR 1050. These structural changes were characterized using a combined approach involving Raman spectroscopy and atomic force microscopy. These qualitative and quantitative characterization resulted in a valuable understanding of the changes in the material microstructure when subjected to plastic deformation. A molecular non-uniform alignment of the UHMWPE molecules, with fragmentation and kinking of polymer lamellae, was observed in the direction of material flow, perpendicular to the compressive load direction, following an inhomogeneous strain field generated by the mechanical compression. The microstructural analyses revealed an increased crystalline content and decreased intermediate phase while amorphous phase content remained unchanged, in all the regions of the deformed specimen. The tribological performance, evaluated by the scratch resistance force, decreased along the material flow direction and increased along the load direction in the deformed polymer compared to that of the uncompressed polymer. Plane-strain compression was able to modify the polymer microstructure, introducing directional anisotropy in its tribological behavior that can impact the wear performance of the material.

Ultra-High Molecular Weight Polyethylene Modifications Produced by Carbon Nanotubes and Fe2O3 Nanoparticles

Thin sheets of ultra-high molecular weight polyethylene (UHMWPE), both in pristine form and containing carbon nanotubes (CNTs) or Fe₂O₃ nanoparticles (NPs) at different concentrations, were prepared. The CNT and Fe₂O₃ NP weight percentages used ranged from 0.01% to 1%. The presence of CNTs and Fe₂O₃ NPs in UHMWPE was confirmed by transmission and scanning electron microscopy and by energy dispersive X-ray spectroscopy analysis (EDS). The effects of the embedded nanostructures on the UHMWPE samples were studied using attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy and UV-Vis absorption spectroscopy. The ATR-FTIR spectra show the characteristic features of the UHMWPE, CNTs, and Fe₂O₃. Concerning the optical properties, regardless of the type of embedded nanostructures, an increase in the optical absorption was observed. The allowed direct optical energy gap value was determined from the optical absorption spectra: in both cases, it decreases with increasing CNT or Fe₂O₃ NP concentrations. The obtained results will be presented and discussed.

Oxidation in Retrieved, Never-Irradiated UHMWPE Bearings: What Can We Learn About in Vivo Oxidation?

BACKGROUND

Published analyses of never-irradiated, ethylene oxide (EtO)-sterilized tibial inserts and EtO- and gas plasma (GP)-sterilized acetabular ultra-high molecular weight polyethylene (UHMWPE) retrievals demonstrated minimal UHMWPE in vivo oxidation, whereas another analysis of EtO-sterilized acetabular liners found elevated oxidation linked with in vivo stresses. This study explored whether never-irradiated UHMWPE bearings are (1) oxidized by the in vivo environment, and (2) more likely to oxidize in higher-stress articulations (knee, ankle, shoulder).

METHODS

An institutional review board-approved retrieval archive was queried for never-irradiated, EtO- and GP-sterilized UHMWPE bearings received at revision from 2001 to 2021. A total of 193 EtO-sterilized and 112 GP-sterilized conventional UHMWPE retrievals were analyzed (0 to 25 years in vivo; 133 hip, 144 knee, 18 ankle, and 10 shoulder). Retrieved implants were evaluated for in vivo damage and analyzed for trans-vinylene and ketone content by Fourier transform infrared spectroscopy (FTIR). Twelve never-implanted EtO-sterilized tibial knee inserts, (shelf-aged 5 to 19 years) were non-oxidized controls. Mechanical properties of 3 never-implanted and 3 retrieved tibial inserts were evaluated by ASTM Type-V uniaxial tensile testing. Statistical analyses evaluated correlations between time in vivo and oxidation, and compared mean oxidation rates by articulation.

RESULTS

Burnishing was the most common clinical damage for all articulations. Eight retrievals exhibited oxidation-related fatigue damage. All retrievals were validated as never-irradiated (median trans-vinylene index [TVI] = 0.000). Maximum ketone oxidation in retrievals correlated with in vivo time (p < 0.001). Thirty-seven percent of retrievals exhibited UHMWPE (subsurface) oxidation, most frequently ankle, knee, and glenoid inserts. Tensile properties differed between retrieved and never-implanted inserts, changing with oxidation. The oxidation rate differed significantly among the articulations (p < 0.001).

CONCLUSIONS

This study cohort confirmed the presence of in vivo oxidation in some non-irradiation-sterilized UHMWPE bearings, with higher-stress articulations (knee, ankle, shoulder) showing evidence of oxidation more frequently and having significantly higher oxidation rates than hips. Mechanical properties degraded by oxidation led to fatigue damage in 8 retrievals after a long duration in vivo.

CLINICAL RELEVANCE

Conventional EtO- or GP-sterilized UHMWPE bearings are at minimal risk for fatigue damage secondary to oxidation. However, higher stresses and longer time in vivo (more cycles of use) can lead to increased wear, oxidation, and fatigue damage.

Synergy between vitamin E and D-sorbitol in enhancing oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene

Oxidative stability of radiation crosslinked ultrahigh molecular weight polyethylene (UHMWPE) artificial joints is significantly improved by vitamin E (VE), but there is a dilemma that VE hinders crosslinking and thus jeopardizes the wear of UHMWPE. In this effort, we proposed an efficient strategy to stabilize UHMWPE under limited antioxidant contents, where VE and D-sorbitol (DS) were used as the primary antioxidant and the secondary antioxidant respectively. For non-irradiated blends with fixed antioxidant contents, oxidative stability accessed by oxidation induction time (OIT) of VE/DS/UHMWPE blends was superior to that of VE/UHMWPE blends, while DS/UHMWPE blends showed no increase in OIT. The cooperation between DS and VE exhibited a synergistic effect on enhancing the oxidative stability of UHMWPE. Interestingly, the irradiated VE/DS/UHMWPE blends showed comparable OIT but a significantly higher crosslink density than the irradiated VE/UHMWPE blends. The crystallinity, melting point, and in vitro biocompatibility of the blends were not affected by VE and DS. The quantitative relationships of mechanical properties, oxidation stability, crystallinity and crosslink density were established to unveil the correlation of these key factors. The overall properties of VE/UHMWPE and VE/DS/UHMWPE blends were compared to elucidate the superiority of the antioxidant compounding strategy. These findings provide a paradigm to break the trade-off between oxidative stability, crosslink density and mechanical properties, which is constructive to develop UHMWPE bearings with upgraded performance for total joint replacements. STATEMENT OF SIGNIFICANCE: VE-stabilized UHMWPE is the most commonly used material in total joint replacements at present. However, oxidation and wear resistance of VE/UHMWPE implants cannot be unified since VE reduces the efficiency of radiation crosslinking. It limits the use of VE. Herein, we proposed a compounding stabilization by the synergy between VE and DS. The antioxidation capability of VE was revived by DS, thus enhancing the oxidation stability of unirradiated UHMWPE. The irradiated VE/DS/UHMWPE exhibited similar oxidation stability but higher crosslink density than irradiated VE/UHMWPE, which is beneficial to combat wear of UHMWPE and to inhibit the occurrence of osteolysis. This synergistic antioxidation strategy endows the UHMWPE joint material with good overall performance, which is of clinical significance.

The Impact of Free Radical Stabilization Techniques on in vivo Mechanical Changes in Highly Cross-Linked Polyethylene Acetabular Liners

Introduction

Numerous thermal free radical stabilization techniques are used in the production of highly cross-linked polyethylene (HXLPE) to improve oxidative stability. Little knowledge exists on the effects of in vivo time on the mechanical properties of HXLPE. The purpose of this study was to determine if free radical stabilization of HXLPE impacts mechanical properties as well as oxidative stability of acetabular liner rims after extended in vivo time.

Methods

Retrieved and control remelted, single annealed and sequentially annealed HXLPE liner rims were tested for mechanical properties. Oxidation was measured with FTIR spectroscopy and crystalline phase composition measured with Raman spectroscopy.

Results

No correlation was found between in vivo, ex vivo time and hardness for annealed groups. A statistically significant difference in hardness was identified between free radical stabilization groups. No correlation between maximum rim oxidation and in vivo time was found. Detectable levels of rim oxidation were present in 100% of single annealed, 75% of sequentially annealed, and 25% of remelted retrieved liners. Single and sequentially annealed liners demonstrated oxidation and increased crystallinity. Rim mechanical properties change in vivo for implant types. With in vivo time, retrieved remelted HXLPE demonstrated decreased mechanical properties, whereas retrieved single and sequentially annealed HXLPE properties remained stable. All liner cohorts demonstrated evidence of rim oxidation. Subsequent changes in crystallinity were only observed in oxidized annealed liners.

Conclusion

HXLPE acetabular liner rims show evidence of in vivo mechanical property degradation, notably in remelted HXLPE, which may be a risk factor in rim fracture and catastrophic implant failure.

Effect of Oxidative Stress on Bone Remodeling in Periprosthetic Osteolysis

The success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.

Influence of radiation conditions on the wear behaviour of Vitamin E treated UHMWPE gliding components for total knee arthroplasty after extended artificial aging and simulated daily patient activities

The long term performance of total knee arthroplasty (TKA) with regards to the bearing materials is related to the aging behaviour of these materials. The use of highly crosslinked materials in hip arthroplasty improved the clinical outcome. Nevertheless, the outcome for these materials compared to conventional UHMWPE (ultra-high molecular weight polyethylene) remains controversial in TKA and alternative bearing materials may be advantageous to improve its outcome in the second and third decade. The aim of this study is the evaluation of the influence of radiation conditions on the wear behaviour of Vitamin E blended UHMWPE gliding components for TKA by simulation of extended aging and high demanding daily patient activities. For a medium radiation dose (30 kGy), the influence of the irradiation type (E-beam or Gamma radiation) and the thermal conditions (room temperature (RT) or heated to 115 °C) are evaluated in comparison to non-irradiated material. Significant influences on the wear behaviour were found for the radiation source and temperature during irradiation. Furthermore, no relevant degradation of the tested materials was observed after extended artificial aging. There was a good correspondence between the wear pattern in this study and retrievals.

Multiwall Carbon Nanotube Composites as Artificial Joint Materials

Because ultrahigh-molecular-weight polyethylene (UHMWPE) is susceptible to frictional wear when used in sliding members of artificial joints, it is common practice to use cross-linked UHMWPE instead. However, cross-linked UHMWPE has low impact resistance; implant breakage has been reported in some cases. Hence, sliding members of artificial joints pose a major trade-off between wear resistance and impact resistance, which has not been resolved by any UHMWPE. On the other hand, multiwall carbon nanotubes (MWCNTs) are used in industrial products for reinforcement of polymeric materials but not used as biomaterials because of their unclear safety. In the present study, we attempted to solve this trade-off issue by complexing UHMWPE with MWCNTs. In addition, we assessed the safety of these composites for use in sliding members of artificial joints. The results showed the equivalence of MWCNT/UHMWPE composites to cross-linked UHMWPE in terms of wear resistance and to non-cross-linked UHMWPE in terms of impact resistance. In addition, all MWCNT/UHMWPE composites examined complied with the requirements of biosafety testing in accordance with the ISO10993-series specifications for implantable medical devices. Furthermore, because MWCNTs can occur alone in wear dust, MWCNTs in an amount of about 1.5 times that contained in the dust produced from 50 years of wear (in the worst case) were injected into rat knees, which were monitored for 26 weeks. Although mild inflammatory reactions occurred in the joints, the reactions soon became quiescent. In addition, the MWCNTs did not migrate to other organs. Furthermore, MWCNTs did not exhibit carcinogenicity when injected into the knees of mice genetically modified to spontaneously develop cancer. The MWCNT/UHMWPE composite is a new biomaterial expected to be safe for clinical applications in both total hip arthroplasty and total knee arthroplasty as the first sliding member of artificial joints to have both high wear resistance and high impact resistance.

Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) as a Promising Polymer Material for Biomedical Applications: A Concise Review

Ultra-High Molecular Weight Polyethylene (UHMWPE) is used in biomedical applications due to its high wear-resistance, ductility, and biocompatibility. A great deal of research in recent decades has focused on further improving its mechanical and tribological performances in order to provide durable implants in patients. Several methods, including irradiation, surface modifications, and reinforcements have been employed to improve the tribological and mechanical performance of UHMWPE. The effect of these modifications on tribological and mechanical performance was discussed in this review.

High Oxidation Stability of Tea Polyphenol-stabilized Highly Crosslinked UHMWPE Under an in Vitro Aggressive Oxidative Condition

BACKGROUND

Synovial fluid components, especially lipids, can trigger oxidation of ultrahigh-molecular-weight polyethylene (UHMWPE) artificial joint components in vivo. The use of antioxidants such as vitamin E effectively diminishes the oxidative cascade by capturing free radicals and reducing the oxidation potential of UHMWPE implants. Using a thermo-oxidative aging method, we recently found that tea polyphenols can enhance the oxidation resistance of irradiated UHMWPE in comparison with commercial vitamin E. However, it is yet unknown whether tea polyphenols can reduce lipid-induced oxidation.

QUESTIONS/PURPOSES

We explored whether tea polyphenol-stabilized UHMWPE would exhibit (1) lower squalene absorption; (2) stronger oxidation resistance; and (3) lower content of free radicals than vitamin E-stabilized UHMWPE under a physiologically-motivated in vitro accelerated-aging model.

METHODS

Tea polyphenol (lipid-soluble epigallocatechin gallate [lsEGCG]) and vitamin E were blended with UHMWPE powders followed by compression molding and electron beam irradiation at 100 and 150 kGy. Small cubes (n = 3, 60 mg, 4 × 4 × 4 mm) cut from the blocks were doped in squalene at 60°, 80°, 100°, and 120° C for 2 hours. Gravimetric change of the cubes after squalene immersion was measured to assess absorption. Thin films (n = 3, ∼60 μm) were also microtomed from the blocks and were doped at 120° C for 24 hours. Oxidation induction time (n = 3, 5 mg of material from the cubes) and incipient oxidation temperature (n = 3, thin films) were obtained to determine the oxidation stability. Signal intensity of the free radicals, obtained by electron spin resonance spectroscopy, was used to qualitatively rank the antioxidant ability of vitamin E and lsEGCG.

RESULTS

Squalene absorption was comparable between lsEGCG/UHMWPE and vitamin E/UHMWPE at a given temperature and radiation dose. The oxidation induction time of 100 kGy-irradiated UHMWPE was increased with lsEGCG compared with vitamin E except at 120° C. For example, the oxidation induction time value of 100 kGy-irradiated lsEGCG/UHMWPE immersed at 60 C was 25.3 minutes (24.2-27.8 minutes), which was 8.3 minutes longer than that of 100 kGy-irradiated vitamin E/UHMWPE which was 17.0 minutes (15.0-17.1 minutes) (p = 0.040). After squalene immersion at 120° C, the incipient oxidation temperature of 100 and 150 kGy irradiated lsEGCG/UHMWPE was 234° C (227-240° C) and 227° C (225-229° C), which was higher than vitamin E-stabilized counterparts with value of 217° C (214-229° C; p = 0.095) and 216° C (207-218° C; p = 0.040), respectively. The electron spin resonance signal of 150 kGy irradiated lsEGCG/UHMWPE was qualitatively weaker than that of 150 kGy irradiated vitamin E/UHMWPE.

CONCLUSIONS

lsEGCG-stabilized UHMWPE demonstrated higher oxidation resistance than vitamin E-stabilized UHMWPE after squalene immersion, likely because lsEGCG donates more protons to eliminate macroradicals than vitamin E.

CLINICAL RELEVANCE

Our in vitro findings provide support that lsEGCG may be effective in protecting against oxidation that may be associated with synovial fluid-associated oxidation of highly crosslinked UHMWPE joint replacement components.