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Savin L, Pinteala T, Mihai DN, Mihailescu D, Miu SS, Sirbu MT, Veliceasa B, Popescu DC, Sirbu PD, Forna N. Updates on Biomaterials Used in Total Hip Arthroplasty (THA). Polymers (Basel) 2023; 15:3278. [PMID: 37571172 PMCID: PMC10422432 DOI: 10.3390/polym15153278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.
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Affiliation(s)
- Liliana Savin
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Tudor Pinteala
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Dana Nicoleta Mihai
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
- Department of Protheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dan Mihailescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Smaranda Stefana Miu
- Department of Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Mihnea Theodor Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Dragos Cristian Popescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Paul Dan Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Norin Forna
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
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Gamna F, Spriano S. Vitamin E: A Review of Its Application and Methods of Detection When Combined with Implant Biomaterials. MATERIALS 2021; 14:ma14133691. [PMID: 34279260 PMCID: PMC8269872 DOI: 10.3390/ma14133691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 01/12/2023]
Abstract
Vitamin E is a common compound used for tocopherols and tocotrienols (α, β, γ, δ); it is the component of many natural products of both plant and animal origin. Thanks to its powerful antioxidant capacity, vitamin E has been very successful in hip and knee arthroplasty, used to confer resistance to oxidation to irradiated UHMWPE. The positive results of these studies have made vitamin E an important object of research in the biomedical field, highlighting other important properties, such as anti-bacterial, -inflammatory, and -cancer activities. In fact, there is an extensive literature dealing with vitamin E in different kinds of material processing, drug delivery, and development of surface coatings. Vitamin E is widely discussed in the literature, and it is possible to find many reviews that discuss the biological role of vitamin E and its applications in food packaging and cosmetics. However, to date, there is not a review that discusses the biomedical applications of vitamin E and that points to the methods used to detect it within a solid. This review specifically aims to compile research about new biomedical applications of vitamin E carried out in the last 20 years, with the intention of providing an overview of the methodologies used to combine it with implantable biomaterials, as well as to detect and characterize it within these materials.
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Schwiesau J, Fritz B, Bergmann G, Puente Reyna AL, Schilling C, Grupp TM. Influence of radiation conditions on the wear behaviour of Vitamin E treated UHMWPE gliding components for total knee arthroplasty after extended artificial aging and simulated daily patient activities. J Mech Behav Biomed Mater 2021; 122:104652. [PMID: 34246078 DOI: 10.1016/j.jmbbm.2021.104652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
The long term performance of total knee arthroplasty (TKA) with regards to the bearing materials is related to the aging behaviour of these materials. The use of highly crosslinked materials in hip arthroplasty improved the clinical outcome. Nevertheless, the outcome for these materials compared to conventional UHMWPE (ultra-high molecular weight polyethylene) remains controversial in TKA and alternative bearing materials may be advantageous to improve its outcome in the second and third decade. The aim of this study is the evaluation of the influence of radiation conditions on the wear behaviour of Vitamin E blended UHMWPE gliding components for TKA by simulation of extended aging and high demanding daily patient activities. For a medium radiation dose (30 kGy), the influence of the irradiation type (E-beam or Gamma radiation) and the thermal conditions (room temperature (RT) or heated to 115 °C) are evaluated in comparison to non-irradiated material. Significant influences on the wear behaviour were found for the radiation source and temperature during irradiation. Furthermore, no relevant degradation of the tested materials was observed after extended artificial aging. There was a good correspondence between the wear pattern in this study and retrievals.
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Affiliation(s)
- Jens Schwiesau
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany.
| | | | - Georg Bergmann
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Thomas M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany
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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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Vitamin E-blended versus conventional polyethylene liners in prostheses : Prospective, randomized trial with 3-year follow-up. DER ORTHOPADE 2021; 49:1077-1085. [PMID: 31696260 DOI: 10.1007/s00132-019-03830-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite continuous technical improvements, polyethylene wear debris induced periprosthetic osteolysis remains the main cause for failure of hip arthroplasty. Progressive oxidation of polyethylene was identified as another risk factor for material failure. To overcome this problem, antioxidants such as vitamin E (alpha-tocopherol) were supplemented by diffusion into the latest generation of polyethylene liners. OBJECTIVE The purpose of the present study was to investigate the clinical outcome of patients treated with vitamin E blended highly cross-linked ultra-high molecular weight polyethylene liners (UHMWPE-XE) in comparison with conventional UHMWPE‑X liners by evaluating patient-reported outcome measures (PROM's) at 3‑year follow-up. METHODS A total of 143 patients were recruited into this prospective, randomized trial in our academic center. Three years after implantation, 101 patients were examined in the outpatient clinic for follow-up. Of these, 51 (50.5%) received UHMWPE-XE and 50 (49.5%) UHMWPE‑X liners. Clinical outcome was evaluated using Harris-Hip-Score (HHS) UCLA-Score and Hip Disability and Osteoarthritis Outcome Score (HOOS). RESULTS There was a significant improvement in all PROM's at one- and three-year follow-up compared to the status before implantation. PROM's did not differ significantly between the first and third year follow-up. Both liner groups showed an equal clinical outcome. CONCLUSION The present study demonstrates that the supplementation of vitamin E to polyethylene liners is reliable and safe without showing higher complication rates compared with conventional polyethylene liners. The shortterm clinical outcome of vitamin E-blended (UHMWPE‑XE) is equivalent to those of conventional highly cross-linked polyethylene liners.
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Di Foggia M, Affatato S, Taddei P. Does the addition of vitamin E to conventional UHMWPE improve the wear performance of hip acetabular cups? Micro-Raman characterization of differently processed polyethylene acetabular cups worn on a hip joint simulator. Braz J Med Biol Res 2020; 53:e9930. [PMID: 32813853 PMCID: PMC7437989 DOI: 10.1590/1414-431x20209930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
In knee replacements, vitamin E-doped ultra-high molecular weight polyethylene (UHMWPE) shows a better wear behavior than standard UHMWPE. Therefore, different sets of polyethylene (PE) acetabular cups, i.e. standard UHMWPE and cross-linked polyethylene irradiated with 50 kGy and 75 kGy, were compared, at a molecular level, with vitamin E-doped UHMWPE to evaluate their wear performance after being tested on a hip joint simulator for five million cycles. Unworn control and worn acetabular cups were analyzed by micro-Raman spectroscopy to gain insight into the effects of wear on the microstructure and phase composition of PE. Macroscopic wear was evaluated through mass loss measurements. The data showed that the samples could be divided into two groups: 1) standard and vitamin E-doped cups (mass loss of about 100 mg) and 2) the cross-linked cups (mass loss of about 30-40 mg). Micro-Raman spectroscopy disclosed different wear mechanisms in the four sets of acetabular cups, which were related to surface topography data. The vitamin E-doped samples did not show a better wear behavior than the cross-linked ones in terms of either mass loss or morphology changes. However, they showed lower variation at the morphological level (lower changes in phase composition) than the UHMWPE cups, thus confirming a certain protecting role of vitamin E against microstructural changes induced by wear testing.
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Affiliation(s)
- M Di Foggia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Affatato
- Medical Technology Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - P Taddei
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Kaku N, Tagomori H, Akase H, Tabata T, Kataoka M, Tsumura H. Efficacy of vitamin E for mechanical damage and oxidation of polyethylene rim by stem neck impingement. Clin Biomech (Bristol, Avon) 2019; 68:8-15. [PMID: 31128555 DOI: 10.1016/j.clinbiomech.2019.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study is to determine the influence of crosslinking and addition of 0.3 wt% vitamin E in a polyethylene rim on its mechanical damage and oxidation caused by impingement. METHODS Six ultrahigh-molecular weight polyethylene samples were studied (control; crosslinked; vitamin-E containing; crosslinked and vitamin-E containing; aged control; and aged crosslinked and vitamin-E containing). Crosslinking was attained by irradiation with a 300 kGy electron beam; vitamin E incorporation was at 0.3 wt%; and aging was performed through forced oxidation for 14 days. Resistance to impingement was evaluated by stereoscopic observations, three-dimensional measurements, and oxidation measurements by Fourier transform infrared spectroscopy. FINDINGS Rim breakage (delamination and fracture) due to impingement was observed only for the aged control specimen. In contrast, crosslinked specimens containing vitamin E showed no failure of the rim after aging. The addition of vitamin E to polyethylene suppressed its oxidation and reduced the oxidation caused by crosslinking or impingement. The impingement resistance of the control sample deteriorated upon oxidation, whereas that of vitamin E-containing crosslinked polyethylene remained high due to the antioxidant property of vitamin E. INTERPRETATION Vitamin E-containing polyethylene showed a reduced risk of wear/breakage of polyethylene rims by impingement.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tomonori Tabata
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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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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Popoola OO, Orozco Villasenor DA, Fryman JC, Mimnaugh K, Rufner A. High cycle in vitro hip wear of and in vivo biological response to vitamin E blended highly crosslinked polyethylene. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.biotri.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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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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Gilbert TJ, Anoushiravani AA, Sayeed Z, Chambers MC, El-Othmani MM, Saleh KJ. Osteolysis Complicating Total Knee Arthroplasty. JBJS Rev 2018; 4:01874474-201607000-00001. [PMID: 27509327 DOI: 10.2106/jbjs.rvw.15.00081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Osteolysis is a process mounted by the host immune system that relies on several variables, including patient-related factors, type of insert material, modes of wear, and implant design. Imaging techniques such as radiography, computed tomography (CT) scans, magnetic resonance imaging (MRI), and tomosynthesis aid in diagnosing osteolysis. Surgical options for the treatment of osteolysis include the insertion of bone grafts, bone cement, and prosthetic augmentation. Although no approved pharmacological therapies for the specific treatment of osteolysis exist, the use of bisphosphonates and statins decreases the risk of osteolysis.
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Affiliation(s)
- Theodore J Gilbert
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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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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Yamamoto K, Tateiwa T, Takahashi Y. Vitamin E-stabilized highly crosslinked polyethylenes: The role and effectiveness in total hip arthroplasty. J Orthop Sci 2017; 22:384-390. [PMID: 28209339 DOI: 10.1016/j.jos.2017.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 02/09/2023]
Abstract
Morphology and design of ultra-high molecular weight polyethylene (UHMWPE or simply PE) acetabular components used in total hip arthroplasty (THA) have been evolving for more than half a century. Since the late-1990s, there were two major technological innovations in PE emerged from necessity to overcome the wear-induced periprosthetic osteolysis, i.e., the development of highly crosslinked PEs (HXLPEs). There are many literature reporting that radiation crosslinked and remelted/annealed (first-generation) HXLPEs markedly reduced the incidence of osteolysis and aseptic loosening. Regardless of such clinical success in the first-generation technologies, there were some recent shifts in Japan toward the use of new second-generation HXLPEs subjected to sequential irradiation/annealing or antioxidant vitamin E (α-tocopherol) incorporation. Although the selection rate of first-generation liners still account for more than half of all the PE THAs (∼58% in 2015), the use of vitamin E-stabilized liners has been steadily growing each year since their clinical introduction in 2010. In these contexts, it is of great importance to evaluate and understand the real clinical benefits of using the new second-generation liners as compared to the first generation. This article first summarizes structural evolution and characteristic features of first-generation HXLPEs, and then provides a detailed description of second-generation antioxidant HXLPEs in regard to the role of vitamin E incorporation on their chemical and mechanical performances in THA.
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Affiliation(s)
- Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1,Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Takahashi Y, Tateiwa T, Pezzotti G, Shishido T, Masaoka T, Yamamoto K. Improved Resistance to Neck-Liner Impingement in Second-Generation Highly Crosslinked Polyethylene-The Role of Vitamin E and Crosslinks. J Arthroplasty 2016; 31:2926-2932. [PMID: 27378642 DOI: 10.1016/j.arth.2016.05.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/26/2016] [Accepted: 05/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Radiation crosslinking of ultrahigh molecular weight polyethylene (UHMWPE) results in the reduced tensile strength and fracture toughness as an expense of dramatic increase in the wear resistance. Clinical rim fracture has been reported due to neck-liner impingement on a first-generation highly crosslinked UHMWPE acetabular component. The objective of this study was to investigate whether a second-generation, vitamin E-blended highly crosslinked UHMWPE possesses the improved impingement resistance. METHODS Cyclic impingement testing was performed in a variety of UHMWPE acetabular components (vitamin E free or blended, noncrosslinked or highly crosslinked, and GUR1050 or GUR1020) with the same design specification. The kinematics used to reproduce the neck-liner impingement was a uniaxial fatigue compression in concert with an axial rotational torque. After the test, the geometry and morphological changes were characterized by coordinate measuring machine, scanning electron microscopy, and confocal Raman microspectroscopy. RESULTS A total of 300-kGy irradiated and annealed GUR1050 liner resulted in a significant geometry change and microcracks on the rim surface after the test. However, regardless of the similar level of crosslinking, much less damage was noted in the 300-kGy irradiated GUR1050 liner blended with vitamin E at a concentration of 3000 ppm. On the other hand, vitamin E-blended noncrosslinked GUR1050 exhibited an extensive microscopic fibrillation and folding on the impinged surface. CONCLUSION These results suggest that vitamin E-blending into UHMWPE has compensated the negative effect of toughness decrease induced by radiation crosslinking. We concluded that the coexistence of vitamin E and crosslinks can restrain impingement damage more effectively than either of them.
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Affiliation(s)
- Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Giuseppe Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Kyoto, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Takahashi Y, Tateiwa T, Shishido T, Masaoka T, Kubo K, Yamamoto K. Size and thickness effect on creep behavior in conventional and vitamin E-diffused highly crosslinked polyethylene for total hip arthroplasty. J Mech Behav Biomed Mater 2016; 62:399-406. [PMID: 27261923 DOI: 10.1016/j.jmbbm.2016.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/11/2016] [Accepted: 05/15/2016] [Indexed: 11/29/2022]
Abstract
Since the early 2000s, the use of large femoral heads is becoming increasingly popular in total hip arthroplasty (THA), which provides an improved range of motion and joint stability. Large femoral heads commonly necessitate to be coupled with thinner acetabular liners than the conventionally used because of the limited sizes of outer shells (especially for patients with small pelvic size). However, the influence of the liner thinning on the mechanical performance is still not clearly understood. The objective of this study was to experimentally clarify the size and thickness effect on the rates of compressive creep strain in conventional (virgin low-crosslinked) and vitamin E-diffused highly crosslinked, ultra-high molecular weight polyethylene (UHMWPE) acetabular liners. We applied uniaxial compression to these liners of various internal diameters (28, 32 and 36mm) and thicknesses (4.8, 6.8 and 8.9mm) up to 4320min under the constant load of 3000N. Vitamin E-diffused highly crosslinked UHMWPE components showed significantly greater creep resistance than the conventional ones. In the both types of UHMWPE, the rates of creep strain significantly decreased by increasing the internal diameter and thickness. Varying the component thickness contributed more largely to the creep behavior rather than the internal diameter. Our results suggest the positive mechanical advantage of using large femoral heads, but at the same time, a considerable liner thinning is not recommended for minimizing creep strain. Therefore, the further in-vitro as well as in-vivo research are necessary to conclude the optimal balance of head diameter and liner thickness within the limited sizes of outer shells.
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Affiliation(s)
- Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kosuke Kubo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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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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17
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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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Forster AL, Forster AM, Chin JW, Peng JS, Lin CC, Petit S, Kang KL, Paulter N, Riley MA, Rice KD, Al-Sheikhly M. Long-term stability of UHMWPE fibers. Polym Degrad Stab 2015. [DOI: 10.1016/j.polymdegradstab.2015.01.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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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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20
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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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21
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Rattanawongwiboon T, Pasanphan W. Light stabilizer–conjugated–stearylate chitosan nanoparticles: A bio-based additive for free radical stabilization of healthcare plastics under irradiation. Polym Degrad Stab 2014. [DOI: 10.1016/j.polymdegradstab.2014.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Bichara DA, Malchau E, Sillesen NH, Cakmak S, Nielsen GP, Muratoglu OK. Vitamin E-diffused highly cross-linked UHMWPE particles induce less osteolysis compared to highly cross-linked virgin UHMWPE particles in vivo. J Arthroplasty 2014; 29:232-7. [PMID: 24998319 DOI: 10.1016/j.arth.2014.03.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 03/14/2014] [Indexed: 02/01/2023] Open
Abstract
Recent in vitro findings suggest that UHMWPE wear particles containing vitamin E (VE) may have reduced biologic activity and decreased osteolytic potential. We hypothesized that particles from VE-stabilized, radiation cross-linked UHMWPE would cause less osteolysis in a murine calvarial bone model when compared to virgin gamma irradiated cross-linked UHMWPE. Groups received equal amount of particulate debris overlaying the calvarium for 10 days. Calvarial bone was examined using high resolution micro-CT and histomorphometric analyses. There was a statistically significant difference between virgin (12.2%±8%) and VE-UHMWPE (3%±1.4%) groups in regards to bone resorption (P=0.005) and inflammatory fibrous tissue overlaying the calvaria (0.48 vs. 0.20, P<0.0001). These results suggest that VE-UHMWPE particles have reduced osteolytic potential in vivo when compared to virgin UHMWPE.
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Affiliation(s)
- David A Bichara
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Nanna H Sillesen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Selami Cakmak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - G Petur Nielsen
- Harvard Medical School, Boston, Massachusetts; Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Shen J, Costa L, Xu Y, Cong Y, Cheng Y, Liu X, Fu J. Stabilization of highly crosslinked ultra high molecular weight polyethylene with natural polyphenols. Polym Degrad Stab 2014. [DOI: 10.1016/j.polymdegradstab.2014.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jäger M, van Wasen A, Warwas S, Landgraeber S, Haversath M, Group V. A multicenter approach evaluating the impact of vitamin e-blended polyethylene in cementless total hip replacement. Orthop Rev (Pavia) 2014; 6:5285. [PMID: 25002933 PMCID: PMC4083306 DOI: 10.4081/or.2014.5285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/07/2014] [Indexed: 11/23/2022] Open
Abstract
Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant material itself over a time period of 15 years.
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Affiliation(s)
- Marcus Jäger
- Orthopaedic Department, University of Duisburg-Essen, University Hospital Essen ; Tuttlingen, Germany
| | - Andrea van Wasen
- Orthopaedic Department, University of Duisburg-Essen, University Hospital Essen ; Tuttlingen, Germany
| | - Sebastian Warwas
- Orthopaedic Department, University of Duisburg-Essen, University Hospital Essen ; Tuttlingen, Germany
| | - Stefan Landgraeber
- Orthopaedic Department, University of Duisburg-Essen, University Hospital Essen ; Tuttlingen, Germany
| | - Marcel Haversath
- Orthopaedic Department, University of Duisburg-Essen, University Hospital Essen ; Tuttlingen, Germany
| | - Vitas Group
- B. Braun Melsungen AG, Aesculap Division , Tuttlingen, Germany
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25
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van der Veen HC, van den Akker-Scheek I, Bulstra SK, van Raay JJ. Wear, bone density, functional outcome and survival in vitamin E-incorporated polyethylene cups in reversed hybrid total hip arthroplasty: design of a randomized controlled trial. BMC Musculoskelet Disord 2012; 13:178. [PMID: 22994935 PMCID: PMC3517763 DOI: 10.1186/1471-2474-13-178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/19/2012] [Indexed: 11/11/2022] Open
Abstract
Background Aseptic loosening of total hip arthroplasties is generally caused by periprosthetic bone resorption due to tissue reactions on polyethylene wear particles. In vitro testing of polyethylene cups incorporated with vitamin E shows increased wear resistance. The objective of this study is to compare vitamin E-stabilized highly cross-linked polyethylene with conventional cross-linked polyethylene in “reversed hybrid” total hip arthroplasties (cemented all-polyethylene cups combined with uncemented femoral stems). We hypothesize that the adjunction of vitamin E leads to a decrease in polyethylene wear in the long-term. We also expect changes in bone mineral density, less osteolysis, equal functional scores and increased implant survival in polyethylene cemented cups incorporated with vitamin E in the long-term. Design A double-blinded randomized controlled trial will be conducted. Patients to be included are aged under 70, suffer from non-inflammatory degenerative joint disease of the hip and are scheduled for a primary total hip arthroplasty. The study group will receive a reversed hybrid total hip arthroplasty with a vitamin E-stabilized highly cross-linked polyethylene cemented cup. The control group will receive a reversed hybrid total hip arthroplasty with a conventional cross-linked polyethylene cemented cup. Radiological follow-up will be assessed at 6 weeks and at 1, 3, 5, 7 and 10 years postoperatively, to determine polyethylene wear and osteolysis. Patient-reported functional status (HOOS), physician-reported functional status (Harris Hip Score) and patients’ physical activity behavior (SQUASH) will also be assessed at these intervals. Acetabular bone mineral density will be assessed by dual energy X-ray absorptiometry (DEXA) at 6 weeks and at 1 year and 2 years postoperatively. Implant survival will be determined at 10 years postoperatively. Discussion In vitro results of vitamin E-stabilized polyethylene are promising, showing increased wear resistance. However, controlled clinical follow-up data are not available at this moment. This randomized controlled trial has been designed to determine wear, bone mineral density, functional outcome and survival in reversed hybrid total hip arthroplasty comparing cemented vitamin E-stabilized highly cross-linked polyethylene cups with cemented conventional cross-linked polyethylene cups. Trial registration Dutch Trial Registry NTR3049
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Affiliation(s)
- Hugo C van der Veen
- Department of Orthopaedic Surgery, Martini Hospital, P,O, Box 30033, 9700, RM, Groningen, The Netherlands.
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26
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Kasser MJ. Regulation of UHMWPE biomaterials in total hip arthroplasty. J Biomed Mater Res B Appl Biomater 2012; 101:400-6. [PMID: 22987363 DOI: 10.1002/jbm.b.32809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/02/2012] [Accepted: 07/26/2012] [Indexed: 11/07/2022]
Abstract
This manuscript provides a brief history of the development of ultrahigh molecular weight polyethylene (UHWMPE) biomaterials and how the U.S. Food and Drug Administration (FDA) regulates medical devices. The flowchart used to decide whether a device is medium or high risk, known as the 510(k) flowchart, is illustrated by taking several examples through the flowchart. In order to demonstrate how changes to UHWMPE material used in the acetabular liners of total hips have been regulated, two major modifications to UHMWPE, highly crosslinked polyethylene and Vitamin E polyethylene, are taken through the flowchart. This manuscript describes the testing that has been provided to demonstrate safety and effectiveness of these modifications, as well as an explanation why the testing was supplied to the FDA.
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Affiliation(s)
- Michael J Kasser
- Orthopedic Joint Devices Branch, Office of Device Evaluation, Food and Drug Administration, Silver Spring, Maryland, USA.
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27
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Banche G, Bracco P, Bistolfi A, Allizond V, Boffano M, Costa L, Cimino A, Cuffini AM, Del Prever EMB. Vitamin E blended UHMWPE may have the potential to reduce bacterial adhesive ability. J Orthop Res 2011; 29:1662-7. [PMID: 21520260 DOI: 10.1002/jor.21432] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 03/21/2011] [Indexed: 02/04/2023]
Abstract
Biomaterial-associated infection (BAI), a clinical problem resulting in septic failure of joint replacement implants, is initiated by bacterial adhesion, often by Staphylococcus epidermidis. Ultra high molecular weight polyethylene (UHMWPE) is a material of choice for joint replacement; reducing the adhesion of S. epidermidis to the polymer could be a means to decrease infection. We examined the adhesion of two ATCC and one clinical strain of S. epidermidis to standard polyethylene (PE), vitamin E blended UHMWPE (VE-PE), and oxidized UHMWPE (OX-PE) after different incubation times: a significant (p < 0.01) decrease in the adhered staphylococci on VE-PE and a significantly higher incidence of the dislodged biofilm bacteria on OX-PE was observed compared with that registered on PE. With attenuated total reflectance (ATR)-FTIR spectroscopy before and after suspension in bacterial medium for 48 h, new absorptions were observed mainly in OX-PE, indicating adsorption of protein-like substances on the polymer surface. We hypothesized that the different hydrophilicity of the surfaces with different chemical characteristics influenced protein adsorption and bacterial adhesion. These results may have clinical implications concerning the prevention of septic loosening: the VE-PE could have the potential to reduce S. epidermidis adhesive ability if the preliminary data observed in these selected strains is further confirmed, as diversity among clinical strains is well known.
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Affiliation(s)
- Giuliana Banche
- Department of Public Health and Microbiology, University of Turin, Via Santena 9, 10126 Turin, Italy
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Abstract
BACKGROUND Osteolysis due to wear of UHMWPE limits the longevity of joint arthroplasty. Oxidative degradation of UHMWPE gamma-sterilized in air increases its wear while decreasing mechanical strength. Vitamin E stabilization of UHMWPE was proposed to improve oxidation resistance while maintaining wear resistance and fatigue strength. QUESTIONS/PURPOSES We reviewed the preclinical research on the development and testing of vitamin E-stabilized UHMWPE with the following questions in mind: (1) What is the rationale behind protecting irradiated UHMWPE against oxidation by vitamin E? (2) What are the effects of vitamin E on the microstructure, tribologic, and mechanical properties of irradiated UHMWPE? (3) Is vitamin E expected to affect the periprosthetic tissue negatively? METHODS We performed searches in PubMed, Scopus, and Science Citation Index to review the development of vitamin E-stabilized UHMWPEs and their feasibility as clinical implants. RESULTS The rationale for using vitamin E in UHMWPE was twofold: improving oxidation resistance of irradiated UHMWPEs and fatigue strength of irradiated UHMWPEs with an alternative to postirradiation melting. Vitamin E-stabilized UHMWPE showed oxidation resistance superior to that of irradiated UHMWPEs with detectable residual free radicals. It showed equivalent wear and improved mechanical strength compared to irradiated and melted UHMWPE. The biocompatibility was confirmed by simulating elution, if any, of the antioxidant from implants. CONCLUSIONS Vitamin E-stabilized UHMWPE offers a joint arthroplasty technology with good mechanical, wear, and oxidation properties. CLINICAL RELEVANCE Vitamin E-stabilized, irradiated UHMWPEs were recently introduced clinically. The rationale behind using vitamin E and in vitro tests comparing its performance to older materials are of great interest for improving longevity of joint arthroplasties.
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Affiliation(s)
- Pierangiola Bracco
- Dipartimento di Chimica IFM and NIS Centre of Excellence, Università di Torino, Via Pietro Guria, 7, 10125 Torino, Italy
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA USA
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Europium stearate additives delay oxidation of UHMWPE for orthopaedic applications: a pilot study. Clin Orthop Relat Res 2011; 469:2294-301. [PMID: 21153455 PMCID: PMC3126970 DOI: 10.1007/s11999-010-1711-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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 used as an articulating surface in prosthetic devices. Its failure under various mechanisms after oxidation is of utmost concern. Free radicals formed during the sterilization process using high-energy irradiation result in oxidation. Europium, an element of the lanthanide family, has a unique electron configuration with an unusual lack of preference for directional bonding and notable bonding to oxygen. Because of this, it currently is used in studies for stabilization of polymers such as polyvinyl chloride. QUESTIONS/PURPOSES We asked whether europium stearate could enhance the oxidation resistance after irradiation in nitrogen of UHMWPE. METHODS Conventional nonirradiated and gamma-irradiated in nitrogen UHMWPE were compared with polyethylene doped with 375 ppm and 3750 ppm europium(III) stearate under the same treatment conditions. Chemical characterization was performed by Fourier transform infrared (FTIR) microspectroscopy using 200-μm thin films. The oxidation of doped samples with time was compared with that of conventional samples using accelerated oven aging. The types of oxidation products were identified by FTIR and quantified per material and treatment condition as indications of the oxidation level and mechanism. RESULTS The generation rate of hydroperoxides and ketones was decelerated proportionally with concentration of europium stearates. The oxidative mechanism appeared similar to that of conventional polyethylene with the same types of measurable end products as ketones and hydroperoxides. Yet, the rate of generation of the latter appeared to be slowed down by the action of europium stearate. CONCLUSIONS Europium stearate mixed in UHMWPE decelerated the oxidation reactions triggered by gamma irradiation in nitrogen, seemingly without major alteration of the oxidation mechanism.
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Gómez-Barrena E, Esteban J, Molina-Manso D, Adames H, Martínez-Morlanes MJ, Terriza A, Yubero F, Puértolas JA. Bacterial adherence on UHMWPE with vitamin E: an in vitro study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:1701-1706. [PMID: 21574013 DOI: 10.1007/s10856-011-4340-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/07/2011] [Indexed: 05/30/2023]
Abstract
Orthopaedic materials may improve its capacity to resist bacterial adherence, and subsequent infection. Our aim was to test the bacterial adherence to alpha-tocopherol (frequently named vitamin E, VE) doped or blended UHMWPE with S. aureus and S. epidermidis, compared to virgin material. Collection strains and clinical strains isolated from patients with orthopaedic infections were used, with the biofilm-developing ability as a covariable. While collection strains showed significantly less adherence to VE-UHMWPE, some clinical strains failed to confirm this effect, leading to the conclusion that VE doped or blended UHMWPE affects the adherence of some S. epidermidis and S. aureus strains, independently of the concentration in use, but the results showed important intraspecies differences and cannot be generalized.
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Affiliation(s)
- E Gómez-Barrena
- Department of Orthopaedic Surgery, Hospital La Paz, Madrid, Spain.
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31
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Puértolas JA, Martínez-Morlanes MJ, Mariscal MD, Medel FJ. Thermal and dynamic mechanical properties of vitamin E infused and blended ultra-high molecular weight polyethylenes. J Appl Polym Sci 2010. [DOI: 10.1002/app.33454] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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32
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Molina-Manso D, Gómez-Barrena E, Esteban J, Adames H, Martínez MJ, Cordero J, Fernández-Roblas R, Puértolas JA. Bacterial adherence on UHMWPE doped with Vitamin E: anin vitrostudy. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/252/1/012014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jarrett BT, Cofske J, Rosenberg AE, Oral E, Muratoglu O, Malchau H. In vivo biological response to vitamin E and vitamin-E-doped polyethylene. J Bone Joint Surg Am 2010; 92:2672-81. [PMID: 21084577 DOI: 10.2106/jbjs.i.00068] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cross-linking has decreased the wear of ultra-high molecular weight polyethylene, a cause of osteolysis leading to total joint replacement failure. Compared with melting or annealing, doping cross-linked ultra-high molecular weight polyethylene with vitamin E stabilizes free radicals from irradiation while maintaining mechanical properties and wear resistance. This study was done to determine the local tissue effects of free vitamin E and vitamin E eluted from ultra-high molecular weight polyethylene implants in the joint space. METHODS Three studies were performed. First, pure vitamin E and solubilized vitamin E were injected into rabbit knees to simulate vitamin-E elution from radiation cross-linked ultra-high molecular weight polyethylene; second, vitamin-E-doped, irradiated ultra-high molecular weight polyethylene plugs were implanted into dorsal subcutaneous pouches of rabbits to determine the local effects of vitamin-E elution from radiation cross-linked ultra-high molecular weight polyethylene; and, third, two groups of vitamin-E-doped, irradiated acetabular liners (high surface and uniform vitamin-E concentration profiles) were compared with undoped, control ultra-high molecular weight polyethylene liners in a canine model of total hip replacement to determine the effect of possible vitamin-E elution on bone ingrowth and the local tissue response to it in a load-bearing environment. RESULTS Injection of solubilized vitamin E resulted in histologically normal surrounding soft tissue at both two and twelve-week follow-up intervals, while injection of pure vitamin E resulted in acute and chronic inflammation at the time of the two-week follow-up. Both control and vitamin-E-doped subcutaneous plugs showed inflammation associated with surgery at two weeks of follow-up, but showed stable fibrous encapsulation without inflammation at twelve weeks of follow-up. In the canine total hip replacement model, there was no qualitative difference in local tissue appearance and no significant difference in the percent bone ingrowth and the percent bone density between the control and vitamin-E groups. CONCLUSIONS These investigations showed that vitamin-E-doped ultra-high molecular weight polyethylene plugs and total hip replacement components are well tolerated in both a small and a large-animal model with no observed adverse effects on the surrounding tissues at twelve weeks of follow-up.
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Affiliation(s)
- Bryan T Jarrett
- Harris Orthopaedic Biomechanics and Biomaterials Laboratory, Massachusetts General Hospital, 1125 Gray/Jackson, 55 Fruit Street, Boston, MA 02115, USA.
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Morrison ML, Jani S. Evaluation of sequentially crosslinked ultra-high molecular weight polyethylene. J Biomed Mater Res B Appl Biomater 2009; 90:87-100. [PMID: 18988279 DOI: 10.1002/jbm.b.31257] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study was undertaken to investigate the effect of crosslinking ultra-high molecular weight polyethylene (UHMWPE) in a sequential manner to the final desired dose and to compare the results to single-dose crosslinking. To verify these results, an explanted, commercially available, sequentially crosslinked component was characterized. Finally, additional tensile testing was conducted to determine if tensile-sample thickness has a significant effect on the mechanical properties of UHMWPE. Based upon this well-controlled study with the same starting material, there is no apparent benefit of sequential crosslinking over crosslinking by single dose in any of the mechanical, thermophysical, physical, or oxidative properties evaluated in this study. In contrast, the soak temperature of the postirradiation heat treatment was more influential and exhibited statistically significant effects on the stability, structure, and properties of the resultant material. Compared to virgin material, crosslinking always resulted in decreases in tensile strength, elongation, and impact strength. These results were confirmed by characterization of a retrieved, sequentially crosslinked (X3) cup. All of the metrics derived for the retrieved cup were virtually identical to the sequential- and single-dose-crosslinked materials produced in this study. Examination of the effect of tensile-sample thickness demonstrated that there are significant effects on the resultant properties. In particular, the ultimate tensile strength of UHMWPE can be elevated by conducting tensile tests with thin specimens.
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Affiliation(s)
- M L Morrison
- Smith and Nephew Orthopaedics, Memphis, Tennessee 38116, USA.
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Teramura S, Sakoda H, Terao T, Endo MM, Fujiwara K, Tomita N. Reduction of wear volume from ultrahigh molecular weight polyethylene knee components by the addition of vitamin E. J Orthop Res 2008; 26:460-4. [PMID: 17975842 DOI: 10.1002/jor.20514] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Wear performance and debris-size distribution of vitamin E (DL-alpha tocopherol, VE)-added ultrahigh molecular weight polyethylene (UHMWPE) was evaluated using a knee-simulator test. VE was mixed with GUR 1050 UHMWPE powder at 0.3 wt%, and the tibial components of the knee joint were made by direct compression molding. The VE-added UHMWPE showed consistently lower wear volume throughout the test.
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Affiliation(s)
- Satoshi Teramura
- Graduate School of Engineering, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto, Kyoto 606-8501, Japan
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Bracco P, Brunella V, Zanetti M, Luda M, Costa L. Stabilisation of ultra-high molecular weight polyethylene with Vitamin E. Polym Degrad Stab 2007. [DOI: 10.1016/j.polymdegradstab.2007.02.023] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wolf C, Lederer K, Pfragner R, Schauenstein K, Ingolic E, Siegl V. Biocompatibility of ultra-high molecular weight polyethylene (UHMW-PE) stabilized with alpha-tocopherol used for joint endoprostheses assessed in vitro. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2007; 18:1247-52. [PMID: 17277986 DOI: 10.1007/s10856-006-0098-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 02/09/2006] [Indexed: 05/13/2023]
Abstract
Adding the natural antioxidant alpha-tocopherol to ultra-high molecular weight polyethylene (UHMW-PE) can remarkably delay the oxidation of hip cups made thereof. However, alpha-tocopherol is likely to undergo different chemical transformations during manufacturing and sterilization of hip cups than in human metabolism. Therefore, the biocompatibility of the putative transformation products has to be investigated. In-vitro tests with L929 mice fibroblast-cells gave no evidence for cytotoxicity. To further ensure the biocompatibility, in-vitro tests with human cells were carried out in this study. Two different human cell lines, one adherent cell line, HF-SAR, and one suspension culture, GSJO, were tested on UHMW-PE-tablets (diameter: 15 mm; thickness: 2 mm; processed according to standard procedures for artificial hip-cups) with and without alpha-tocopherol with respect to cell viability, proliferation and morphology by means of cell counting, WSt-1 proliferation assay and scanning electron microscopy. Similar proliferation rates were found with both polyethylene samples. Further, we found intact morphology in light and electron microscopy on each substrate. The morphologic characteristics of skin fibroblasts were not changed by any material. Normal adherence and spreading of the fibroblasts was found on controls of glass, as well as on polystyrene and on stabilized and unstabilized polyethylene. The characteristic behaviour as suspension of the GSJO cells remained unchanged. The mitochondrial activity, as studied by WST-1 cell proliferation reagent, was identical on each substrate during the whole observation period of 7 days.
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Affiliation(s)
- Christian Wolf
- Department of Chemistry of Polymeric Materials, University of Leoben, 8700 Leoben, Austria
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Ries MD, Pruitt L. Effect of cross-linking on the microstructure and mechanical properties of ultra-high molecular weight polyethylene. Clin Orthop Relat Res 2005; 440:149-56. [PMID: 16239799 DOI: 10.1097/01.blo.0000185310.59202.e5] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ultra-high molecular weight polyethylene is a semicrystalline polymer, which means that a portion of the molecules is in a solid crystalline phase and the remaining portion is in a rubbery amorphous phase. Varying the polymer chemistry in the two phases can alter the mechanical properties of the material. When highly cross-linked polyethylene is formed, the cross-links occur in the amorphous but not the crystalline region. Remelting after irradiation-induced cross-linking neutralizes the free radicals that are caused by irradiation but also decreases the amount of crystallinity. Decreased crystallinity can contribute to a decrease in mechanical properties. Annealing below the melt temperature after irradiation retains a higher level of crystallinity. However, heating below the melt temperature does not neutralize irradiation-induced free radicals that can then react with oxygen, causing oxidative degradation. Newer "second-generation" highly cross-linked polyethylenes have been developed that are annealed below the melt temperature, but use either a pharmacologic antioxidant, mechanical deformation, or sequential low-dose irradiation and annealing treatments rather than heating above the melt point to neutralize residual free radicals. High-pressure treatment at elevated temperatures also can increase crystallinity. However, increased crystallinity is associated with an increase in modulus and contact stress, which can increase wear. Although cross-linking ultra-high molecular weight polyethylene can reduce wear, currently available highly cross-linked polyethylenes also decrease mechanical properties when compared with conventional ultra-high molecular weight polyethylene, so that use of these materials in total knee arthroplasty may contribute to mechanical failure of the bearing surface.
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Affiliation(s)
- Michael D Ries
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
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Shibata N, Tomita N. The anti-oxidative properties of α-tocopherol in γ-irradiated UHMWPE with respect to fatigue and oxidation resistance. Biomaterials 2005; 26:5755-62. [PMID: 15949542 DOI: 10.1016/j.biomaterials.2005.02.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 02/23/2005] [Indexed: 11/20/2022]
Abstract
Although addition of an antioxidant (alpha-tocopherol) is reported to prevent delamination in ultrahigh molecular weight polyethylene (UHMWPE) knee components, contribution of alpha-tocopherol as an antioxidant to the improvement of long-term fatigue performance of UHMWPE is an unknown mechanism. To solve this problem, bi-directional sliding fatigue tests were performed for gamma-irradiated (25 kGy), gamma-irradiated (25 kGy) with 0.3 wt% alpha-tocopherol added, and gamma-irradiated (25 kGy) with 0.3 wt% tocopheryl acetate added UHMWPE specimens. Internal defect initiation was quantified with scanning acoustic tomography (SAT). Also, oxidation index and crystallinity were obtained from infrared absorption spectra measured using Fourier transform infrared (FT-IR) microscopy. Only gamma-irradiated UHMWPE specimens resulted in severe fatigue fractures. alpha-Tocopherol-added UHMWPE specimens showed significantly lower projected area ratio of defects (1.80+/-0.82) than did gamma-irradiated (7.0+/-2.29) and tocopheryl acetate-added ones (8.50+/-2.01). The oxidation index of gamma-irradiated UHMWPE specimens (0.111+/-0.0052) was extremely higher compared to those of doped ones; 0.0179+/-0.0026 and 0.0144+/-0.0069 for alpha-tocopherol-added and tocopheryl acetate-added ones, respectively. The crystallinity of gamma-irradiated UHMWPE specimens (57.5+/-1.16) was lower compared to those of doped ones; 60.3+/-0.72 and 60.4+/-1.38 for alpha-tocopherol-added and tocopheryl acetate-added ones, respectively. The incorporation of alpha-tocopherol significantly improves the long-term fatigue performance of gamma-irradiated UHMWPE with oxidation stability. Also, the addition of alpha-tocopherol controls macromolecular structures resulting in the improvement of fatigue performance of UHMWPE.
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Affiliation(s)
- Nobuyuki Shibata
- Department of Human Engineering, National Institute of Industrial Health, 6-21-1, Nagao, Tama-ku, Kawasaki 214-8585, Japan.
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The influence of soft segment length on the properties of poly(butylene terephthalate-co-succinate)-b-poly(ethylene glycol) segmented random copolymers. Eur Polym J 2004. [DOI: 10.1016/j.eurpolymj.2004.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Aust N. Application of size-exclusion chromatography to polymers of ultra-high molar mass. JOURNAL OF BIOCHEMICAL AND BIOPHYSICAL METHODS 2003; 56:323-34. [PMID: 12834987 DOI: 10.1016/s0165-022x(03)00069-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article describes the experimental conditions that should be applied to avoid molecular degradation in size-exclusion chromatography of polymers of ultra-high molar mass (weight-average molar mass M(w)>5000 kg/mol). The applicability of the optimized experimental conditions is demonstrated using polystyrene as a model substance, but also by using polymers of biochemical and biophysical interest, such as polyethylene of ultra-high molar mass, suitable, e.g., for articulating surfaces in joint endoprotheses, and natural rubber, the most important commercial source for products like septa or medical gloves.
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Affiliation(s)
- Nicolai Aust
- Department of Chemistry of Polymeric Materials, University of Leoben, Franz-Josef-Str. 18, A-8700, Leoben, Austria.
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Parth M, Aust N, Lederer K. Molecular Characterization of Ultrahigh Molar Mass and Soluble Fractions of Partially Cross-Linked Polyethylenes. INTERNATIONAL JOURNAL OF POLYMER ANALYSIS AND CHARACTERIZATION 2003. [DOI: 10.1080/10236660304874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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