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Lekkala S, Inverardi N, Grindy SC, Hugard S, Muratoglu OK, Oral E. Irradiation Behavior of Analgesic and Nonsteroidal Anti-Inflammatory Drug-Loaded UHMWPE for Joint Replacement. Biomacromolecules 2024; 25:2312-2322. [PMID: 38456765 DOI: 10.1021/acs.biomac.3c01179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Local delivery of pain medication can be a beneficial strategy to address pain management after joint replacement, as it can decrease systemic opioid usage, leading to less side and long-term effects. In this study, we used ultrahigh molecular weight polyethylene (UHMWPE), commonly employed as a bearing material for joint implants, to deliver a wide set of analgesics and the nonsteroidal anti-inflammatory drug tolfenamic acid. We blended the drugs with UHMWPE and processed the blend by compression molding and sterilization by low-dose gamma irradiation. We studied the chemical stability of the eluted drugs, drug elution, tensile properties, and wear resistance of the polymer blends before and after sterilization. The incorporation of bupivacaine hydrochloride and tolfenamic acid in UHMWPE resulted in either single- or dual-drug loaded materials that can be sterilized by gamma irradiation. These compositions were found to be promising for the development of clinically relevant drug-eluting implants for joint replacement.
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Affiliation(s)
- Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Scott C Grindy
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Shannon Hugard
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
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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.
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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
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Zaharescu T, Nicula N, Râpă M, Iordoc M, Tsakiris V, Marinescu VE. Structural Insights into LDPE/UHMWPE Blends Processed by γ-Irradiation. Polymers (Basel) 2023; 15:polym15030696. [PMID: 36771997 PMCID: PMC9920361 DOI: 10.3390/polym15030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) matrices containing low-density polyethylene (LDPE), hydroxyapatite (HAp) as filler, and rosemary extract (RM) as stabilizer were investigated for their qualification for long-term applications. The significant contributions of the blend components were analyzed, and variations in mechanical properties, oxidation strength, thermal behavior, crystallinity, and wettability were discussed. SEM images of microstructural peculiarities completed the introspective survey. The stability improvement due to the presence of both additives was an increase in the total degradation period of 67% in comparison with an unmodified HDPE/UHMWPE blend when the materials were subjected to a 50 kGy γ-dose. There was growth in activation energies from 121 kJ mol-1 to 139 kJ mol-1 when HAp and rosemary extract delayed oxidation. The exposure of samples to the action of γ-rays was found to be a proper procedure for accomplishing accelerated oxidative degradation. The presence of rosemary extract and HAp powder significantly increased the thermal and oxidation resistances. The calculation of material lifetimes at various temperatures provided meaningful information on the wearability and integrity of the inspected composites.
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Affiliation(s)
- Traian Zaharescu
- INCDIE ICPE CA, 3131 Splaiul Unirii, 030138 Bucharest, Romania
- Correspondence: (T.Z.); (N.N.)
| | - Nicoleta Nicula
- INCDIE ICPE CA, 3131 Splaiul Unirii, 030138 Bucharest, Romania
- Correspondence: (T.Z.); (N.N.)
| | - Maria Râpă
- Faculty of Materials Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania
| | - Mihai Iordoc
- INCDIE ICPE CA, 3131 Splaiul Unirii, 030138 Bucharest, Romania
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Shah NA, Lan RT, Dai R, Jiang K, Shen HY, Hong R, Xu JZ, Li L, Li ZM. Improved oxidation stability and crosslink density of chemically crosslinked ultrahigh molecular weight polyethylene using the antioxidant synergy for artificial joints. J Biomed Mater Res B Appl Biomater 2023; 111:26-37. [PMID: 35809250 DOI: 10.1002/jbm.b.35129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023]
Abstract
Vitamin E (VE) is currently an approved antioxidant to improve the oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene (UHMWPE) insert used commercially in total joint arthroplasty. However, the decrease in crosslink density caused by VE reduces wear resistance of UHMWPE, showing an uncoordinated challenge. In this work, we hypothesized that D-sorbitol (DS) as a secondary antioxidant can improve the antioxidant efficacy of VE on chemically crosslinked UHMWPE. The combined effect of VE and DS on oxidation stability of UHMWPE was investigated at a set of controlled hybrid antioxidant content. The hybrid antioxidant strategy showed significantly synergistic enhancement on the oxidation stability of chemically crosslinked UHMWPE compared with the single VE strategy. More strikingly, the crosslink density of the blends with hybrid antioxidants stayed at a high level since DS is not sensitive to crosslinking. The relationships between oxidation stability, mechanical properties, crosslink density, and crystallinity were investigated, by which the clinically relevant overall performance of UHMWPE was optimized. This work provides a leading-edge design mean for the development of joint bearings.
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Affiliation(s)
- Nouman Ali Shah
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,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
| | - Rui Dai
- College of Biomass Science and Engineering, Sichuan University, Chengdu, China
| | - Kai Jiang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Hui-Yuan Shen
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Rui Hong
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Jia-Zhuang Xu
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China.,College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
| | - Lingli Li
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Ming Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, China
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Bakshi AK, Ghosh AK. Processability and physico‐mechanical properties of ultrahigh‐molecular‐weight polyethylene using low‐molecular‐weight olefin wax. POLYM ENG SCI 2022. [DOI: 10.1002/pen.26013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ashok Kumar Bakshi
- Department of Materials Science and Engineering Indian Institute of Technology Delhi, Hauz Khas New Delhi India
| | - Anup K. Ghosh
- Department of Materials Science and Engineering Indian Institute of Technology Delhi, Hauz Khas New Delhi India
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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
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Catauro M, Scolaro C, Dal Poggetto G, Pacifico S, Visco A. Wear Resistant Nanocomposites Based on Biomedical Grade UHMWPE Paraffin Oil and Carbon Nano-Filler: Preliminary Biocompatibility and Antibacterial Activity Investigation. Polymers (Basel) 2020; 12:polym12040978. [PMID: 32331367 PMCID: PMC7240565 DOI: 10.3390/polym12040978] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 02/01/2023] Open
Abstract
In the present paper, we investigate the effectiveness of nanocomposites (composed of ultra-high molecular weight polyethylene (UHMWPE) mixed with carbon nano-filler (CNF) and medical grade paraffin oil (PO), from the biological point of view. Wear measurements were carried out without (air) and with lubricant (distilled water, natural, and artificial lubricant), and antibacterial activity and cytotoxicity were evaluated. The results highlighted that the presence of CNF is important in the nanocomposite formulation because it reduces the wear rate and prevents oxidative degradation during its processing. An amount of 1.0 wt % of CNF is best because it reaches the optimal distribution within the polymeric matrix, resulting in the best wear resistant, bio-active, and anti-bacterial nanocomposite among all investigated samples.
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Affiliation(s)
- Michelina Catauro
- Department of Engineering, University of Campania “Luigi Vanvitelli”, Via Roma 29, I-81031 Aversa, Italy
- Correspondence: (M.C.); (A.V.); Tel.: +39-082/5010360 (M.C.); Tel.: +39-090-676-5249/3808 (A.V.)
| | - Cristina Scolaro
- Department of Engineering, University of Messina, C.da Di Dio, 98166 Messina, Italy;
| | | | - Severina Pacifico
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies; University of Campania “Luigi Vanvitelli”, Via Vivaldi 43, 81100 Caserta, Italy;
| | - Annamaria Visco
- Department of Engineering, University of Messina, C.da Di Dio, 98166 Messina, Italy;
- Istituto per i Polimeri, Compositi e Biomateriali - CNR IPCB, Via Paolo Gaifami 18, 9-95126 Catania, Italy
- Correspondence: (M.C.); (A.V.); Tel.: +39-082/5010360 (M.C.); Tel.: +39-090-676-5249/3808 (A.V.)
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