1
|
Muratoglu OK, Asik MD, Nepple CM, Wannomae KK, Micheli BR, Connolly RL, Oral E. Di-cumyl peroxide cross-linked UHMWPE/vitamin-E blend for total joint arthroplasty implants. J Orthop Res 2024; 42:306-316. [PMID: 37593816 DOI: 10.1002/jor.25679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Majority of ultrahigh molecular weight polyethylene (UHMWPE) medical devices used in total joint arthroplasty are cross-linked using gamma radiation to improve wear resistance. Alternative methods of cross-linking are urgently needed to replace gamma radiation due to rapid decline in its supply. Peroxide cross-linking is a candidate method with widespread industrial applications. Oxidative stability and biocompatibility, which are critical requirements for medical device applications, can be achieved using vitamin-E as an additive and by removing peroxide by-products through high-temperature melting, respectively. We investigated compression molded UHMWPE/vitamin-E/di-cumyl peroxide blends followed by high-temperature melting in inert gas as a material candidate for tibial knee inserts. Wear resistance increased and mechanical properties remained largely unchanged. Oxidation induction time was higher than most of the other clinically available formulations. The material passed the local-end point biocompatibility tests per ISO 10993. Compounds found in exhaustive extraction were of no concern with margin-of-safety values well above the accepted level, indicating a desirable toxicological risk profile. Statement of Clinical Significance: Peroxide cross-linked, vitamin-E stabilized, and high-temperature melted UHMWPE has recently been cleared for clinical use in tibial knee inserts. With all the salient characteristics needed in a material that can provide superior long-term performance in total joint patients, peroxide cross-linking can replace the gamma radiation cross-linking of UHMWPE.
Collapse
Affiliation(s)
- Orhun K Muratoglu
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mehmet D Asik
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith K Wannomae
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brad R Micheli
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel L Connolly
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ebru Oral
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Influence of molecular weight on molding efficiency and properties of sintered UHMWPE thick-size products. JOURNAL OF POLYMER RESEARCH 2021. [DOI: 10.1007/s10965-021-02690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Shah NA, Ren Y, Lan R, Lv J, Gul RM, Tan P, Huang S, Tan L, Xu J, Li Z. Ultrahigh molecular weight polyethylene with improved crosslink density, oxidation stability, and microbial inhibition by chemical crosslinking and tea polyphenols for total joint replacements. J Appl Polym Sci 2021. [DOI: 10.1002/app.51261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Nouman Ali Shah
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Yue Ren
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Ri‐Tong Lan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Jia‐Cheng Lv
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Rizwan M. Gul
- Department of Mechanical Engineering University of Engineering and Technology Peshawar Pakistan
| | - Peng‐Fei Tan
- College of Biomass Science and Engineering Sichuan University Chengdu China
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine Sichuan University Chengdu China
| | - Lin Tan
- College of Biomass Science and Engineering Sichuan University Chengdu China
| | - Jia‐Zhuang Xu
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| | - Zhong‐Ming Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu China
| |
Collapse
|
4
|
Hussain M, Naqvi RA, Abbas N, Khan SM, Nawaz S, Hussain A, Zahra N, Khalid MW. Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) as a Promising Polymer Material for Biomedical Applications: A Concise Review. Polymers (Basel) 2020; 12:polym12020323. [PMID: 32033140 PMCID: PMC7077409 DOI: 10.3390/polym12020323] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 01/01/2023] Open
Abstract
Ultra-High Molecular Weight Polyethylene (UHMWPE) is used in biomedical applications due to its high wear-resistance, ductility, and biocompatibility. A great deal of research in recent decades has focused on further improving its mechanical and tribological performances in order to provide durable implants in patients. Several methods, including irradiation, surface modifications, and reinforcements have been employed to improve the tribological and mechanical performance of UHMWPE. The effect of these modifications on tribological and mechanical performance was discussed in this review.
Collapse
Affiliation(s)
- Muzamil Hussain
- Mechanical Engineering Department, NFC Institute of Engineering and Technology, Multan 60000, Pakistan;
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore 42000, Pakistan;
| | - Rizwan Ali Naqvi
- Department of Unmanned Vehicle Engineering, Sejong University, Seoul 05006, Korea;
| | - Naseem Abbas
- School of Mechanical Engineering, College of Engineering, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea
- Correspondence:
| | - Shahzad Masood Khan
- Department of Polymer Engineering and Technology, University of the Punjab, Lahore 42000, Pakistan;
| | - Saad Nawaz
- Department of Mechanical Engineering, University of Engineering & Technology Lahore, KSK-Campus, Sheikhupura 39350, Pakistan;
| | - Arif Hussain
- Department of Mechanical Convergence Engineering, Hanyang University, Seoul 04763, Korea;
| | - Nida Zahra
- Department of Physics, Government College University Faisalabad, Faisalabad 38000, Pakistan;
| | - Muhammad Waqas Khalid
- Biomedical Engineering Technology Department, NFC Institute of Engineering and Technology, Multan 60000, Pakistan;
| |
Collapse
|
5
|
Duan W, Wu M, Han J, Ni Z. Research into the thermal stability and mechanical properties of vitamin E diffusion modified irradiation cross-linked graphene oxide/ultra-high molecular weight polyethylene composites. RSC Adv 2020; 10:4175-4188. [PMID: 35495271 PMCID: PMC9049050 DOI: 10.1039/c9ra09893c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/11/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
Recently, there has been increasing interest in modifying ultra-high molecular weight polyethylene (UHMWPE) due to glaring needs in the artificial joint replacement field. It is generally reported in the literature that irradiation cross-linking and adding graphene oxide (GO)/vitamin E (VE) can enhance the mechanical properties of UHMWPE, but this can sacrifice the oxidation stability and gel content. This paper examines how VE diffusion can influence irradiation cross-linked GO/UHMWPE composites and whether mechanical performance and oxidation resistance can be maintained simultaneously, which will provide new guidance for prolonging the longevity of UHMWPE implants. The GO/UHMWPE composites were fabricated by means of liquid ultrasonic dispersion, hot pressing and irradiation cross-linking, followed by VE diffusion and homogenization treatment. The results indicated that limited VE diffusion decreased the water absorption and wettability. The crystallinity, melting temperature, thermal stability, hardness and scratch resistance of the composites basically remain essentially the same, except in the case of pure UHMWPE. In addition, the oxidation resistance was improved significantly after incorporating VE. Furthermore, the diffusion and enhancement mechanisms were also demonstrated, respectively.
Collapse
Affiliation(s)
- Weipeng Duan
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Meiping Wu
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Jitai Han
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| | - Zifeng Ni
- School of Mechanical Engineering, Jiangnan University Wuxi 214122 China
| |
Collapse
|
6
|
Wilhelm SK, Henrichsen JL, Siljander M, Moore D, Karadsheh M. Polyethylene in total knee arthroplasty: Where are we now? J Orthop Surg (Hong Kong) 2019; 26:2309499018808356. [PMID: 30369289 DOI: 10.1177/2309499018808356] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Polyethylene (PE) remains the gold standard for the articulating surface in hip and knee arthroplasty. To increase arthroplasty longevity and improve wear resistance, newer versions of PE have been designed with resultantly different wear properties. Highly cross-linked polyethylene (HXLPE) is used in total hip arthroplasty with excellent outcomes; however, its use in total knee arthroplasty (TKA) remains conflicting. This review summarizes biomechanical and wear properties, clinical outcomes, and cost of polyethylene inserts in TKA. Simulation studies have convincingly shown decreased wear and oxidation rates with HXLPE when compared to conventional polyethylene (CPE). Registry results have been conflicting, and short- to midterm clinical studies have not demonstrated a significant difference between HXLPE and CPE. The cost of HXLPE inserts is higher than CPE. Long-term clinical data are lacking and further studies are warranted to evaluate the role of HXLPE in TKA.
Collapse
Affiliation(s)
- Spencer K Wilhelm
- 1 Oakland University William Beaumont School of Medicine, Michigan, USA
| | | | | | - Drew Moore
- 2 Beaumont Health System, Orthopaedic Surgery, Michigan, USA
| | - Mark Karadsheh
- 2 Beaumont Health System, Orthopaedic Surgery, Michigan, USA
| |
Collapse
|
7
|
Kayandan S, Doshi BN, Oral E, Muratoglu OK. Surface cross-linked ultra high molecular weight polyethylene by emulsified diffusion of dicumyl peroxide. J Biomed Mater Res B Appl Biomater 2017; 106:1517-1523. [PMID: 28741857 DOI: 10.1002/jbm.b.33957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/13/2017] [Accepted: 07/04/2017] [Indexed: 11/06/2022]
Abstract
Cross-linking improves the wear resistance of ultrahigh molecular weight polyethylene (UHMWPE) used in hip and knee implants. Free radicals, generated by ionizing radiation or chemically, react to form cross-links. Limiting cross-linking to the articulating surface of the implant is desirable to enable high wear resistance on the surface and higher strength and toughness in the bulk. We investigated the diffusion of emulsified dicumyl peroxide (DCP) into vitamin E-blended UHMWPE (0.1 and 0.3 wt. % vitamin-E) with subsequent thermal decomposition in situ to obtain surface cross-linking with the objective of achieving surface wear rate equivalent or lower than that of current clinically available materials. We diffused emulsified DCP at 100°C followed by in situ decomposition at 150°C. We also assessed the effect of having vitamin-E in the DCP emulsion. The oxidative stability of the treated samples increased with increasing vitamin E concentration in the blend and by incorporating vitamin E into the peroxide emulsion. The impact strength of a surface cross-linked, 0.3 wt% vitamin E blended UHMWPE prepared using this method was superior to a clinically available irradiated and melted highly cross-linked UHMWPE while the wear resistance was comparable. These results showed the feasibility of surface cross-linking using emulsified peroxide diffusion as a method of making tough and wear resistant joint implant bearing surfaces. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1517-1523, 2018.
Collapse
Affiliation(s)
- Sanem Kayandan
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Brinda N Doshi
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| |
Collapse
|