Fracture behavior of UHMWPE in non-implanted, shelf-aged knee prostheses after gamma irradiation in air

HIGHLY CROSSLINKED POLYETHYLENE: A COMPARATIVE STUDY BETWEEN TWO UHMWPES WITH DISTINCT MOLECULAR WEIGHT

In the recent years, radiation-induced highly crosslinked polyethylenes have been introduced in arthroplasties as an alternative to conventional ultra high molecular weight polyethylene (UHMWPE) for their superior wear resistance. In the present study, the influence of the molecular weight of the raw on end-user properties of highly crosslinked polyethylenes (HXLPE) is investigated by means of a comparative study between two resins with distinct molecular weights. The main outcomes indicate that the differences in mechanical and wear properties between the row materials disappear after crosslinking; nevertheless the resin with the highest molecular weight is likely to retain a better resistance to short-term oxidation.

Polyethylene oxidation in total hip arthroplasty: evolution and new advances

Ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard acetabular bearing material for hip arthroplasty. Its successful performance has shown consistent results and survivorship in total hip replacement (THR) above 85% after 15 years, with different patients, surgeons, or designs. As THR results have been challenged by wear, oxidation, and liner fracture, relevant research on the material properties in the past decade has led to the development and clinical introduction of highly crosslinked polyethylenes (HXLPE). More stress on the bearing (more active, overweighted, younger patients), and more variability in the implantation technique in different small and large Hospitals may further compromise the clinical performance for many patients. The long-term in vivo performance of these materials remains to be proven. Clinical and retrieval studies after more than 5 years of in vivo use with HXLPE in THR are reviewed and consistently show a substantial decrease in wear rate. Moreover, a second generation of improved polyethylenes is backed by in vitro data and awaits more clinical experience to confirm the experimental improvements. Also, new antioxidant, free radical scavengers, candidates and the reinforcement of polyethylene through composites are currently under basic research.Oxidation of polyethylene is today significantly reduced by present formulations, and this forgiving, affordable, and wellknown material is still reliable to meet today's higher requirements in total hip replacement.

Comparative fatigue behavior and toughness of remelted and annealed highly crosslinked polyethylenes

Highly cross-linked polyethylenes (HXLPEs) have been incorporated into the hip replacement armamentarium based on their improved wear resistance. However, two different methods of thermal treatment separate the orthopedic community as strategies to control potential long-term oxidation, and controversy remains with problems in the long-term use of acetabular liners (long-term oxidation, rim fracture after impingement, etc.). Meanwhile, the mechanical properties of HXLPEs that may alleviate these problems are still unclear. On the other hand, HXLPEs are scarcely used in knee replacements, as there exists concern about the probably reduced fatigue and fracture performances of these materials. Thus, our aim was to compare the effects of both thermal treatment regimes on mechanical properties and to associate these findings with the material microstructure. The fatigue behavior of annealed and remelted HXLPEs was characterized using short-term cyclic stress-strain, long-term fatigue, and fatigue crack propagation tests. On the other hand, impact tests, tensile experiments, and the J-integral multispecimen method allowed us to assess toughness. Microstructure features such as crosslink density, crystallinity percentage, and lamellar thickness were investigated by swelling measurements, differential scanning calorimetry, and transmission electron microscopy, respectively. This study confirms that annealing preserves mechanical properties better than remelting from both fatigue and fracture resistance points of view, and it remarks that a suitable selection of irradiation and stabilization conditions is needed to achieve optimal mechanical performances of ultra high molecular weight polyethylenes for each specific total joint replacement.

Influence of the remelting process on the fatigue behavior of electron beam irradiated UHMWPE

Electron beam irradiation at doses below 150 kGy is a widely used technique to obtain highly crosslinked ultra-high-molecular-weight polyethylene (UHMWPE). Its current use in total joint replacement components may improve wear resistance and decrease UHMWPE particle debris. However, currently used post-irradiation thermal treatments, which aim to decrease the free radicals within the material, introduce microstructural changes that affect UHMWPE mechanical properties, particularly the fatigue strength. This influence may be crucial in total knee replacements, where fatigue-related damage limits the lifespan of the prosthesis. Therefore, more studies are required to understand UHMWPE fatigue after current crosslinking protocols. This study was planned to evaluate the influence of UHMWPE remelting after irradiation on the material fatigue resistance. The remelting was achieved at 150 degrees C for 2 h on UHMWPE previously irradiated at 50, 100, and 150 kGy. Fatigue evaluation included short-term tests under cyclic tensile stress with zero load ratio, R = 0, and 1 Hz. In addition, stress-life testing was performed using 12% yield as the criterion for failure. Near-threshold fatigue crack propagation experiments were also performed at a frequency of 5 Hz, and crack length was measured in nonthermally treated and remelted irradiated UHMWPE. Crystallinity percentage was calculated from DSC measurements. The results pointed out that irradiation positively contributed to total life analysis, but the further remelting process decreased the flaw initiation resistance. On the other hand, both processes negatively affected the fatigue resistance of notched components. From a clinical point of view, the results suggest that the material fatigue behavior should be carefully studied in new UHMWPE to avoid changes related to material processing.

Fractography evolution in accelerated aging of UHMWPE after gamma irradiation in air

We studied the fracture surface evolution of ultra high molecular weight polyethylene (UHMWPE) specimens, manufactured from GUR 1050 compression moulded sheets, after gamma sterilisation in air followed by different aging times after thermal treatment at 120 degrees C. Degradation profiles were obtained by FTIR and DSC measurements after 0, 7, 14, 24 and 36h aging. We observed by SEM the morphology patterns at these aging times, in surface fractographies after uniaxial tensile test of standardised samples. The results pointed out clear differences between short and long aging times. At shorter times, 7h, the behaviour was similar to non-degraded UHMWPE, exhibiting ductile behaviour. At longer times, 24-36h, this thermal protocol provided a highly degraded zone in the subsurface, similar to the white band found after gamma irradiation in air followed by natural aging, although closer to the surface, at 150-200mum. The microstructure of this oxidation zone, similarly found in gamma irradiated samples shelf-aged for 6-7 years, although with different distribution of microvoids, was formed by fibrils, associated with embrittlement of the oxidised UHMWPE. In addition, the evolution of the oxidation index, the enthalpy content, the mechanical parameters, and the depth of the oxidation front deduced from the fractographies versus aging time showed that a changing behaviour in the degradation rate appeared at intermediate aging times.

Comparative cyclic stress-strain and fatigue resistance behavior of electron-beam- and gamma-irradiated ultrahigh molecular weight polyethylene

Fatigue-related damage in UHMWPE is one of the main causes of long-term failure in total joint replacements. Crosslinking ultrahigh molecular weight polyethylene (UHMWPE) by gamma or electron-beam irradiation, in combination with prior or further thermal treatment, enhances its wear resistance against metallic components in total hip replacements, and eventually in knees. However, little information is available on the fatigue response of this modified UHMWPE. The objective of this study was to compare electron-beam-irradiated UHMWPE at 50, 100, and 150 kGy, with the well-known 25 kGy gamma-irradiated UHMWPE. Two different cyclic tests were performed under tensile stress, with a zero load ratio, R = 0. First, specimens were subjected to a sinusoidal load cycle at 1 Hz, which provided stress-life curves with the use of a failure criterion based on 12% yield strain. Second, specimens were tested under 50 load cycles at a displacement rate of 15 mm/min, which provided information about the evolution of secant modulus and plastic strain. The incubation period was also analyzed. DSC measurements were carried out to check the crystallization effect of irradiation. According to the results of fatigue resistance there was a crossover behavior between gamma- and electron-beam-irradiated UHMWPE regarding the applied stress. When the stress was higher than the crossover value, the fatigue resistance of gamma-irradiated samples was higher than electron-beam-irradiated ones. When the stress was lower, the fatigue behavior was the opposite. The crossover stress depended on the electron-beam-irradiation dose. The clinical relevance of this study lies in an improved knowledge of electron-beam-irradiated material under extreme mechanical circumstances, such as fatigue.