1
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Sakoda H, Tamazawa K, Shoyama Y, Osaka Y, Uetsuki K, Okamoto Y, Yamamoto E. Sensitivity, robustness, and reproducibility of U-shaped delamination test for evaluation of candidate ultra-high molecular weight polyethylene materials for joint replacements. Proc Inst Mech Eng H 2024:9544119241253322. [PMID: 38831562 DOI: 10.1177/09544119241253322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The delamination of ultra-high molecular weight polyethylene (UHMWPE) in artificial joints is a major cause limiting the long-term clinical results of arthroplasty. However, the conventional test method using simple reciprocation to evaluate the delamination resistance of UHMWPE materials has insufficient detection sensitivity. To reproduce delamination, the unconformity contact must be maintained throughout the test so that the maximum stress is generated below the surface. Therefore, a test method that applies a U-shaped motion comprising two long-linear and one short linear sliding motion was developed. The sensitivity, robustness, and reproducibility of the U-shaped delamination test were investigated and compared with the traditional test method. The traditional test method could reproduce delamination only in materials that had degraded considerably, whereas the U-shaped delamination test could reproduce delamination in a wide range of materials, demonstrating its superior sensitivity. Additionally, using a higher load helped accelerate the test without affecting the test results. The optimal length of the short linear sliding motion was confirmed to be 1 mm. Finally, the inter-laboratory reproducibility of the U-shaped delamination test was confirmed using the round-robin test. The U-shaped delamination test demonstrates high sensitivity, robustness, and reproducibility and contributes to the selection and development of UHMWPE materials and artificial joints with a lower risk of delamination.
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Affiliation(s)
- Hideyuki Sakoda
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Japan
| | | | | | - Yuta Osaka
- Teijin Nakashima Medical Co., Ltd., Okayama, Japan
| | | | - Yoshihiro Okamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Japan
| | - Eiichi Yamamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Japan
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2
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Wahed SB, Dunstan CR, Boughton PA, Ruys AJ, Faisal SN, Wahed TB, Salahuddin B, Cheng X, Zhou Y, Wang CH, Islam MS, Aziz S. Functional Ultra-High Molecular Weight Polyethylene Composites for Ligament Reconstructions and Their Targeted Applications in the Restoration of the Anterior Cruciate Ligament. Polymers (Basel) 2022; 14:polym14112189. [PMID: 35683861 PMCID: PMC9182730 DOI: 10.3390/polym14112189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
The selection of biomaterials as biomedical implants is a significant challenge. Ultra-high molecular weight polyethylene (UHMWPE) and composites of such kind have been extensively used in medical implants, notably in the bearings of the hip, knee, and other joint prostheses, owing to its biocompatibility and high wear resistance. For the Anterior Cruciate Ligament (ACL) graft, synthetic UHMWPE is an ideal candidate due to its biocompatibility and extremely high tensile strength. However, significant problems are observed in UHMWPE based implants, such as wear debris and oxidative degradation. To resolve the issue of wear and to enhance the life of UHMWPE as an implant, in recent years, this field has witnessed numerous innovative methodologies such as biofunctionalization or high temperature melting of UHMWPE to enhance its toughness and strength. The surface functionalization/modification/treatment of UHMWPE is very challenging as it requires optimizing many variables, such as surface tension and wettability, active functional groups on the surface, irradiation, and protein immobilization to successfully improve the mechanical properties of UHMWPE and reduce or eliminate the wear or osteolysis of the UHMWPE implant. Despite these difficulties, several surface roughening, functionalization, and irradiation processing technologies have been developed and applied in the recent past. The basic research and direct industrial applications of such material improvement technology are very significant, as evidenced by the significant number of published papers and patents. However, the available literature on research methodology and techniques related to material property enhancement and protection from wear of UHMWPE is disseminated, and there is a lack of a comprehensive source for the research community to access information on the subject matter. Here we provide an overview of recent developments and core challenges in the surface modification/functionalization/irradiation of UHMWPE and apply these findings to the case study of UHMWPE for ACL repair.
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Affiliation(s)
- Sonia B. Wahed
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
- Correspondence: (S.B.W.); (S.A.)
| | - Colin R. Dunstan
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Philip A. Boughton
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Andrew J. Ruys
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Shaikh N. Faisal
- ARC Centre of Excellence for Electromaterials Science & Intelligent Polymer Research Institute, Australian Institute of Innovative Materials, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Tania B. Wahed
- Department of Pharmacy, Jahangirnagar University, Savar 1342, Bangladesh;
| | - Bidita Salahuddin
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Xinying Cheng
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Yang Zhou
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Chun H. Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Mohammad S. Islam
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Shazed Aziz
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia;
- Correspondence: (S.B.W.); (S.A.)
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3
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Matsumae G, Kida H, Takahashi D, Shimizu T, Ebata T, Yokota S, Alhasan H, Aly MK, Yutani T, Uetsuki K, Terkawi MA, Iwasaki N. Determination of optimal concentration of vitamin E in polyethylene liners for producing minimal biological response to prosthetic wear debris. J Biomed Mater Res B Appl Biomater 2022; 110:1587-1593. [PMID: 35122380 DOI: 10.1002/jbm.b.35019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/28/2021] [Accepted: 01/15/2022] [Indexed: 01/07/2023]
Abstract
The introduction of vitamin E-blended ultra-high molecular weight polyethylene (VE-UHMWPE) for use in prosthetic components of hip implants has resulted in the production of implants that have excellent mechanical properties and substantially less adverse cellular responses. Given the importance of a biological response to wear in the survival of a prosthesis, we generated wear debris from UHMWPE that had been prepared with different concentrations of vitamin E of 0.1, 0.3, 0.5, and 1% and evaluated their biological reaction in vitro and in vivo. All types of VE-UHMWPE debris promoted a significantly lower expression of Tnf-α in murine peritoneal macrophages than that induced by conventional UHMWPE debris. However, levels of Tnf-α were not significantly different among the macrophages that were stimulated with VE-UHMWPE wear at the concentrations tested. The ability of wear debris to induce inflammatory osteolysis was assessed in a mouse calvarial osteolysis model. The expressions of Tnf-α, Il-6, and Rankl in granulomatous tissue formed around the wear debris were significantly reduced in mice that had been implanted with 0.3%VE-UHMWPE debris as compared to the corresponding values for mice that had been implanted with UHMWPE debris. Consistent with this finding, 0.3%VE-UHMWPE debris showed the lowest osteolytic activity, as evidenced by the reduced bone resorption area, the degree of infiltration of inflammatory cells and the TRAP staining area. Our results suggested that a 0.3% vitamin E concentration is the most appropriate concentration for use in prosthetic components with a reduced adverse cellular response for prolonging the life-span of the implant.
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Affiliation(s)
- Gen Matsumae
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Kida
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taku Ebata
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shunichi Yokota
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hend Alhasan
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mahmoud Khamis Aly
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomoyo Yutani
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama, Japan
| | - Keita Uetsuki
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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4
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Sakoda H, Uematsu M, Okamoto Y, Haishima Y. In vitro evaluation of delamination resistance of PEEK and CFR-PEEK. Proc Inst Mech Eng H 2021; 236:279-285. [PMID: 34431397 DOI: 10.1177/09544119211042992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poly-ether-ether-ketone (PEEK) and carbon fiber reinforced PEEK as orthopedic implant materials exhibit excellent material properties. Although delamination of PEEK materials has been reported in knee joint wear research, the delamination resistance behavior remains unclear. In this study, the delamination resistance of PEEK materials was investigated; these materials were compared to ultra-high molecular weight polyethylene (UHMWPE). The results of a ball-on-flat type delamination test indicated that the PEEK materials underwent delamination considerably earlier than UHMWPE, and the contact area of the PEEK materials was smaller than that of UHMWPE. Moreover, the indentation modulus, hardness, and coefficient of friction were higher for PEEK materials than for UHMWPE. The reduced tendency of PEEK materials to undergo deformation to mitigate stress concentration at low conformity contact conditions contributed to their inferior delamination resistance compared to that of UHMWPE. The delamination resistance of the PEEK materials was equivalent to that of degraded UHMWPE, which highlights the risk of delamination of PEEK implants in a clinical context. Consequently, when using PEEK materials as an implant component loaded at a low conformity contact condition, the material selection and component design must be carefully considered. Overall, the results of this study can help guide the future development of PEEK-based implants.
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Affiliation(s)
- Hideyuki Sakoda
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa Prefecture, Japan
| | - Miyuki Uematsu
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa Prefecture, Japan
| | - Yoshihiro Okamoto
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa Prefecture, Japan
| | - Yuji Haishima
- Division of Medical Devices, National Institute of Health Sciences, Kawasaki, Kanagawa Prefecture, Japan
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5
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Medley JB. Highly cross‐linked polyethylene is the new ‘gold standard’ bearing material for total hip arthroplasty. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- John B. Medley
- Department of Mechanical and Mechatronics Engineering University of Waterloo Waterloo Ontario Canada
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6
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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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7
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Chammingkwan P, Bando Y, Mai LTT, Wada T, Thakur A, Terano M, Sinthusai L, Taniike T. Less Entangled Ultrahigh-Molecular-Weight Polyethylene Produced by Nano-Dispersed Ziegler–Natta Catalyst. Ind Eng Chem Res 2021. [DOI: 10.1021/acs.iecr.0c05432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patchanee Chammingkwan
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Yusuke Bando
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Le Thi Tuyet Mai
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Toru Wada
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Ashutosh Thakur
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Minoru Terano
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
| | - Likhasit Sinthusai
- IRPC Public Company Limited, 299 Moo 5, Sukhumvit Road, Cheng Nern, Muang, Rayong 21000, Thailand
| | - Toshiaki Taniike
- Graduate School of Advanced Science and Technology, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan
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8
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Li B, Shen X. Preliminary study on discrimination of transgenic cotton seeds using terahertz time-domain spectroscopy. Food Sci Nutr 2020; 8:5426-5433. [PMID: 33133545 PMCID: PMC7590308 DOI: 10.1002/fsn3.1846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
Presence of genetically modified (GM) organisms is considered to be controversial by legislation and public. It is very important to develop detection methods for early discriminations. Conventional gene detection methods, including protein detection (PCR, ELISA, and so on) and DNA detection (Southern blot, GC/MS, and so on), have the disadvantages of high costs, time-consuming, complex operations, and destructive of the samples. Terahertz spectroscopy (THz) is a brand-new radiation with many unique advantages. Most biological macromolecules have fingerprint characteristics in THz band from the current recognition. In this study, feasibility of identifying the transgenic cotton seeds from nontransgenic counterparts using THz spectroscopy method was investigated. The transgenic cotton seeds-Lumianyan No.28 and nontransgenic cotton seeds-Xinluzao No.51 were selected and the sample-making methods were studied; then the refractive and absorption curves of samples were got and given a detailed discussion; finally, absorption index of transgenic and nontransgenic DNA was observed and discussed. The results showed there were small fluctuations in THz band, and refractive index of transgenic seeds was lower than nontransgenic ones and had obvious turning point at 1.4-2.0 THz region. There were significant peaks in 1.0-1.2 and 1.3-1.5 THz regions for the transgenic cotton seeds. Transgenic DNA had higher absorption index than nontransgenic DNA, and there were 3-4 peaks corresponding to the cotton seed samples in 1.0-1.6 THz region. These results showed cotton seeds samples can provide important bio-information in THz band, and this study provided a basis for developing potential THz-based gene detection technologies.
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Affiliation(s)
- Bin Li
- Beijing Research Center for Information Technology in AgricultureBeijingChina
| | - Xiaochen Shen
- Beijing Research Center for Information Technology in AgricultureBeijingChina
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9
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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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10
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11
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Hameister R, Kaur C, Dheen ST, Lohmann CH, Singh G. Reactive oxygen/nitrogen species (ROS/RNS) and oxidative stress in arthroplasty. J Biomed Mater Res B Appl Biomater 2020; 108:2073-2087. [PMID: 31898397 DOI: 10.1002/jbm.b.34546] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 12/16/2022]
Abstract
The interplay between implant design, biomaterial characteristics, and the local microenvironment adjacent to the implant is of utmost importance for implant performance and success of the joint replacement surgery. Reactive oxygen and nitrogen species (ROS/RNS) are among the various factors affecting the host as well as the implant components. Excessive formation of ROS and RNS can lead to oxidative stress, a condition that is known to damage cells and tissues and also to affect signaling pathways. It may further compromise implant longevity by accelerating implant degradation, primarily through activation of inflammatory cells. In addition, wear products of metallic, ceramic, polyethylene, or bone cement origin may also generate oxidative stress themselves. This review outlines the generation of free radicals and oxidative stress in arthroplasty and provides a conceptual framework on its implications for soft tissue remodeling and bone resorption (osteolysis) as well as implant longevity. Key findings derived from cell culture studies, animal models, and patients' samples are presented. Strategies to control oxidative stress by implant design and antioxidants are explored and areas of controversy and challenges are highlighted. Finally, directions for future research are identified. A better understanding of the host-implant interplay and the role of free radicals and oxidative stress will help to evaluate therapeutic approaches and will ultimately improve implant performance in arthroplasty.
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Affiliation(s)
- Rita Hameister
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shaikali Thameem Dheen
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Gurpal Singh
- Centre for Orthopaedics Pte Ltd, Singapore, Singapore
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12
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13
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Kamada K, Takahashi Y, Tateiwa T, Shishido T, Masaoka T, Pezzotti G, Yamamoto K. Influence of liner offset and locking mechanism on fatigue durability in highly cross-linked polyethylene total hip prostheses. J Biomed Mater Res B Appl Biomater 2019; 108:1993-2004. [PMID: 31876393 DOI: 10.1002/jbm.b.34540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/03/2019] [Accepted: 12/08/2019] [Indexed: 12/19/2022]
Abstract
Highly cross-linked, ultrahigh molecular weight polyethylene (HXLPE) acetabular liners are inherently associated to a risk of fatigue failure due to femoral neck impingement. Different thicknesses and designs employed with HXLPE liners greatly affect mechanical loading scenario. The purpose of this study was to clarify the influence of liner offset (lateralization) and locking mechanism (presence/absence of anti-rotation tabs in the external surface) on fatigue durability in annealed and vitamin E-blended HXLPE liners with a current commercial design. Each liner tested had six anti-rotation tabs, which were engaged in the 6 of 12 recesses on the metal shell. The remaining six recesses had no direct contact with the liner, where HXLPE was mechanically unsupported by the metal backing. These mated and/or unmated rim regions in the offset (2, 3, 4-mm lateralized) liners were exposed to severe neck impingement until crack propagation was identified. Phase volume percentages (crystalline, amorphous, and intermediate phase contents) of HXLPE liners were compared before and after impingement in order to interpret differences in impingement micromechanics associated with the rim design variations. Our results showed that the presence of unmated recesses served as a stress concentrator due to the formation of millimeter-scale gaps between the liner and shell. Another potential design problem drawn from our study was liner offset associated with a small volume protruding above the metal rim. Therefore, surgeons should take special care in selecting locking designs and geometries especially when using HXLPE offset liners.
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Affiliation(s)
- Kosuke Kamada
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - 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
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Giuseppe Pezzotti
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Ceramic Physics Laboratory, Kyoto Institute of Technology, Kyoto, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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14
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Hatano N, Higaki M, Otsu Y, Otsu T, Mikami S, Matsumoto M, Kono D, Matsubara A, Tomita N. Destruction energy index (DEI) of vitamin E blended UHMWPE for artificial joints. BIOSURFACE AND BIOTRIBOLOGY 2019. [DOI: 10.1049/bsbt.2018.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Naoya Hatano
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Masaya Higaki
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Youhei Otsu
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Tatsuya Otsu
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Shinji Mikami
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | | | | | | | - Naohide Tomita
- Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
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15
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Affatato S, Ruggiero A, Jaber SA, Merola M, Bracco P. Wear Behaviours and Oxidation Effects on Different UHMWPE Acetabular Cups Using a Hip Joint Simulator. MATERIALS 2018; 11:ma11030433. [PMID: 29547536 PMCID: PMC5873012 DOI: 10.3390/ma11030433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/07/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Given the long-term problem of polyethylene wear, medical interest in the new improved cross-linked polyethylene (XLPE), with or without the adding of vitamin E, has risen. The main aim of this study is to gain further insights into the mutual effects of radiation cross-linking and addition of vitamin E on the wear performance of ultra-high-molecular-weight polyethylene (UHMWPE). We tested four different batches of polyethylene (namely, a standard one, a vitamin E-stabilized, and two cross-linked) in a hip joint simulator for five million cycles where bovine calf serum was used as lubricant. The acetabular cups were then analyzed using a confocal profilometer to characterize the surface topography. Moreover; the cups were analyzed by using Fourier Transformed Infrared Spectroscopy and Differential Scanning Calorimetry in order to assess the chemical characteristics of the pristine materials. Comparing the different cups’ configuration, mass loss was found to be higher for standard polyethylene than for the other combinations. Mass loss negatively correlated to the cross-link density of the polyethylenes. None of the tested formulations showed evidence of oxidative degradation. We found no correlation between roughness parameters and wear. Furthermore, we found significantly differences in the wear behavior of all the acetabular cups. XLPEs exhibited lower weight loss, which has potential for reduced wear and decreased osteolysis. However, surface topography revealed smoother surfaces of the standard and vitamin E stabilized polyethylene than on the cross-linked samples. This observation suggests incipient crack generations on the rough and scratched surfaces of the cross-linked polyethylene liners.
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Affiliation(s)
- Saverio Affatato
- Medical Technology Laboratory, IRCCS-Rizzoli Orthopaedic Institute, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Alessandro Ruggiero
- Department of Industrial Engineering, University of Salerno, 84084 Fisciano, Italy.
| | - Sami Abdel Jaber
- Medical Technology Laboratory, IRCCS-Rizzoli Orthopaedic Institute, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Massimiliano Merola
- Department of Industrial Engineering, University of Salerno, 84084 Fisciano, Italy.
| | - Pierangiola Bracco
- Chemistry Department and Nanostructured Interfaces and Surfaces (NIS) Centre, University of Turin, Via Giuria 7, 10125 Turin, Italy.
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16
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Sakoda H, Osaka Y, Uetsuki K, Okamoto Y, Haishima Y. Evaluating the durability of UHMWPE biomaterials used for articulating surfaces of joint arthroplasty using delamination tests. J Biomed Mater Res B Appl Biomater 2018; 107:65-72. [PMID: 29480570 DOI: 10.1002/jbm.b.34095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/18/2017] [Accepted: 02/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Hideyuki Sakoda
- Division of Medical DevicesNational Institute of Health SciencesTokyo Japan
| | - Yuta Osaka
- Teijin Nakashima Medical Co., Ltd.Okayama Japan
| | | | - Yoshihiro Okamoto
- Division of Medical DevicesNational Institute of Health SciencesTokyo Japan
| | - Yuji Haishima
- Division of Medical DevicesNational Institute of Health SciencesTokyo Japan
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17
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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: 96] [Impact Index Per Article: 13.7] [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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18
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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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19
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Doshi B, Ward JS, Oral E, Muratoglu OK. Fatigue toughness of irradiated vitamin E/UHMWPE blends. J Orthop Res 2016; 34:1514-20. [PMID: 26773556 DOI: 10.1002/jor.23168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
Radiation cross-linked ultrahigh molecular weight polyethylenes (UHMWPEs) have become the standard-of-care in total joint replacements (TJR) in the last decade because of their superior wear resistance in comparison with previously used "conventional" gamma sterilized UHMWPE. Some first generation radiation cross-linked UHMWPEs were stabilized against oxidation by post-irradiation melting, which significantly reduced their fatigue crack propagation resistance or fatigue toughness. Second generation cross-linked UHMWPEs incorporated instead an antioxidant such as vitamin E, eliminating the need for melting. In this study, we investigated the fatigue crack propagation resistance and the impact toughness of vitamin E-blended and radiation cross-linked UHMWPEs as a function of vitamin E concentration and radiation dose. Both properties were strongly dependent on the cross-link density and they showed a good correlation with each other (R(2) = 0.89). © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1514-1520, 2016.
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Affiliation(s)
- Brinda Doshi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts
| | - Jerel S Ward
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ-1212b, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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20
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J-integral fracture toughness, Tearing modulus and tensile properties of Vitamin E stabilized radiation crosslinked UHMWPE. J Mech Behav Biomed Mater 2016; 61:493-498. [DOI: 10.1016/j.jmbbm.2016.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/30/2016] [Indexed: 11/19/2022]
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21
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Bellare A, D'angelo F, Ngo HD, Thornhill TS. Oxidation resistance and abrasive wear resistance of vitamin E stabilized radiation crosslinked ultra-high molecular weight polyethylene. J Appl Polym Sci 2016. [DOI: 10.1002/app.44125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anuj Bellare
- Department of Orthopedic Surgery; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts 02115
| | - Fabio D'angelo
- Department of Orthopedic Surgery; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts 02115
| | - Hung D Ngo
- Department of Orthopedic Surgery; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts 02115
| | - Thomas S. Thornhill
- Department of Orthopedic Surgery; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts 02115
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22
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Nebergall AK, Troelsen A, Rubash HE, Malchau H, Rolfson O, Greene ME. Five-Year Experience of Vitamin E-Diffused Highly Cross-Linked Polyethylene Wear in Total Hip Arthroplasty Assessed by Radiostereometric Analysis. J Arthroplasty 2016; 31:1251-1255. [PMID: 26777551 DOI: 10.1016/j.arth.2015.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (VEPE) was developed to reduce oxidation without compromising mechanical strength. The purpose of this study was to evaluate VEPE in vivo using radiostereometric analysis (RSA) and patient-reported outcome measures (PROMs). METHODS Fifty-one hips were enrolled. Each patient received a VEPE liner, a porous titanium shell, and an uncemented stem with a 32-mm cobalt-chrome femoral head. Tantalum beads were inserted into the VEPE to measure femoral head penetration using RSA. RSA radiographs and PROMs were obtained preoperatively immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. RESULTS Forty-seven hips returned at 3 years, and 42 hip at 5 years. The mean ± standard error of the mean proximal head penetration into the polyethylene was 0.06 ± 0.01 at 5 years. The amount of head penetration did not change significantly with increasing time in vivo. The mean ± standard error of the mean Harris Hip Score was 58 ± 2 preoperatively, which improved significantly to 93 ± 2 at 5 years (P < .001). CONCLUSION The head penetration into VEPE liners was low compared with non-VEPE at 5 years. After settling of the liners in the early period, no significant head penetration occurred from 2- to 5-year follow-up. All PROMs improved significantly from preoperative to postoperative and remained very favorable at 5 years. This study documents the longest-term evaluation of in vivo wear performance of VEPE.
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Affiliation(s)
- Audrey K Nebergall
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Anders Troelsen
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Copenhagen University Hvidovre Hospital, Hvidovre, Denmark
| | - Harry E Rubash
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Henrik Malchau
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Ola Rolfson
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meridith E Greene
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
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23
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Ansari F, Ries MD, Pruitt L. Effect of processing, sterilization and crosslinking on UHMWPE fatigue fracture and fatigue wear mechanisms in joint arthroplasty. J Mech Behav Biomed Mater 2016; 53:329-340. [DOI: 10.1016/j.jmbbm.2015.08.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
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24
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Murakami T, Yarimitsu S, Nakashima K, Sakai N, Yamaguchi T, Sawae Y, Suzuki A. Biphasic and boundary lubrication mechanisms in artificial hydrogel cartilage: A review. Proc Inst Mech Eng H 2015; 229:864-78. [DOI: 10.1177/0954411915611160] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Various studies on the application of artificial hydrogel cartilage to cartilage substitutes and artificial joints have been conducted. It is expected in clinical application of artificial hydrogel cartilage that not only soft-elastohydrodynamic lubrication but biphasic, hydration, gel-film and boundary lubrication mechanisms will be effective to sustain extremely low friction and minimal wear in daily activities similar to healthy natural synovial joints with adaptive multimode lubrication. In this review article, the effectiveness of biphasic lubrication and boundary lubrication in hydrogels in thin film condition is focused in relation to the structures and properties of hydrogels. As examples, the tribological behaviors in three kinds of poly(vinyl alcohol) hydrogels with high water content are compared, and the importance of lubrication mechanism in biomimetic artificial hydrogel cartilage is discussed to extend the durability of cartilage substitute.
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Affiliation(s)
- Teruo Murakami
- Research Center for Advanced Biomechanics, Kyushu University, Fukuoka, Japan
| | - Seido Yarimitsu
- Research Center for Advanced Biomechanics, Kyushu University, Fukuoka, Japan
- Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Kazuhiro Nakashima
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
| | - Nobuo Sakai
- Department of Applied Science for Integrated System Engineering, Graduate School of Engineering, Kyushu Institute of Technology, Kitakyushu, Japan
| | - Tetsuo Yamaguchi
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
| | - Yoshinori Sawae
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
| | - Atsushi Suzuki
- Department of Materials Science and Research Institute of Environment and Information Sciences, Yokohama National University, Yokohama, Japan
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25
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Effects of Surface Modification and Bulk Geometry on the Biotribological Behavior of Cross-Linked Polyethylene: Wear Testing and Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:435432. [PMID: 26583106 PMCID: PMC4637033 DOI: 10.1155/2015/435432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/12/2015] [Indexed: 11/23/2022]
Abstract
The wear and creep deformation resistances of polymeric orthopedic bearing materials are both important for extending their longevity. In this study, we evaluated the wear and creep deformation resistances, including backside damage, of different polyethylene (PE) materials, namely, conventional PE, cross-linked PE (CLPE), and poly(2-methacryloyloxyethyl
phosphorylcholine)- (PMPC-) grafted CLPE, through wear tests and finite element analysis. The gravimetric and volumetric degrees of wear of disks (3 or 6 mm in thickness) of these materials against a cobalt-chromium-molybdenum alloy pin were examined using a multidirectional pin-on-disk tester. Cross-linking and PMPC grafting decreased the gravimetric wear of the PE disks significantly. The volumetric wear at the bearing surface and the volumetric penetration in the backside of the 3-mm thick PE disk were higher than those of the 6-mm thick PE disk, regardless of the bearing material. The geometrical changes induced in the PE disks consisted of creep, because the calculated internal von Mises stress at the bearing side of all disks and that at the backside of the 3-mm thick disks exceeded their actual yield strengths. A highly hydrated bearing surface layer, formed by PMPC grafting, and a cross-linking-strengthened substrate of adequate thickness are essential for increasing the wear and creep deformation resistances.
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26
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Yarimitsu S, Moro T, Kyomoto M, Watanabe K, Tanaka S, Ishihara K, Murakami T. Influences of dehydration and rehydration on the lubrication properties of phospholipid polymer-grafted cross-linked polyethylene. Proc Inst Mech Eng H 2015; 229:506-14. [PMID: 26036469 DOI: 10.1177/0954411915588969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
Abstract
Surface modification by grafting of biocompatible phospholipid polymer onto the surface of artificial joint material has been proposed to reduce the risk of aseptic loosening and improve the durability. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted cross-linked polyethylene (CLPE) has shown promising results for reducing wear of CLPE. The main lubrication mechanism for the PMPC layer is considered to be the hydration lubrication. In this study, the lubrication properties of PMPC-grafted CLPE were evaluated in reciprocating friction test with rehydration process by unloading in various lubricants. The start-up friction of PMPC-grafted CLPE was reduced, and the damage of PMPC layer was suppressed by rehydration in water or hyaluronic acid solutions. In contrast, the start-up friction of PMPC-grafted CLPE increased in fetal bovine serum solution, and the damage for PMPC layer was quite noticeable. Interestingly, the start-up friction of PMPC-grafted CLPE was reduced in fetal bovine serum solution containing hyaluronic acid, and the damage of the PMPC layer was suppressed. These results indicate that the rehydration by unloading and hyaluronic acid are elemental in maximizing the lubrication effect of hydrated PMPC layer.
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Affiliation(s)
- Seido Yarimitsu
- Research Center for Advanced Biomechanics, Kyushu University, Fukuoka, Japan Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Kyomoto
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Materials Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan Research Department, KYOCERA Medical Corporation, Osaka, Japan
| | - Kenichi Watanabe
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Research Department, KYOCERA Medical Corporation, Osaka, Japan
| | - Sakae Tanaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Teruo Murakami
- Research Center for Advanced Biomechanics, Kyushu University, Fukuoka, Japan
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27
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28
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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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29
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Huang CH, Lu YC, Chang TK, Hsiao IL, Su YC, Yeh ST, Fang HW, Huang CH. In vivo biological response to highly cross-linked and vitamin e-doped polyethylene--a particle-Induced osteolysis animal study. J Biomed Mater Res B Appl Biomater 2015; 104:561-7. [PMID: 25952769 DOI: 10.1002/jbm.b.33426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 03/06/2015] [Accepted: 03/27/2015] [Indexed: 01/13/2023]
Abstract
Polyethylene particle-induced osteolysis is the primary limitation in the long-term success of total joint replacement with conventional ultra high molecular weight polyethylene (UHMWPE). Highly cross-linked polyethylene (HXLPE) and vitamin E-doped cross-linked polyethylene (VE-HXLPE) have been developed to increase the wear resistance of joint surfaces. However, very few studies have reported on the incidence of particle-induced osteolysis for these novel materials. The aim of this study was to use a particle-induced osteolysis animal model to compare the in vivo biological response to different polymer particles. Three commercially available polymers (UHMWPE, HXLPE, and VE-HXLPE) were compared. Osseous properties including the bone volume relative to the tissue volume (BV/TV), trabecular thickness (Tb. Th), and bone mineral density (BMD) were examined using micro computed tomography. Histological analysis was used to observe tissue inflammation in each group. This study demonstrated that the osseous properties and noticeable inflammatory reactions were obviously decreased in the HXLPE group. When compared with the sham group, a decrease of 12.7% was found in BV/TV, 9.6% in BMD and 8.3% in Tb.Th for the HXLPE group. The heightened inflammatory response in the HXLPE group could be due to its smaller size and greater amount of implanted particles. Vitamin E diffused in vivo may not affect the inflammatory and osteolytic responses in this model. The morphological size and total cumulative amount of implanted particles could be critical factors in determining the biological response.
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Affiliation(s)
- Chang-Hung Huang
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Chang Lu
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan.,Department of Cosmetic Application and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Ting-Kuo Chang
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan.,Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan
| | - I-Lin Hsiao
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan
| | - Yi-Ching Su
- Department of Chemical Engineering and Biotechnology and Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Shu-Ting Yeh
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital (MMH), Taipei, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology and Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Hsiung Huang
- Institue of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedic Surgery, MMH, Taipei, Taiwan
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30
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Shen J, Gao G, Liu X, Fu J. Natural polyphenols enhance stability of crosslinked UHMWPE for joint implants. Clin Orthop Relat Res 2015; 473:760-6. [PMID: 25106800 PMCID: PMC4317458 DOI: 10.1007/s11999-014-3850-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND 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. QUESTIONS/PURPOSES We asked whether UHMWPE blended with polyphenols would (1) show higher oxidation resistance after radiation crosslinking; (2) preserve the mechanical properties of UHMWPE after accelerated aging; and (3) alter the wear resistance of radiation-crosslinked UHMWPE. METHODS The polyphenols, gallic acid and dodecyl gallate, were blended with medical-grade UHMWPE followed by consolidation and electron beam irradiation at 100 kGy. Radiation-crosslinked virgin and vitamin E-blended UHMWPEs were used as reference materials. The UHMWPEs were aged at 120 °C in air with oxidation levels analyzed by infrared spectroscopy. Tensile (n = 5 per group) and impact (n = 3 per group) properties before and after aging as per ASTM F2003 were evaluated. The wear rates were examined by pin-on-disc testing (n = 3 per group). The data were reported as mean ± SDs. Statistical analysis was performed by using Student's t-test for a two-tailed distribution with unequal variance for tensile and impact data obtained with n ≥ 3. A significant difference is defined with p < 0.05. RESULTS The oxidation induction time of 100 kGy UHMWPE was prolonged to 144 hours with 0.05 wt% dodecyl gallate and 192 hours with 0.05 wt% gallic acid compared with 48 hours for 0.05 wt% vitamin E-blended UHMWPE. Accelerated aging of these polyphenol-blended UHMWPEs resulted in ultimate tensile strength of 50.4 ± 1.4 MPa and impact strength of 53 ± 5 kJ/m(2) for 100 kGy-irradiated UHMWPE with 0.05 wt% dodecyl gallate, for example, in comparison to 51.2 ± 0.7 MPa (p = 0.75) and 58 ± 5 kJ/m(2) (p = 0.29) before aging. The pin-on-disc wear rates of 100 kGy-irradiated UHMWPE with 0.05 wt% dodecyl gallate and 0.05 wt% gallic acid were 2.29 ± 0.31 and 1.65 ± 0.32 mg/million cycles, comparable to 1.68 ± 0.25 and 2.05 ± 0.22 mg/million cycles for 100 kGy-irradiated virgin and 0.05 wt% vitamin E-blended UHMWPE. CONCLUSIONS Based on the sample numbers tested in this study, polyphenols appear to effectively enhance the oxidation stability without altering the mechanical properties or pin-on-disc wear rate of radiation-crosslinked UHMWPE. CLINICAL RELEVANCE Crosslinked UHMWPE with natural polyphenols with improved oxidative stability and low wear may find clinical application in joint implants.
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Affiliation(s)
- Jie Shen
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
- />Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China
| | - Guorong Gao
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
| | - Xincai Liu
- />Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China
| | - Jun Fu
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
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31
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Hope N, Bellare A. A comparison of the efficacy of various antioxidants on the oxidative stability of irradiated polyethylene. Clin Orthop Relat Res 2015; 473:936-41. [PMID: 25238806 PMCID: PMC4317412 DOI: 10.1007/s11999-014-3946-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrahigh-molecular-weight polyethylene (UHMWPE) is subjected to radiation crosslinking to form highly crosslinked polyethylene (HXLPE), which has improved wear resistance. First-generation HXLPE was subjected to thermal treatment to reduce or quench free radicals that can induce long-term oxidative degeneration. Most recently, antioxidants have been added to HXLPE to induce oxidative resistance rather than by thermal treatment. However, antioxidants can interfere with the efficiency of radiation crosslinking. QUESTIONS/PURPOSES We sought to identify (1) which antioxidant from among those tested (vitamin E, β-carotene, butylated hydroxytoluene, or pentaerythritol tetrakis [methylene-3-(3,5-di-tert-butyl-4-hydroxyphenyl) propionate]) causes the least reduction of crosslinking; (2) which promotes the greatest oxidative stability; and (3) which had the lowest ratio of oxidation index to crosslink density. METHODS Medical-grade polyethylene (PE) resin was blended with 0.1 weight % of the following stabilizers: alpha tocopherol (vitamin E), β-carotene, butylated hydroxytoluene (BHT), and pentaerythritol tetrakis [methylene-3-(3,5-di-tert-butyl-4-hydroxyphenyl) propionate] (a hindered phenol antioxidant [HPAO]). These blends were compression-molded into sheets and subjected to electron beam irradiation to a dose of 100 kGy. Equilibrium swelling experiments were conducted to calculate crosslink density. Each PE was subjected to accelerated aging for a period of 2 weeks and Fourier transform infrared spectroscopy was used to measure the maximum oxidation. Statistical analysis was conducted using analysis of variance with Fisher's protected least significant difference in which a p value of < 0.05 was used to define a significant difference. RESULTS The least reduction of crosslinking in antioxidant-containing HXLPE was observed with HPAO, which had a crosslink density (n = 6) of 0.167 (effect size [ES] = 0.87; 95% confidence interval [CI], 0.162-0.173) mol/dm(3) compared with 0.139 (ES = 1.57; 95% CI, 0.132-0.146) mol/dm(3) (p = 0.020) for BHT, 0.131 (ES = 1.77; 95% CI, 0.123-0.139) mol/dm(3) (p = 0.004) for β-carotene, and 0.130 (ES = 1.79; 95% CI, 0.124-0.136) mol/dm(3) (p = 0.003) for vitamin E, whereas pure HXLPE had a crosslink density of 0.203 (95% CI, 0.170-0.235) mol/dm(3) (p = 0.005). BHT-PE had an oxidation index of 0.21 (ES = 13.14; 95% CI, 0.19-0.22) followed by HPAO-PE, vitamin E-PE and β-carotene-PE, which had oxidation indices of 0.28 (ES = 9.68; 95% CI, 0.28-0.29), 0.29 (ES = 9.59; 95% CI, 0.27-0.30), and 0.35 (ES = 6.68; 95% CI, 0.34-0.37), respectively (p < 0.001 for all groups). BHT-PE had the lowest ratio of oxidation index to crosslink density of the materials tested (1.49, ES = 1.94; 95% CI, 1.32-1.66) followed by HPAO-PE (1.70, ES = 1.52; 95% CI, 1.61-1.80), vitamin E-PE (2.21, ES = 0.52; 95% CI, 2.05-2.38), and β-carotene-PE (2.69, ES = -0.43; 95% CI, 2.46-2.93) compared with control PE (2.47, 95% CI, 2.07-2.88) with β-carotene (p = 0.208) and vitamin E (p = 0.129) not being different from the control. CONCLUSIONS BHT-modified HXLPE was found in this study to have the lowest oxidation index as well as the lowest ratio of oxidation index to crosslink density compared with vitamin E, HPAO, and β-carotene-modified HXLPEs. More comprehensive studies are required such as wear testing using joint simulators as well as biocompatibility studies before BHT-modified HXLPE can be considered for clinical use. CLINICAL RELEVANCE BHT is a synthetic antioxidant commonly used in the polymer industry to prevent long-term oxidative degradation and has been approved by the FDA for use in cosmetics and foodstuffs. It may be an attractive potential stabilizer for HXLPE in total joint replacements.
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Affiliation(s)
- Natalie Hope
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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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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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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George A, Ngo H, Bellare A. Influence of crystallization conditions on the tensile properties of radiation crosslinked, vitamin E stabilized UHMWPE. J Mech Behav Biomed Mater 2014; 40:406-412. [DOI: 10.1016/j.jmbbm.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
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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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Kobayashi M, Koide T, Hyon SH. Tribological characteristics of polyethylene glycol (PEG) as a lubricant for wear resistance of ultra-high-molecular-weight polyethylene (UHMWPE ) in artificial knee join. J Mech Behav Biomed Mater 2014; 38:33-8. [PMID: 25016174 DOI: 10.1016/j.jmbbm.2014.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/30/2014] [Accepted: 06/05/2014] [Indexed: 11/25/2022]
Abstract
For the longevity of total knee joint prostheses, we have developed an artificial lubricant using polyethylene glycol (PEG) for the prevention of wear of ultra-high-molecular-weight polyethylene (UHMWPE). In the present study, the lubricative function of this PEG lubricant was evaluated by a wear test using Co-Cr alloy and UHMWPE counter surface samples. As a result, human synovial fluid including the PEG lubricant showed good result regarding the wear volume and a worn surface of UHMWPE. Considering its lubrication mechanism, it is suspected that interaction between the PEG molecules and the proteins in synovial fluid was involved. Since PE molecules are also organic compounds having a hydroxyl group at one or both ends, the albumin and PEG molecule complex would have bound more strongly to the metal oxide surface and UHMWPE surfaces might enhance and stabilize the lubricating film between the contact surfaces under the boundary lubrication. This study suggests that PEG lubricant as an intra-articular viscous supplement has the potential to prevent wear of UHMWPE by mixing with synovial fluid and to contribute to the longevity of knee joint prostheses.
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Affiliation(s)
- Masanori Kobayashi
- Bio-medical Engineering Laboratory, Department of Integral Mechanical Engineering, Faculty of Engineering, Daido University, 10-3 Takiharu-cho, Minami-ku, Nagoya, Japan.
| | - Takayuki Koide
- Bio-medical Engineering Laboratory, Department of Integral Mechanical Engineering, Faculty of Engineering, Daido University, 10-3 Takiharu-cho, Minami-ku, Nagoya, Japan
| | - Suong-Hyu Hyon
- Institute for Frontier Medical Sciences, Kyoto University, 353 Shogoin, Sakyo-ku, Kyoto, Japan
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Turner A, Okubo Y, Teramura S, Niwa Y, Ibaraki K, Kawasaki T, Hamada D, Uetsuki K, Tomita N. The antioxidant and non-antioxidant contributions of vitamin E in vitamin E blended ultra-high molecular weight polyethylene for total knee replacement. J Mech Behav Biomed Mater 2014; 31:21-30. [PMID: 23369759 DOI: 10.1016/j.jmbbm.2012.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/19/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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Bladen CL, Teramura S, Russell SL, Fujiwara K, Fisher J, Ingham E, Tomita N, Tipper JL. Analysis of wear, wear particles, and reduced inflammatory potential of vitamin E ultrahigh-molecular-weight polyethylene for use in total joint replacement. J Biomed Mater Res B Appl Biomater 2013; 101:458-66. [PMID: 23436622 PMCID: PMC3798093 DOI: 10.1002/jbm.b.32904] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 11/27/2012] [Accepted: 01/10/2013] [Indexed: 11/12/2022]
Abstract
Vitamin E (VE) has been added to ultrahigh-molecular-weight polyethylene (UHMWPE) acetabular cups and tibial trays primarily to reduce oxidative damage to the polymer. The aim of this study was to investigate the relative wear rates of UHMWPE-containing VE compared with virgin UHMWPE. The ability of VE to reduce the amount of inflammatory cytokines produced from stimulated peripheral blood mononuclear cells (PBMNCs) was also investigated. Stimulation was achieved by exposure of PBMNCs to either lipoplysaccharide (LPS) or VE-containing UHMWPE (VE-UHMWPE). In the present study, results showed that the wear rates of UHMWPE with or without VE were not significantly different. Particles generated by UHMWPE with and without VE were not significantly different in size distribution. The production of osteolytic mediators, tumor necrosis factor-alpha, interleukin 1β (IL-β), IL-6, and IL-8 were significantly reduced in (PBMNCs) stimulated with either LPS + VE compared with LPS or VE-UHMWPE particles compared to virgin UHMWPE particles. This trend was also observed when VE was added as a liquid to UHMWPE wear particle-stimulated PBMNCs. The exact mechanism of how VE affects the release of inflammatory mediators from particle-stimulated macrophages is not yet understood. It is likely to involve the anti-inflammatory and/or antioxidant effects of VE.
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Affiliation(s)
- C L Bladen
- Institute of Medical and Biological Engineering, University of Leeds, UK.
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Haider H, Weisenburger JN, Kurtz SM, Rimnac CM, Freedman J, Schroeder DW, Garvin KL. Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty? J Arthroplasty 2012; 27:461-9. [PMID: 22146382 DOI: 10.1016/j.arth.2011.03.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 03/11/2011] [Indexed: 02/01/2023] Open
Abstract
Concerns about reduced strength, fatigue resistance, and oxidative stability of highly cross-linked and remelted ultrahigh-molecular-weight polyethylene (UHMWPE) have limited its clinical acceptance for total knee arthroplasty. We hypothesized that a highly cross-linked UHMWPE stabilized with vitamin E would have less oxidation and loss of mechanical properties. We compared the oxidation, in vitro strength, fatigue-crack propagation resistance, and wear of highly cross-linked UHMWPE doped with vitamin E to γ-inert-sterilized direct compression-molded UHMWPE (control). After accelerated aging, the control material showed elevated oxidation, loss of small-punch mechanical properties, and loss of fatigue-crack propagation resistance. In contrast, the vitamin E-stabilized material had minimal changes and exhibited 73% to 86% reduction in wear for both cruciate-retaining and posterior-stabilized total knee arthroplasty designs. Highly cross-linked vitamin E-stabilized UHMWPE performed well in vitro.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical, Center, Omaha, Nebraska 68198, USA
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Bistolfi A, Bellare A. The relative effects of radiation crosslinking and type of counterface on the wear resistance of ultrahigh-molecular-weight polyethylene. Acta Biomater 2011; 7:3398-403. [PMID: 21640855 DOI: 10.1016/j.actbio.2011.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/06/2011] [Accepted: 05/16/2011] [Indexed: 11/19/2022]
Abstract
The lifetime of total joint replacement prostheses utilizing ultrahigh-molecular-weight polyethylene (UHMWPE) components has historically been determined by their wear resistance. It has been discovered that radiation crosslinking of UHMWPE can substantially increase its wear resistance. However, it is also well recognized that there is a radiation-dose-dependent decrease in several important mechanical properties of UHMWPE, such as fracture toughness and resistance to fatigue crack propagation. In this study, the effect of radiation crosslinking (followed by remelting) on the morphology, tensile properties and wear resistance of UHMWPE was investigated. Wear tests were conducted against both the commonly used cobalt-chromium counterface polished to implant grade smoothness as well as a smoother ceramic (alumina) counterface. The results showed that 50kGy dose radiation crosslinking increased the wear resistance of UHMWPE against the cobalt-chromium counterface 7-fold, but the coupling of remelted, crosslinked UHMWPE against the smoother alumina counterface led to a 20-fold increase in wear resistance. This study shows that the use of an alumina counterface would circumvent the need to use a high radiation dose in crosslinking UHMWPE, associated with poor mechanical properties, without compromising wear resistance.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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42
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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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Liu YL, Lin KJ, Huang CH, Chen WC, Chen CH, Chang TW, Lai YS, Cheng CK. Anatomic-like polyethylene insert could improve knee kinematics after total knee arthroplasty--a computational assessment. Clin Biomech (Bristol, Avon) 2011; 26:612-9. [PMID: 21377253 DOI: 10.1016/j.clinbiomech.2011.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS Deficiencies in contemporary posterior crucitate retaining knee included inadequate femoral rollback and insufficient tibial rotation. Current study attempted to restore normal femoral rollback and tibial rotation to facilitate in knee flexion/extension and to achieve appropriate posture at deep knee bending after total knee arthroplasy by mimicking the morphology of convexly lateral tibial plateau of intact knee. METHODS Computational simulation was utilized to analyze motion of three-dimensional knee models, including intact, traditionally symmetrical posterior crucitate retaining and newly anatomic-like posterior crucitate retaining knees. Solid bones, attachments of ligaments and tendons of simulation models were reconstructed by magnetic resonance images of the subject. According to the representative literature, the distal femur was modeled to rotate about the specific axes and the motion of the proximal tibial was unconstrained except for the flexion/extension. Movements of the medial/lateral condyles and tibial rotation were recorded and analyzed. FINDINGS The newly anatomic-like posterior crucitate retaining knee improved the posterior movement of lateral condyle and tibial internal rotation significantly during full range of flexion. Compared with traditionally symmetrical posterior crucitate retaining knee, the improvements displayed by newly developed posterior crucitate retaining knee in posterior movement of lateral condyle and tibial internal rotation were 11.2mm and 9.3° at full flexion, respectively. INTERPRETATION The newly anatomic-like posterior crucitate retaining knee demonstrated that mimicking the morphology of convexly lateral tibial plateau can be expected to restore normal knee kinematics.
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Affiliation(s)
- Yu-Liang Liu
- Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang-Ming University, No.155 Sec.2 Linong St., Taipei, Taiwan
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Kurtz SM, Dumbleton J, Siskey RS, Wang A, Manley M. Trace concentrations of vitamin E protect radiation crosslinked UHMWPE from oxidative degradation. J Biomed Mater Res A 2009; 90:549-63. [PMID: 18563825 DOI: 10.1002/jbm.a.32122] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S M Kurtz
- Exponent, Inc., 3401 Market St., Suite 300, Philadelphia, Pennsylvania 19104, USA.
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Ridley MD, Jahan MS. Effects of packaging environments on free radicals in gamma-irradiated UHMWPE resin powder blend with vitamin E. J Biomed Mater Res A 2009; 88:1097-103. [PMID: 18465824 DOI: 10.1002/jbm.a.32042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) powder (GUR 1020) was blended with high concentration (20%) of vitamin E (alpha-Tocopherol (alpha-T)) for direct detection of alpha-T radicals in presence of PE radicals. Samples were gamma-irradiated in sealed packages filled with N(2), or in open air. Free radicals were measured in open air environment for 71 days using electron spin resonance (ESR) technique. When irradiated in air, both alpha-T and alpha-T-resin produced identical ESR signals characteristics of tochopheroxyl radicals (alpha-T-O(*)), suggesting that PE radicals are quenched by alpha-T. There was no indication of growth of oxygen-induced radicals (OIR) either. However, when alpha-T-resin was irradiated in N(2), presence of both PE and alpha-T radicals were evident in the ESR spectra. And, OIR were produced by the same samples when they were subsequently exposed to air (for 71 days). Oxidation data recorded 85 days after postirradiation aging in air using Fourier transform infra-red (FTIR) spectroscopy, however, did not show any measurable difference between samples irradiated in N(2) and air.
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Affiliation(s)
- M D Ridley
- Department of Physics, Biomaterials Laboratory, The University of Memphis, Memphis, Tennessee 38152, USA
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Abstract
Wear debris related osteolysis is recognised as being the main cause of failure in joint replacements based on UHMWPE inserts. However, many solutions and "new" polyethylenes have been suggested in order to address this issue. This review discusses "historical" issues associated with UHMWPE, such as oxidation, sterilization method and storage, as well as "new" topics, such as crosslinking and stabilization. The final aim is to aid orthopaedic surgeons in their selection of polyethylene inserts and in the information given to the patients. The main problem for the polymer is degradative oxidation, which is caused by the combination of the irradiation used for sterilization and oxygen, and which leads to a decrease in wear resistance and mechanical properties. Irradiation and packaging in the absence of oxygen can only reduce the oxidation, while sterilization with gas (EtO or gas plasma) is the only method that effectively eliminates it. Manufacturing processes are of great relevance to the clinical duration and must be considered by surgeons. Crosslinked polyethylene has been developed for joint inserts due to its superior wear resistance compared to conventional UHMWPE; to prevent the oxidation, crosslinked polyethylene requires post-irradiation thermal treatment, which reduces its mechanical properties and which depends on the producer. Several good clinical results from the use of crosslinked acetabular cups have reported at mid-term, while early results for knee replacements are also encouraging. Recently, the use of the antioxidant vitamin E (alpha-tocopherol) has been introduced for joint prostheses in order to prevent the oxidation of both crosslinked and noncrosslinked UHMWPE.
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Bistolfi A, Turell MB, Lee YL, Bellare A. Tensile and tribological properties of high-crystallinity radiation crosslinked UHMWPE. J Biomed Mater Res B Appl Biomater 2008; 90:137-44. [DOI: 10.1002/jbm.b.31265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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50
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Renò F, Cannas M. UHMWPE and vitamin E bioactivity: an emerging perspective. Biomaterials 2006; 27:3039-43. [PMID: 16457883 DOI: 10.1016/j.biomaterials.2006.01.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 01/11/2006] [Indexed: 01/20/2023]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) is a semicrystalline biomaterial widely used in the components for articular prosthesis for its excellent mechanical qualities. Two major problems limit the UHMWPE prosthesis life-wearing and delamination, both phenomena being mainly due to chemical oxidation of polymer. Wearing causes the release of generated particulate that triggers a macrophage reaction leading to chronic inflammation and osteolysis, while delamination, due to the mechanical stress, macroscopically alters the surfaces. The most diffused method to reduce wearing is UHMWPE molecular cross-linking by high-energy irradiation followed by melting that also reduces polymer fatigue strength. For this reason, the use of vitamin E (alpha-tocopherol), as an anti-oxidative and biocompatible additive for normal and cross-linked UHMWPE, has been suggested as an alternative method to improve polymer wearing resistance without altering its mechanical strength. This paper describes briefly the rationale of vitamin E as UHMWPE additive and its possible use as an emerging perspective in the orthopaedic field.
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Affiliation(s)
- Filippo Renò
- Human Anatomy Laboratory, Research Center for Biocompatibility, Clinical and Experimental Medicine Department, University of Eastern Piedmont A. Avogadro, Via Solaroli 17, 28100 Novara, Italy
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