Surface modifications and oxidative degradation in MPC-grafted highly cross-linked polyethylene liners retrieved from short-term total hip arthroplasty

Minimum 7-year results of cementless total hip arthroplasty with vitamin E-diffused and 2-methacryloyloxyethyl phosphorylcholine-grafted highly cross-linked polyethylene

The purpose of this study was to evaluate the mid-term clinical results and polyethylene wear of vitamin E-diffused highly cross-linked polyethylene (HXLPE) and 2-methacryloyloxyethyl phosphorylcholine (MPC)-grafted HXLPE in cementless total hip arthroplasty (THA). Thirty-four THAs with vitamin E-diffused HXLPE (VEPE) and 32-mm cobalt-chromium head, and 116 THAs with MPC-grafted HXLPE and 32-mm alumina head were evaluated. The Merle d'Aubigné and Postel scores were administered. Kaplan-Meier survivorship was analyzed. Annual radiographs were analyzed using computerized method and linear steady-state wear rate was measured. The mean duration of follow-up was 9 years (range, 7-11 years) in VEPE group and 8 years (range, 7-10 years) in MPC group. The mean Merle d'Aubigné and Postel scores improved postoperatively in both groups. Kaplan-Meier survivorship with endpoint of revision was 100% (95% confidence interval, 100%-100%) in VEPE group and 98.3% (95% confidence interval, 93.4%-99.6%) in MPC group at 10 years (P = .44). The mean steady-state wear rate was 0.007 mm/year in VEPE group and 0.006 mm/year in MPC group (P = .60). The clinical results of both groups were good and wear rates of both liners were very low.

Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties

Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.

Antibacterial and anti-inflammatory ultrahigh molecular weight polyethylene/tea polyphenol blends for artificial joint applications

Periprosthetic joint infection (PJI) is one of the main causes for the failure of joint arthroplasty. In view of the limited clinical effect of oral/injectable antibiotics and the drug resistance problem, there is a pressing need to develop antibacterial implants with therapeutic antimicrobial properties. In this work, we prepared a highly antibacterial ultrahigh molecular weight polyethylene (UHMWPE) implant by incorporating tea polyphenols. The presence of tea polyphenols not only improved the oxidation stability of irradiated UHMWPE, but also gave it the desirable antibacterial property. The potent antibacterial activity was attributed to the tea polyphenols that produced excess intracellular reactive oxygen species and destroyed the bacterial membrane structure. The tea polyphenol-blended UHMWPE had no biological toxicity to human adipose-derived stem cells and effectively reduced bacteria-induced inflammation in vivo. These results indicate that tea polyphenol-blended UHMWPE is promising for joint replacement prostheses with multifunctionality to meet patient satisfaction.

Use of Protein Repellents to Enhance the Antimicrobial Functionality of Quaternary Ammonium Containing Dental Materials

An advancement in preventing secondary caries has been the incorporation of quaternary ammonium containing (QAC) compounds into a composite resin mixture. The permanent positive charge on the monomers allows for electrostatic-based killing of bacteria. Spontaneous adsorption of salivary proteins onto restorations dampens the antimicrobial capabilities of QAC compounds. Protein-repellent monomers can work with QAC restorations to achieve the technology's full potential. We discuss the theory behind macromolecular adsorption, direct and indirect characterization methods, and advances of protein repellent dental materials. The translation of protein adsorption to microbial colonization is covered, and the concerns and fallbacks of the state-of-the-art protein-resistant monomers are addressed. Last, we present new and exciting avenues for protein repellent monomer design that have yet to be explored in dental materials.

Crystalline Characteristics and Their Influence in the Mechanical Performance in Poly(ε-Caprolactone) / High Density Polyethylene Blends

Blends of poly(ε-caprolactone) (PCL) and high-density polyethylene (HDPE) have been prepared at different compositions in order to assess the effect of HDPE on gas transport and mechanical behaviors of PCL. Previous to this evaluation, a complete morphological, structural, and thermal characterization were performed using techniques, including SEM, contact angle, FTIR, differential scanning calorimetry, and X-ray diffraction with synchrotron radiation at small and wide angles. Low HDPE incorporations allow interactions to be established at interfaces in the amorphous regions and the enhancement of the mechanical performance. Consequently, the addition of a small amount of HDPE (ranging from 5 to 10 wt%) appears to be appropriate in certain bio-applications where a higher mechanical behavior is required.

Tuning the tribofilm nanostructures of polymer-on-metal joint replacements for simultaneously enhancing anti-wear performance and corrosion resistance

Total joint replacement is currently the most successful clinical treatment for improving the life quality of individuals afflicted with end-stage osteoarthritis of knee or hip joints. However, release of wear and corrosion products from the prostheses is a critical issue causing adverse physiological responses of local issues. β-SiC nanoparticles were dispersed into polyetheretherketone (PEEK) materials and their role in tribocorrosion performance of PEEK-steel joints exposed to simulated body fluid was investigated. It is demonstrated that β-SiC nanoparticles increase greatly the wear resistance of the PEEK materials, and meanwhile mitigate significantly corrosion of the steel counterpart. It is revealed that tribochemical reactions of β-SiC nanoparticles promoted formation of a robust tribofilm having complex structures providing protection and shielding effects. The present work proposes a strategy for developing high-performance polymer-on-metal joint replacement materials of enhanced lifespan and biocompatibility via tuning interface nanostructures. STATEMENT OF SIGNIFICANCE: Adverse tissue responses to metal wear and corrosion products from metal base implants remain a challenge to surgeons and patients. We demonstrated that leaching of metal ions and release of metallic debris are well decreased via tuning interface nanostructures of metal-polymer joint bearings by dispersing β-SiC nanoparticles into polyetheretherketone (PEEK). It is identified that the addition of β-SiC greatly improves the tribological performances of the PEEK materials and mitigated corrosion of the steel. Tribo-chemistry reactions of SiC induce the formation of complex structures which provide protection and shielding effects. Nanostructures of the tribofilm were also comprehensively investigated. These novel findings proposed a potential route for designing high performance metal-polymer joint replacement materials.

Hydrated Phospholipid Polymer Gel-Like Layer for Increased Durability of Orthopedic Bearing Surfaces

Recently, traditional strategies for manipulating orthopedic bearing substrates have attempted to improve their wear resistance by adjusting polyethylene substrate through cross-linking and antioxidant blending. However, further research is required on the substrate, as well as the surface focused on the structure and role of articular cartilage. We therefore develop an orthopedic bearing surface comprising a nanometer-scale hydrated gel-like layer by grafting highly hydrophilic poly(2-methacryloyloxyethyl phosphorylcholine), with the aim of mimicking the lubrication mechanism of articular cartilage, and investigate its surface characteristics, bulk characteristics, and behavior under load bearing conditions upon accelerated aging. Neither the hydrophilicity nor lubricity of the gel-like surface was influenced by accelerated aging; instead, high stability was revealed, even under strong oxidation conditions. The characteristics of the hydrated gel-like surface potentiated the wear resistance of the cross-linked polyethylene liner, irrespective of accelerated aging. These results suggest that the hydrated gel-like surface enhances the longevity of cross-linked polyethylene bearings even under load-bearing conditions. Furthermore, the inflection point on the time series of wear can be a suitable indicator of the durability of the life-long protectant. In conclusion, the hydrated gel-like surface can positively increase orthopedic implant durability.