Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Advances in UHMWPE Biomaterials 12 articles


Does Cyclic Stress Play a Role in Highly Crosslinked Polyethylene Oxidation?

Francisco Medel PhD, Steven Kurtz PhD, Daniel MacDonald MS, Francisco Javier Pascual MS, José Antonio Puértolas PhD

Minimizing the impact of oxidation on ultrahigh-molecular-weight polyethylene components is important for preserving their mechanical integrity while in vivo. Among the strategies to reduce oxidation in modern first-generation highly crosslinked polyethylenes (HXLPEs), postirradiation remelting was considered to afford the greatest stability. However, recent studies have documented measurable oxidation in remelted HXLPE retrievals. Biologic prooxidants and physiologic loading have been proposed as potential mechanisms.

Retrieval Analysis of Sequentially Annealed Highly Crosslinked Polyethylene Used in Total Hip Arthroplasty

Steven M. Kurtz PhD, Daniel W. MacDonald MS, Michael A. Mont MD, Javad Parvizi MD, Arthur L. Malkani MD, William Hozack MD

First-generation annealed and second-generation sequentially annealed, highly crosslinked polyethylenes (HXLPEs) have documented reduced clinical wear rates in their first decade of clinical use compared with conventional gamma inert-sterilized polyethylene. However, for both types of annealed HXLPE formulations, little is known about their reasons for revision, their in vivo oxidative stability, and their resistance to mechanical degradation.

Spectroscopic and Chromatographic Quantification of an Antioxidant-stabilized Ultrahigh-molecular-weight Polyethylene

Venkat S. Narayan PhD

The oxidative stability of various antioxidant-containing ultrahigh-molecular-weight polyethylene (UHMWPE) formulations has been widely reported. Depending on which specific antioxidant is used, the process by which it is incorporated into UHMWPE, and the amount of the antioxidant incorporated, there could be substantial differences in the material and toxicological properties of the UHMWPE formulation. Pentaerythritol tetrakis (3-[3,5-di tertiary butyl-4-hydroxyphenyl] propionate) (PBHP) has been extensively used as an efficient antioxidant in various applications. However, it has not thus far been used to stabilize UHMWPE in orthopaedic implants. It is therefore important to characterize and verify the concentration and homogeneity of distribution of PBHP in the composition, the chemical consequence of exposure of the antioxidant to gamma irradiation, and to assess the toxicological risk of use by the identification and quantification of leachables before the use of PBHP-containing UHMWPE in implantable devices.

Metal-on-conventional Polyethylene Total Hip Arthroplasty Bearing Surfaces Have a Higher Risk of Revision Than Metal-on-highly Crosslinked Polyethylene: Results From a US Registry

Elizabeth W. Paxton MA, Maria C. S. Inacio PhD, Robert S. Namba MD, Rebecca Love MPH, RN, Steven M. Kurtz PhD

Although studies have reported lower radiological wear in highly crosslinked polyethylene (HXLPE) versus conventional polyethylene in total hip arthroplasty (THA), there is limited clinical evidence on the risk of revision of these polyethylene THA bearing surfaces.

Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?

Elizabeth W. Paxton MA, Maria C. S. Inacio PhD, Steven Kurtz PhD, Rebecca Love MPH, RN, Guy Cafri PhD, Robert S. Namba MD

Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and associated osteolysis in total knee arthroplasty (TKA). However, there is limited clinical evidence that HXLPE is more effective than conventional polyethylene (CPE) in TKA.

UHMWPE Wear Debris and Tissue Reactions Are Reduced for Contemporary Designs of Lumbar Total Disc Replacements

Sai Y. Veruva BS, Todd H. Lanman MD, Jorge E. Isaza MD, Daniel W. MacDonald MS, Steven M. Kurtz PhD, Marla J. Steinbeck MT(ASCP), PhD

Lumbar total disc replacement (L-TDR) is a procedure used to relieve back pain and maintain mobility. Contemporary metal-on-polyethylene (MoP) L-TDRs were developed to address wear performance concerns about historical designs, but wear debris generation and periprosthetic tissue reactions for these newer implants have not been determined.

Do Crosslinking and Vitamin E Stabilization Influence Microbial Adhesions on UHMWPE-based Biomaterials?

Giuliana Banche PhD, Pierangiola Bracco PhD, Valeria Allizond PhD, Alessandro Bistolfi MD, Michele Boffano MD, Andrea Cimino MD, Elena Maria Brach del Prever MD, Anna Maria Cuffini PhD

Microorganism adhesion on polyethylene for total joint arthroplasty is a concern. Many studies have focused on vitamin E-stabilized ultrahigh-molecular-weight polyethylene (UHMWPE), whereas first-generation, highly crosslinked UHMWPE, which is the most commonly used in clinical practice, has been scarcely evaluated.

Multidirectional Wear and Impact-to-wear Tests of Phospholipid-polymer-grafted and Vitamin E-blended Crosslinked Polyethylene: A Pilot Study

Masayuki Kyomoto PhD, Toru Moro MD, Yoshio Takatori MD, Sakae Tanaka MD, Kazuhiko Ishihara PhD

Modifying the surface and substrate of a crosslinked polyethylene (CLPE) liner may be beneficial for high wear resistance as well as high oxidative stability and excellent mechanical properties, which would be useful in contributing to the long-term performance of orthopaedic bearings. A grafted poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) layer on a vitamin E-blended crosslinked PE (HD-CLPE[VE]) surface may provide hydrophilicity and lubricity without compromising the oxidative stability or mechanical properties.

A Comparison of the Efficacy of Various Antioxidants on the Oxidative Stability of Irradiated Polyethylene

Natalie Hope MBBS, MA(Cantab), MRCS, Anuj Bellare PhD

Ultrahigh-molecular-weight polyethylene (UHMWPE) is subjected to radiation crosslinking to form highly crosslinked polyethylene (HXLPE), which has improved wear resistance. First-generation HXLPE was subjected to thermal treatment to reduce or quench free radicals that can induce long-term oxidative degeneration. Most recently, antioxidants have been added to HXLPE to induce oxidative resistance rather than by thermal treatment. However, antioxidants can interfere with the efficiency of radiation crosslinking.

Natural Polyphenols Enhance Stability of Crosslinked UHMWPE for Joint Implants

Jie Shen MEng, Guorong Gao MEng, Xincai Liu PhD, Jun Fu PhD

Radiation-crosslinked UHMWPE has been used for joint implants since the 1990s. Postirradiation remelting enhances oxidative stability, but with some loss in strength and toughness. Vitamin E-stabilized crosslinked UHMWPE has shown improved strength and stability as compared with irradiated and remelted UHMWPE. With more active phenolic hydroxyl groups, natural polyphenols are widely used in the food and pharmaceutical industries as potent stabilizers and could be useful for oxidative stability in crosslinked UHMWPE.

Does Vitamin E-blended UHMWPE Prevent Biofilm Formation?

Dustin L. Williams PhD, John Vinciguerra BS, Julia M. Lerdahl, Roy D. Bloebaum PhD

Biofilm-related periprosthetic infections are catastrophic to patients and clinicians. Data suggest the addition of vitamin E to UHMWPE may have the ability to reduce biofilm formation on the surface of UHMWPE; however, previous studies were performed using stagnant broth solutions that may not have simulated a physiologic environment. In addition, the observed differences in levels of bacterial attachment, though statistically significant, may not be clinically significant.