The wear and kinematics of two medially stabilised total knee replacement systems

BACKGROUND

Medially stabilised total knee replacement systems aim to provide a more natural feeling knee replacement by providing increased stability through flexion. The aim of this study was to compare the kinematics and wear of two different medially stabilised total knee replacement systems in an experimental simulation study. The Medial Rotation Knee™ system (MRK) is an early medially stabilised knee (>20 years clinical success); the SAIPH® knee system being a more modern and refined, bone conserving evolution of the original design with a larger size range.

METHODS

Three SAIPH and three MRK total knee replacements (MatOrtho Ltd, UK) were investigated. The study was performed on a knee simulator with load controlled input kinematic conditions (ISO 14243-1). 6 million cycles of simulation were carried out with the wear of the UHMWPE tibial components assessed gravimetrically. The resulting anterior-posterior translation and tibial rotation position was measured throughout the study.

RESULTS

The mean UHMWPE wear rate was 0.57 ± 0.71 and 1.24 ± 2.0 mm3/million cycles for SAIPH and MRK total knee replacement systems respectively with no significant difference in wear (p = 0.24). Analysis of simulator output kinematics showed a larger range of anterior-posterior motion for SAIPH total knee replacements compared to MRK. The magnitude of tibial rotation was low for both knee replacement systems.

CONCLUSION

The small magnitude of anterior-posterior displacement and tibial rotation motion demonstrates the inherent stability of this knee system design offered by the constrained medial compartment. This study shows the potential for medially stabilised knee systems as a low polyethylene surface wear solution.

Bio-inspired copper ion-chelated chitosan coating modified UHMWPE fibers for enhanced interfacial properties of composites

Ultra-high molecular weight polyethylene (UHMWPE) fibers are broadly applied in lightweight and high-strength composite fiber materials. However, the development of UHMWPE fibers is limited by their smooth and chemically inert surfaces. To address the issues, a modified UHMWPE fibers material has been fabricated through the chelation reaction between Cu2+ and chitosan coatings within the surface of fibers after plasma treatment, which is inspired by the hardening mechanism, a crosslinked network between metal ions and proteins/polysaccharides of the tips and edges in arthropod-specific cuticular tools. The coatings improve the surface wettability and interfacial bonding ability, which are beneficial in extending the application range of UHMWPE fibers. More importantly, compared to the unmodified UHMWPE fiber cloths, the tensile property of the modified fiber cloths is increased by 18.89% without damaging the strength, which is infrequent in modified UHMWPE fibers. Furthermore, the interlaminar shear strength and fracture toughness of the modified fibers laminate are increased by 37.72% and 135.90%, respectively. These improvements can be attributed to the synergistic effects between the surface activity and the tiny bumps of the modified UHMWPE fibers. Hence, this work provides a more straightforward and less damaging idea of fiber modification for manufacturing desirable protective and medical materials.

Di-cumyl peroxide cross-linked UHMWPE/vitamin-E blend for total joint arthroplasty implants

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.

The Development and Performance of Knitted Cool Fabric Based on Ultra-High Molecular Weight Polyethylene

In order to withstand high-temperature environments, ultra-high molecular weight polyethylene (UHMWPE) fibers with cooling properties are being increasingly used in personal thermal management textiles during the summer. However, there is relatively little research on its combination with knitting. In this paper, we combine UHMWPE fiber and knitting structure to investigate the impact of varying UHMWPE fiber content and different knitting structures on the heat and humidity comfort as well as the cooling properties of fabrics. For this purpose, five kinds of different proportions of UHMWPE and polyamide yarn preparation, as well as five kinds of knitted tissue structures based on woven tissue were designed to weave 25 knitted fabrics. The air permeability, moisture permeability, moisture absorption and humidity conduction, thermal property, and contact cool feeling property of the fabrics were tested. Then, orthogonal analysis and correlation analysis were used to statistically evaluate the properties of the fabrics statistically. The results show that as the UHMWPE content increases, the air permeability, heat conductivity, and contact cool feeling property of the fabrics improve. The moisture permeability, moisture absorption and humidity conductivity of fabrics containing UHMWPE are superior to those containing only polyamide. The air permeability, moisture permeability, and thermal conductivity of the fabrics formed by the tuck plating organization are superior to those of the flat needle plating and float wire plating organization. The fabric formed by 2 separate 2 float wire organization has the best moisture absorption, humidity conduction, contact cool feeling property.

Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial

BACKGROUND

The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design.

METHODS

This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile.

DISCUSSION

The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1 . All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.

A review of wear debris in thumb base joint implants

AIM

Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined. Potential adverse wear conditions and inflammatory particle characteristics were also considered.

METHOD

A literature search was performed using PRISMA guidelines and 55 studies were reviewed including 49 cohort studies and 6 case studies. Of the 55 studies, 38/55 (69%) focused on metal-on-polyethylene devices, followed by metal-on-metal (35%), and metal-on-bone (4%).

RESULTS

The summarized data was used to determine the frequency of failure modes potentially related to wear debris from metals and/or polymers. The most commonly reported incidents potentially relating to debris were implant loosening (7.1%), osteolysis (1.2%) and metallosis (0.6%). Interestingly the reported mechanisms behind osteolysis and loosening greatly varied. Inflammatory reactions, while rare, were generally attributed to metallic debris from metal-on-metal devices. Mechanisms of adverse wear conditions included implant malpositioning, over-tensioning, high loading for active patients, third-body debris, and polyethylene wear-through. No specific examination of debris particle characterization was found, pointing to a gap in the literature.

CONCLUSION

This review underscores the types of failure modes associated with wear debris in CMC implants. It was found that failure rates and adverse wear conditions of CMC implants of any design are low and the exact relationship between wear debris and implant incidences, such as osteolysis and loosening remains uncertain. The authors note that further research and specific characterization is required to understand the relationship between debris and implant failure.

Numerical Investigation on Anti-Explosion Performance of Non-Metallic Annular Protective Structures

Explosive shock wave protection is an important issue that urgently needs to be solved in the current military and public security safety fields. Non-metallic protective structures have the characteristics of being lightweight and having low secondary damage, making them an important research object in the field of equivalent protection. In this paper, the numerical simulation was performed to investigate the dynamic mechanical response of non-metallic annular protective structures under the internal blast, which were made by the continuous winding of PE fibers. The impact of various charges, the number of fiber layers, and polyurethane foam on the damage to protective structures was analyzed. The numerical results showed that 120 PE fiber layers could protect 50 g TNT equivalent explosives. However, solely increasing the thickness of fiber layers cannot effectively enhance the protection efficiency. By adding polyurethane foam in the inner layer, the stress acting on the fiber could be effectively reduced. A 30 mm thick polyurethane layer can reduce the equivalent stress of the fiber layer by 41.6%. This paper can provide some reference for the numerical simulations of non-metallic explosion protection structures.

Does a Compatibilizer Enhance the Properties of Carbon Fiber-Reinforced Composites?

We have evaluated the effectiveness of compatibilizers in blends and composites produced using a solvent manufacturing process. The compatibilizers were two different types of polyethylene (linear low-density and high-density) grafted with maleic anhydride (MAH) and a highly functionalized, epoxy-based compatibilizer with the tradename Joncryl. The selected material combinations were an ultra-high-molecular-weight polyethylene (UHMWPE) with MAH-based materials as compatibilizers and a polyphenylene sulfide plus polytetrafluoroethylene (PPS-PTFE) polymer blend with an epoxy-based compatibilizer. The findings revealed that while the compatibilizers consistently enhanced the properties, such as the impact strength and hardness of PPS-based compositions, their utility is constrained to less complex compositions, such as fibrous-reinforced PPS or PPS-PTFE polymer blends. For fibrous-reinforced PPS-PTFE composites, the improvement in performance does not justify the presence of compatibilizers. In contrast, for UHMWPE compositions, compatibilizers demonstrated negligible or even detrimental effects, particularly in reinforced UHMWPE. Overall, the epoxy-based compatibilizer Joncryl stands out as the only effective option for enhancing mechanical performance. Thermal and chemical characterization indicated that the compatibilizers function as chain extenders and enhance the fiber-matrix interface in PPS-based compositions, while they remain inactive in UHMWPE-based compositions. Ultimately, the incompatibility of the compatibilizers with certain aspects of the manufacturing method and the inconsistent integration with the polymer are the main reasons for their ineffectiveness in UHMWPE compositions.

The influence of cross shear and contact pressure on the wear of UHMWPE-on-PEEK-OPTIMA™ for use in total knee replacement

PEEK-OPTIMA™ polymer is being considered as an alternative material to cobalt chrome in the femoral component of total knee arthroplasty to give a metal-free knee replacement system. Simple geometry pin-on-plate wear simulation can be used to systematically investigate and understand the wear of materials under many different conditions. The aim of this study was to investigate the wear of UHMWPE-on-PEEK-OPTIMA™ under a range of contact pressure (2.1-80 MPa) and cross-shear ratio (0-0.18) conditions. With increasing contact pressure, there was a trend of decreasing UHMWPE wear factor with a significant difference (p<0.001) in the wear factor of UHMWPE under the different contact pressure conditions of interest. Under uniaxial motion (cross-shear ratio = 0), the wear of UHMWPE was low, introducing multi-axial motion increased the wear of the UHMWPE. There was a significant difference (p<0.01) in the wear factor at different cross-shear ratios however, post hoc analysis showed only the study carried out under unidirectional motion to be significantly different from the other conditions. With varying contact pressure and cross-shear ratio, the wear of UHMWPE against PEEK-OPTIMA™ polymer showed similar trends to previous studies of UHMWPE-on-cobalt chrome.

Optimization the Stab Resistance and Flexibility of Ultra-High Molecular Weight Polyethylene Knitted Structure Fabric with Response Surface Method

At present, the challenging issue of the compatibility between stab resistance and flexibility of materials frequently appears. Thus, this study proposes a novel method to enhance the comprehensive performance of the material matrix with stab resistance. Based on the stab-resistant mechanism analysis of the textile matrix, the influence of four factors on the performance of ultra-high molecular weight polyethylene (UHMWPE) knitted fabric was discussed. And, the optimal process conditions of material for achieving high stab resistance and high flexibility were obtained by the response surface method. A series of experiments proved that among all factors, the fabric structure had the greatest influence on the flexible stab-resistant knitted material. Following that, the thickness of the yarn also plays a significant role. Under the optimal process conditions, the stab peak force of the knitted material was promoted to 52.450 N, and the flexibility was enhanced to 93.6%. Meanwhile, through comparison with products that have undergone the same treatment, there was little difference in stab resistance but significantly improved flexibility. It achieves the initial stab resistance and comfortable wearing softness of the fabric through process optimization. This improvement in overall performance of the textile matrix enables further enhancement treatments.

Computational nodal displacement analysis of acetabulum fossa for injection molded cemented polyethylene acetabular liner

The acetabular liner (AL) is one of the key components that determine the functionality and durability of the total hip joint replacement (THR) device. The performance of Ultra high molecular weight polyethylene (UHMWPE)-based AL depends critically on the manufacturing route and its properties, which are evaluated pre-clinically using a host of experimental and computational analyses. The conventional manufacturing of an AL involves multiple stages, including extrusion/compression molding followed by machining, which is time/cost intensive and leads to material loss. In such a scenario, injection molding is a promising alternative, yet its feasbility remains unexplored for the manufacturing of AL for THA applications. Against this backdrop, the two-fold objectives of this work are to report our recent efforts to establish the efficacy of the injection molding of new generation UHMWPE biomaterial; HU (60 wt% HDPE- 40 wt% UHMWPE blend) for manufacturing AL prototype and to present the key biomechanical response analysis of this prototype, in silico. A range of manufacturing relevant material properties, as well as customized mold design to manufacture HU-based AL with external design features, are discussed. Such guidelines are particularly relevant to mold polymeric parts with a higher thickness (>8 mm). As part of the pre-clinical validation of AL with new design features, a less explored in silico approach to assess biomechanical micro-strain in the acetabulum fossa is presented, and the results are analysed in accordance with the mechanostat theory. The outcomes revealed that for a 100 kg subject weight, average micro-strain in the remodelling region was 1132, while it was determined as 723 for a 55 kg subject weight. Such results highlight the influence of subject weight on micro-strain generation and distribution in the acetabulum fossa. The von Mises stress in AL also increased with subject weight from 17 MPa in a subject weight of 55 kg to 28 MPa in a subject weight of 100 kg. Taken together, this work demonstrates the feasibility and competence of this new generation biomaterial in terms of implant manufacturing via injection molding with a clinically desired biomechanical response.

Prediction of Tribological Properties of UHMWPE/SiC Polymer Composites Using Machine Learning Techniques

Polymer composites are a class of material that are gaining a lot of attention in demanding tribological applications due to the ability of manipulating their performance by changing various factors, such as processing parameters, types of fillers, and operational parameters. Hence, a number of samples under different conditions need to be repeatedly produced and tested in order to satisfy the requirements of an application. However, with the advent of a new field of triboinformatics, which is a scientific discipline involving computer technology to collect, store, analyze, and evaluate tribological properties, we presently have access to a variety of high-end tools, such as various machine learning (ML) techniques, which can significantly aid in efficiently gauging the polymer's characteristics without the need to invest time and money in a physical experimentation. The development of an accurate model specifically for predicting the properties of the composite would not only cheapen the process of product testing, but also bolster the production rates of a very strong polymer combination. Hence, in the current study, the performance of five different machine learning (ML) techniques is evaluated for accurately predicting the tribological properties of ultrahigh molecular-weight polyethylene (UHMWPE) polymer composites reinforced with silicon carbide (SiC) nanoparticles. Three input parameters, namely, the applied pressure, holding time, and the concentration of SiCs, are considered with the specific wear rate (SWR) and coefficient of friction (COF) as the two output parameters. The five techniques used are support vector machines (SVMs), decision trees (DTs), random forests (RFs), k-nearest neighbors (KNNs), and artificial neural networks (ANNs). Three evaluation statistical metrics, namely, the coefficient of determination (R2-value), mean absolute error (MAE), and root mean square error (RMSE), are used to evaluate and compare the performances of the different ML techniques. Based upon the experimental dataset, the SVM technique was observed to yield the lowest error rates-with the RMSE being 2.09 × 10-4 and MAE being 2 × 10-4 for COF and for SWR, an RMSE of 2 × 10-4 and MAE of 1.6 × 10-4 were obtained-and highest R2-values of 0.9999 for COF and 0.9998 for SWR. The observed performance metrics shows the SVM as the most reliable technique in predicting the tribological properties-with an accuracy of 99.99% for COF and 99.98% for SWR-of the polymer composites.

Drilling of Cross-Ply UHMWPE Laminates: A Study on the Effects of the Tool Geometry and Cutting Parameters on the Integrity of Components

Ultrahigh-molecular-weight polyethylene (UHMWPE) is used in the defence industry mainly owing to its properties, such as excellent dimensional stability, excellent ballistic performance, and light weight. Although UHMWPE laminates are generally studied under impact loads, it is crucial to understand better the optimal machining conditions for assembling auxiliary structures in combat helmets or armour. This work analyses the machinability of UHMWPE laminates by drilling. The workpiece material has been manufactured through hot-pressing technology and subjected to drilling tests. High-speed steel (HSS) twist drills with two different point angles and a brad and spur drill that is 6 mm in diameter have been used for this study. Cutting forces, failure, and main damage modes are analysed, making it possible to extract relevant information for the industry. The main conclusion is that the drill with a smaller point angle has a better cutting force performance and less delamination at the exit zone (5.4 mm at a 60 m/min cutting speed and a 0.05 mm/rev feed) in the samples. This value represents a 46% improvement over the best result obtained in terms of delamination at the exit when using the tool with the larger point angle. However, the brad and spur drill revealed a post-drilling appearance with high fuzzing and delamination.

Identifying differences in the tribological performance of GUR 1020 and GUR 1050 UHMWPE resins associated to pressure × velocity conditions in linear reciprocating sliding tests

In this work, two commercial UHMWPE (ultra-high molecular weight polyethylene) resins used in orthopedics, GUR 1050 and GUR 1020, were evaluated through linear reciprocating dry friction tests. Average contact pressures (P) of 34 MPa and 50 MPa and sliding velocities (V) of 0.02 m/s and 0.10 m/s were selected to perform tests in four PV conditions. The friction coefficient (COF) with both resins was around 0.18 in average, without significant distinctions by PV; however, a distinction was seen in COF dispersion; it was in the range of 5%-19%, in dependence of the PV condition and resin type. COF with GUR 1020 was more disperse, and it was related to the vulnerability of the resin to undergoing dynamic changes in the intensity of adhesive (higher COF) or abrasive (lower COF) wear mechanisms. Both wear mechanisms are displayed simultaneously, but random changes in intensity may occur during the friction process. Such randomness was associated to the susceptibility to have the structure modified by friction, higher in GUR 1020 than GUR 1050. Concerning wear amount, contact pressure was the most influencing parameter on it. GUR 1020 performed more than 30% inferior than GUR 1050 under contact pressure higher than the yield strength of the material. Under pressures near the material strength, the wear level was in the range of surface roughness and both resins performed equal in average; however, in this case, the dispersion was systematically lower for GUR 1050, evidencing its better tribological stability. It was concluded that analyses on the dispersion of the tribological responses disclosed relevant information on stability related performance. Also, when procedural dependent properties, as such friction and wear, are considered as evaluation parameters, care must be taken to compare results from different tribosystems.

Assessing Formability and Failure of UHMWPE Sheets through SPIF: A Case Study in Medical Applications

This work presents a comprehensive investigation of an experimental study conducted on ultra-high molecular weight polyethylene (UHMWPE) sheets using single point incremental forming (SPIF). The analysis is performed within a previously established research framework to evaluate formability and failure characteristics, including necking and fracture, in both conventional Nakajima tests and incremental sheet forming specimens. The experimental design of the SPIF tests incorporates process parameters such as spindle speed and step down to assess their impact on the formability of the material and the corresponding failure modes. The results indicate that a higher step down value has a positive effect on formability in the SPIF context. The study has identified the tool trajectory in SPIF as the primary influencing factor in the twisting failure mode. Implementing a bidirectional tool trajectory effectively reduced instances of twisting. Additionally, this work explores a medical case study that examines the manufacturing of a polyethylene liner device for a total hip replacement. This investigation critically analyses the manufacturing of plastic liner using SPIF, focusing on its formability and the elastic recovery exhibited by the material.

Preparation and characterization of UHMWPE reinforced with polyester fibers for artificial cervical disc replacement (ACDR)

The purpose of this paper is to report on the preparation and improvement of a biocomposite material made from ultra-high molecular weight polyethylene for the replacement of natural discs. Such replacements are necessary due to intervertebral disc degradation as humans age, which can cause persistent pain due to nerve compression and high friction between vertebrae that can lead to vertebral corrosion. The material was shown to have excellent mechanical properties such as low coefficient of friction, and biocompatibility; however, it degraded with time due to wear failure. Moreover, The wear resistance was related to many factors, such as toughness.In the methodology of the current study, UHMWPE is reinforced with different percent of polyester (2, 4, 6, 8, 10%) to improve the mechanical properties of the polymer disc, thus enhancing its toughness and providing its high bearing ability for the load.The findings revealed that the tensile strength and modulus of elasticity improved by 43.415% and 34.286%, respectively, with the 6% polyester fibers due to the excellent entanglement between the matrix and reinforcing phase. The other mechanical properties, such as flexural strength and modulus, impact strength, fracture toughness, and compression strength, were also enhanced in this study. The highest value at 6% polyester fiber was found to be due to good bonding and adhesion between the polymer and polyester fibers. The Fourier Transformation Spectroscopy (FTIR) showed a shift on some peaks.The originality of this work is that the improvements due to the new bio-composite polymers for artificial implant cervical discs can open many applications in future for these materials.

Intra-articular replacement of the caudal cruciate ligament using a UHMWPE ligament under arthroscopic guidance in a dog: A case report

Background

As isolated ruptures of the caudal cruciate ligament (CdCL) are rare in dogs, there is no consensus on the indications and the gold-standard surgical technique for treatment.

Case Description

A 2-year-old Shepherd dog with an isolated rupture of the CdCL was treated with a new surgical technique for synthetic reconstruction. Three bone tunnels were drilled in the femur and the tibia under arthroscopic guidance to make sure the anatomical insertions of the physiological ligament were respected. An ultra-high molecular weight polyethylene (UHMWPE) implant was fixed with interference screws to reconstruct the CdCL. A synovial inflammation remained present on radiographs for 6 months after the surgery, together with a mild lameness. However, the dog fully recovered clinically and recovered a normal level of activity after 6 months. Liverpool osteoarthritis in dogs questionnaire results at 6 months and 1 year postoperatively were excellent.

Conclusion

The use of a UHMWPE implant fixed with interference screws to reconstruct the CdCL allowed a return to full function of the knee without complications, despite a persistent synovial inflammation and mild lameness for a 6-month period after the surgery. The success of this isolated surgical technique could lead to improvements in the surgical management of CdCL rupture, if these initial results are confirmed by a prospective study with a larger number of patients.

Dynamic finite element analysis of hip replacement edge loading: Balancing precision and run time in a challenging model

An important aspect in evaluating the resilience of hip replacement designs is testing their performance under adverse conditions that cause edge loading of the acetabular liner. The representation of edge loading conditions in finite element models is computationally challenging due to the changing contact locations, need for fine meshes, and dynamic nature of the system. In this study, a combined mesh and mass-scaling sensitivity study was performed to identify an appropriate compromise between convergence and solution time of explicit finite element analysis in investigating edge loading in hip replacement devices. The optimised model was then used to conduct a sensitivity test investigating the effect of different hip simulator features (the mass of the translating fixture and mediolateral spring damping) on the plastic strain in the acetabular liner. Finally, the effect of multiple loading cycles on the progressive accumulation of plastic strain was then also examined using the optimised model. A modelling approach was developed which provides an effective compromise between mass-scaling effects and mesh refinement for a solution time per cycle of less than 1 h. This 'Recommended Mesh' model underestimated the plastic strains by less than 10%, compared to a 'Best Estimate' model with a run time of ∼190 h. Starting with this model setup would therefore significantly reduce any new model development time while also allowing the flexibility to incorporate additional complexities as required. The polyethylene liner plastic strain was found to be sensitive to the simulator mass and damping (doubling the mass or damping had a similar magnitude effect to doubling the swing phase load) and these should ideally be described in future experimental studies. The majority of the plastic strain (99%) accumulated within the first three load cycles.

An automated system for polymer wear debris analysis in total disc arthroplasty using convolution neural network

Introduction: Polymer wear debris is one of the major concerns in total joint replacements due to wear-induced biological reactions which can lead to osteolysis and joint failure. The wear-induced biological reactions depend on the wear volume, shape and size of the wear debris and their volumetric concentration. The study of wear particles is crucial in analysing the failure modes of the total joint replacements to ensure improved designs and materials are introduced for the next generation of devices. Existing methods of wear debris analysis follow a traditional approach of computer-aided manual identification and segmentation of wear debris which encounters problems such as significant manual effort, time consumption, low accuracy due to user errors and biases, and overall lack of insight into the wear regime. Methods: This study proposes an automatic particle segmentation algorithm using adaptive thresholding followed by classification using Convolution Neural Network (CNN) to classify ultra-high molecular weight polyethylene polymer wear debris generated from total disc replacements tested in a spine simulator. A CNN takes object pixels as numeric input and uses convolution operations to create feature maps which are used to classify objects. Results: Classification accuracies of up to 96.49% were achieved for the identification of wear particles. Particle characteristics such as shape, size and area were estimated to generate size and volumetric distribution graphs. Discussion: The use of computer algorithms and CNN facilitates the analysis of a wider range of wear debris with complex characteristics with significantly fewer resources which results in robust size and volume distribution graphs for the estimation of the osteolytic potential of devices using functional biological activity estimates.

Anti-Ballistic Performance of PPTA/UHMWPE Laminates

Poly(p-phenylene terephthalamide) (PPTA) and ultra-high-molecular-weight polyethylene (UHMWPE) are high-performance polymer materials largely used for body armor applications. Although composite structures from a combination of PPTA and UHMWPE have been created and described in the literature, the manufacture of layered composites from PPTA fabrics and UHMWPE films with UHMWPE film as an adhesive layer has not been reported. Such a new design can provide the obvious advantage of simple manufacturing technology. In this study, for the first time, we prepared PPTA fabrics/UHMWPE films laminate panels using plasma treatment and hot-pressing and examined their ballistic performance. Ballistic testing results indicated that samples with moderate interlayer adhesion between PPTA and UHMWPE layers exhibited enhanced performance. A further increase in interlayer adhesion showed a reverse effect. This finding implies that optimization of interface adhesion is essential to achieve maximum impact energy absorption through the delamination process. In addition, it was found that the stacking sequence of the PPTA and UHMWPE layers affected ballistic performance. Samples with PPTA as the outermost layer performed better than those with UHMWPE as the outermost layer. Furthermore, microscopy of the tested laminate samples showed that PPTA fibers exhibited shear cutting failure on the entrance side and tensile failure on the exit side of the panel. UHMWPE films exhibited brittle failure and thermal damage at high compression strain rate on the entrance side and tensile fracture on the exit side. For the first time, findings from this study reported in-field bullet testing results of PPTA/UHMWPE composite panels, which can provide important insights for designing, fabricating, and failure analysis of such composite structures for body armors.

Polyethylene wear simulation models applied to a prosthetic hip joint based on unidirectional articulations

Ultra-high molecular weight polyethylene (UHMWPE) is commonly used as soft-bearing material in total joint replacements. However, the release of polymeric wear debris is still related to complications leading to aseptic loosening. Recently, a novel hip prosthesis showing reduced wear was developed by the authors of this study, consisting of unidirectional cylindrical articulations instead of the conventional multidirectional ball-and-socket design. This study evaluates four different theoretical wear models applied to this new design. The calculated volumetric wear was compared to experimental results. Although all models provided a good indication of the wear rates for the ball-and-socket prosthesis, they exhibited high discrepancies when predicting the amount of wear of the new unidirectional design. It was observed that the closest agreement with experimental results was obtained by the models that consider the friction-induced molecular orientation phenomenon exhibited by UHMWPE.

Chain Dynamics of Partially Disentangled UHMWPE around Melting Point Characterized by 1H Low-Field Solid-State NMR

Melts of ultrahigh molecular weight polyethylene (UHMWPE) entangled significantly, suffering processing difficulty. In this work, we prepared partially disentangled UHMWPE by freeze-extracting, exploring the corresponding enchantment of chain mobility. Fully refocused ¹H free induction decay (FID) was used to capture the difference in chain segmental mobility during the melting of UHMWPE with different degrees of entanglement by low-field solid-state NMR. The longer the polyethylene (PE) chain is in a less-entangled state, the harder the process of merging into mobile parts after detaching from crystalline lamella during melting. ¹H double quantum (DQ) NMR was further used to obtain information caused by residual dipolar interaction. Before melting, the DQ peak appeared earlier in intramolecular-nucleated PE than in intermolecular-nucleated PE because of the strong constraints of crystals in the former one. During melting, less-entangled UHMWPE could keep disentangled while less-entangled high density polyethylene (HDPE) could not. Unfortunately, no noticeable difference was found in DQ experiments between PE melts with different degrees of entanglement after melting. It was ascribed to the small contribution of entanglements compared with total residual dipolar interaction in melts. Overall, less-entangled UHMWPE could reserve its disentangled state around the melting point long enough to achieve a better way of processing.

Ultra-High Molecular Weight Polyethylene Modifications Produced by Carbon Nanotubes and Fe(2)O(3) Nanoparticles

Thin sheets of ultra-high molecular weight polyethylene (UHMWPE), both in pristine form and containing carbon nanotubes (CNTs) or Fe₂O₃ nanoparticles (NPs) at different concentrations, were prepared. The CNT and Fe₂O₃ NP weight percentages used ranged from 0.01% to 1%. The presence of CNTs and Fe₂O₃ NPs in UHMWPE was confirmed by transmission and scanning electron microscopy and by energy dispersive X-ray spectroscopy analysis (EDS). The effects of the embedded nanostructures on the UHMWPE samples were studied using attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy and UV-Vis absorption spectroscopy. The ATR-FTIR spectra show the characteristic features of the UHMWPE, CNTs, and Fe₂O₃. Concerning the optical properties, regardless of the type of embedded nanostructures, an increase in the optical absorption was observed. The allowed direct optical energy gap value was determined from the optical absorption spectra: in both cases, it decreases with increasing CNT or Fe₂O₃ NP concentrations. The obtained results will be presented and discussed.

Structural, Mechanical, and Tribological Properties of Oriented Ultra-High Molecular Weight Polyethylene/Graphene Nanoplates/Polyaniline Films

Preparing high-strength polymeric materials using an orientation drawing process is considered one of the most urgent topics in the modern world. Graphene nanoplates/polyaniline (GNP/PANI) were added to the commercial grade UHMWPE (GUR 4120) matrix as a filler with antifriction properties. The effect of GNP/PANI addition on the structure, the orientation process, the void formation (cavitation), the mechanical, and tribological properties was studied using differential scanning calorimetry (DSC), dynamical mechanical analysis (DMA), and scanning electron microscopy (SEM). The paper's findings indicated an increase in the cavitation effect of 120-320% after the addition of GNP/PANI to the UHMWPE polymer matrix. This increase, during the process of the oriented films' thermal orientation hardening, led, in turn, to a decrease in the tensile strength during the process of the oriented films' thermal orientation hardening. Furthermore, the decrease in the coefficient of friction in the best samples of oriented UHMWPE films was two times greater, and the increase in wear resistance was more than an order of magnitude. This process was part of the orientation hardening process for the UHMWPE films containing PE-wax as an intermolecular lubricant, as well as the presence of GNP/PANI in the material, which have a high resistance to abrasive wear.

Clearance of senescent cells by navitoclax (ABT263) rejuvenates UHMWPE-induced osteolysis

Periprosthetic osteolysis is the leading cause of prosthesis failure and subsequent total joint revision. Wear particles produced by prosthetic materials are the main biological factors that cause periprosthetic osteolysis. Reducing the inflammatory response induced by the phagocytosis of wear particles by macrophages, blocking the activation of osteoclastogenesis, and promoting bone regeneration are essential for preventing the aseptic loosening of prostheses. In this study, we demonstrated that cellular senescence played a vital role during the process of ultra-high molecular weight polyethylene (UHMWPE) particle-induced osteolysis. Administration of the senolytic drug navitoclax (ABT263) could eliminate senescent cells and inhibit the secretion and inflammatory state of the senescence-associated secretory phenotype (SASP). We also discovered that ABT263 inhibited the formation of osteoclasts and had a significant therapeutic effect on UHMWPE particle-induced osteolysis based on the results of UHMWPE-induced mouse cranial osteolysis. Therefore, our research provided innovative strategies and ideas for the prevention and treatment of periprosthetic osteolysis.

A 3-Dimensional Suture Technique for Flexor Tendon Repair: A Biomechanical Study

PURPOSE

Flexor tendon injury continues to pose a number of challenges for hand surgeons. Improving mechanical properties of repairs should allow for earlier and unprotected rehabilitation. A 3-dimensional (3D) 4-strand suture technique has been proposed to combine high tensile strength and low gliding resistance without causing suture pullout due to tendon delamination. Our hypothesis is that the 3D technique can result in better mechanical properties than the Adelaide technique.

METHODS

Four groups of 10 porcine flexor tendons were sutured using the 3D or Adelaide technique with a 3-0 polypropylene or ultrahigh molecular weight polyethylene (UHMWPE) suture. The axial traction test to failure was performed on each tendon to measure 2-mm gap force and ultimate tensile strength.

RESULTS

The mean 2-mm gap force was 49 N for group A (3D + polypropylene), 145 N for group B (3D + UHMWPE), 47 N for group C (Adelaide + polypropylene), and 80 N for group D (Adelaide + UHMWPE). Failure mode was caused by suture breakage for group A (10/10) and mainly by suture pullout for the other groups (8/10 up to 10/10). With the UHMWPE suture, the mean ultimate tensile strength was 145 N for the 3D technique and 80 N for the Adelaide technique.

CONCLUSIONS

Porcine flexor tendons repaired using the 3D technique and UHMWPE suture exceeded a 2-mm gap force and tensile strength of 140 N. The ultimate tensile strength was superior to that of the Adelaide technique, regardless of the suture material.

CLINICAL RELEVANCE

This in vitro study on porcine flexor tendon suture highlights that the mechanical properties of 3D repair are better than those of 3D repair using the Adelaide technique when a UHMWPE suture is used.

Structural Insights into LDPE/UHMWPE Blends Processed by γ-Irradiation

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.

European Database of Explanted UHMWPE Liners from Total Joint Replacements: Correlations among Polymer Modifications, Structure, Oxidation, Mechanical Properties and Lifetime In Vivo

This contribution lays the foundation for the European database of explanted UHMWPE liners from total joint replacements. Three EU countries (Czech Republic, Italy and Spain) have joined their datasets containing anonymized patient data (such as age and BMI), manufacturer data (such as information on UHMWPE crosslinking, thermal treatment and sterilization), orthopedic evaluation (such as total duration of the implant in vivo and reasons for its revision) and material characterization (such as oxidative degradation and micromechanical properties). The joined database contains more than 500 entries, exhibiting gradual growth, and it is beginning to show interesting trends, which are discussed in our contribution, including (i) strong correlations between UHMWPE oxidative degradation, degree of crystallinity and microhardness; (ii) statistically significant differences between UHMWPE liners with different types of sterilization; (iii) realistic correlations between the extent of oxidative degradation and the observed reasons for total joint replacement failures. Our final objective and task for the future is to continuously expand the database, involving researchers from other European countries, in order to create a robust tool that will contribute to the better understanding of structure-properties-performance relationships in the field of arthroplasty implants.

Improved oxidation stability and crosslink density of chemically crosslinked ultrahigh molecular weight polyethylene using the antioxidant synergy for artificial joints

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.

Analysis of Polyethylene-Related Revisions After Total Ankle Replacements Reported in US Food and Drug Administration Medical Device Adverse Event Database

BACKGROUND

There are 2 general types of total ankle replacement (TAR) designs with respect to the polyethylene insert, mobile-bearing (MB) and fixed-bearing (FB) TARs. The aim of this study is to compare polyethylene-related adverse events (AEs), particularly revisions, reported for MB TARs and FB TARs using the US Food and Drug Administration's (FDA's) Manufacturer and User Facility Device Experience (MAUDE) database.

METHODS

A text mining method was applied to the medical device reporting (MDR) in the MAUDE database from 1991 to 2020, followed by manual reviews to identify, characterize, and describe all polyethylene-related AEs, including revisions, reported for MB and FB TARs.

RESULTS

We found 1841 MDRs for MB (STAR Ankle only) and 1273 MDRs for 40+ FB TARs approved/cleared by the FDA. For the MB design, 33% (606/1841) of the AEs reported related to the polyethylene component, compared to 24% (291/1273) of the AEs reported for FB designs. Polyethylene fractures were reported in 11.3% (208/1841) for the MB designs compared to 0.2% (2/1273) for the FB designs. Half of the polyethylene-related revisions occurred within an average of 4.1 years after implantation for the MB design compared within an average of 5.2 years for FB designs.

CONCLUSION

Analysis of this database revealed a higher proportion of reported polyethylene fractures and greater need for earlier revisions for polyethylene-related issues with use of the primary MB design in the database as compared with FB TAR designs. Further study of device-related complications with more recent designs for both MB and FB ankle replacement components are needed to improve the outcomes of total ankle replacement.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Effect of Nano-SiO2 on Different Stages of UHMWPE/HDPE Fiber Preparation via Melt Spinning

Ultra-high molecular weight polyethylene (UHMWPE)/high-density polyethylene (HDPE) blend with lower viscosity is more suitable for melt spinning compared to pure UHMWPE; however, the mechanical property of the blend fiber is hard to dramatically improve (the maximum tensile strength of 998.27 MPa). Herein, different content modified-nano-SiO₂ is incorporated to UHMWPE/HDPE blend fiber. After adding 0.5 wt% nano-SiO₂, the tensile strength and initial modulus of UHMWPE/HDPE/nano-SiO₂ fiber are increased to 1211 MPa and 12.81 GPa, respectively, 21.57% and 43.32% higher than that of UHMWPE/HDPE fiber. Meanwhile, the influence of the nano-SiO₂ content on the performance for as-spun filament and fiber are emphatically analyzed. The crystallinity and molecular chain orientation of as-spun filament reduces with the addition of nano-SiO₂. On the contrary, for fiber, the addition of nano-SiO₂ promoted the crystallinity, molecular chain orientation and grain refinement more obvious at a lower content. Furthermore, the possible action mechanism of nano-SiO₂ in the as-spun filament extrusion and fiber hot drawing stage is explained.

Analysis of Stress Relaxation in Bulk and Porous Ultra-High Molecular Weight Polyethylene (UHMWPE)

The reported study was devoted to the investigation of viscoelastic behavior for solid and porous ultra-high molecular weight polyethylene (UHMWPE) under compression. The obtained experimental stress curves were interpreted using a two-term Prony series to represent the superposition of two coexisting activation processes corresponding to long molecular (~160 s) and short structural (~20 s) time scales, respectively, leading to good statistical correlation with the observations. In the case of porous polymer, the internal strain redistribution during relaxation was quantified using digital image correlation (DIC) analysis. The strongly inhomogeneous deformation of the porous polymer was found not to affect the relaxation times. To illustrate the possibility of generalizing the results to three dimensions, X-ray tomography was used to examine the porous structure relaxation at the macro- and micro-scale levels. DIC analysis revealed positive correlation between the applied force and relative density. The apparent stiffness variation for UHMWPE foams with mixed open and closed cells was described using a newly proposed three-term expression. Furthermore, in situ tensile loading and X-ray scattering study was applied for isotropic solid UHMWPE specimens to investigate the evolution of internal structure and orientation during drawing and stress relaxation in another loading mode.

Formation of UHMWPE Nanofibers during Solid-State Deformation

A network of nanofibers is formed in situ through solid-state deformation of disentangled ultra-high molecular weight polyethylene (dis-UHMWPE) during compounding with a polyolefin elastomer below the melting temperature of dis-UHMWPE crystals. Dis-UHMWPE was prepared in the form of powder particles larger than 50 μm by polymerization at low temperatures, which favored the crystallization and prevention of macromolecules from entangling. Shearing the blend for different durations and at different temperatures affects the extent to which the grains of dis-UHMWPE powder deform into nanofibers. Disentangled powder particles could deform into a network of nanofibers with diameters between 110 and 340 nm. The nanocomposite can be further sheared for a longer time to decrease the diameter of dis-UHMWPE nanofibers below 40 nm, being still composed of ≈70 wt.% of crystalline and ≈30 wt.% of amorphous components. Subsequently, these thinner fibers begin to melt and fragment because they are thinner and also because the amorphous defects locally decrease the nanofibers' melting temperature, which results in their fragmentation and partial loss of nanofibers. These phenomena limit the thickness of dis-UHMWPE nanofibers, and this explains why prolonged or more intense shearing does not lead to thinner nanofibers of dis-UHMWPE when compounded in a polymeric matrix.

Failure Analysis of Ultra-High Molecular Weight Polyethylene Tibial Insert in Total Knee Arthroplasty

Knee osteoarthritis is treated based on total knee arthroplasty (TKA) interventions. The most frequent failure cause identified in surgical practice is due to wear and oxidation processes of the prothesis' tibial insert. This component is usually manufactured from ultra-high molecular weight polyethylene (UHMWPE). To estimate the clinical complications related to a specific prosthesis design, we investigated four UHMWPE tibial inserts retrieved from patients from Clinical Hospital Colentina, Bucharest, Romania. For the initial analysis of the polyethylene degradation modes, macrophotography was chosen. A light stereomicroscope was used to estimate the structural performance and the implant surface degradation. Scanning electron microscopy confirmed the optical results and fulfilled the computation of the Hood index. The oxidation process in UHMWPE was analyzed based on Fourier-transform infrared spectroscopy (FTIR). The crystallinity degree and the oxidation index were computed in good agreement with the existing standards. Mechanical characterization was conducted based on the small punch test. The elastic modulus, initial peak load, ultimate load, and ultimate displacement were estimated. Based on the aforementioned experimental tests, a variation between 9 and 32 was found in the case of the Hood score. The oxidation index has a value of 1.33 for the reference sample and a maximum of 9.78 for a retrieved sample.

Processing and interpretation of core-electron XPS spectra of complex plasma-treated polyethylene-based surfaces using a theoretical peak model

Interpretation of X-ray photoelectron spectroscopy (XPS) spectra of complex material surfaces, such as those obtained after surface plasma treatment of polymers, is confined by the available references. The limited understanding of the chemical surface composition may impact the ability to determine suitable coupling chemistries used for surface decoration or assess surface-related properties like biocompatibility. In this work, XPS is used to investigate the chemical composition of various ultra-high-molecular-weight polyethylene (UHMWPE) surfaces. UHMWPE doped with α-tocopherol or functionalised by active screen plasma nitriding (ASPN) was investigated as a model system. Subsequently, a more complex combined system obtained by ASPN treatment of α-tocopherol doped UHMWPE was investigated. Through ab initio orbital calculations and by employing Koopmans' theorem, the core-electron binding energies (CEBEs) were evaluated for a substantial number of possible chemical functionalities positioned on PE-based model structures. The calculated ΔCEBEs showed to be in reasonable agreement with experimental reference data. The calculated ΔCEBEs were used to develop a material-specific peak model suitable for the interpretation of merged high-resolution C 1 s, N 1 s and O 1 s XPS spectra of PE-based materials. In contrast to conventional peak fitting, the presented approach allowed the distinction of functionality positioning (i.e. centred or end-chain) and evaluation of the long-range effects of the chemical functionalities on the PE carbon backbone. Altogether, a more detailed interpretation of the modified UHMWPE surfaces was achieved whilst reducing the need for manual input and personal bias introduced by the spectral analyst.

Analysis of Elastic Properties of Polypropylene Composite Materials with Ultra-High Molecular Weight Polyethylene Spherical Reinforcement

This study proposes an isotropic composite material with enhanced elastic properties based on a reinforcement mechanism using ultra-high molecular weight polyethylene (UHMWPE) spherical molecules. Elastic properties are predicted through finite element analysis by randomly mixing UHMWPE using polypropylene (PP) as a matrix. The change in elastic properties of the composite is calculated for volume fractions of UHMWPE from 10 to 70%. Furthermore, the results of finite element analysis are compared and analyzed using a numerical approach. The results show that the physical properties of the composite material are enhanced by the excellent elastic properties of the UHMWPE, and the finite element analysis results confirm that it is effective up to a volume fraction of 35%.

Discussion of Orientation and Performance of Crosslinked Ultrahigh-Molecular-Weight Polyethylene Used for Artificial Joints

Previously, the orientation structure of ultrahigh-molecular-weight polyethylene (UHMWPE) for artificial joints was considered to be unchanged after irradiation crosslinking. Therefore, much of the research related to the long-term failure of artificial joints has focused on material improvements. In this study, ultrasmall-angle X-ray scattering (USAXS) and the small/wide-angle X-ray scattering (SAXS-WAXS) combined technique reveal that the orientation structures of UHMWPE materials at all scales (nanoscale to microscale) are responsible for the long-term failure of artificial joints. To further illustrate the formation of these hierarchical oriented structures, a simple model is presented. In this model, first, the migration of free radicals plays a vital role, and the different steric hindrances in different directions directly lead to uneven migration behavior of free radicals. Second, the uneven migration of free radicals contributes to an inhomogeneous concentration of free radicals, thus resulting in observable crosslinking nonuniformities. Finally, all the hierarchical structural nonuniformities promote long-term failure of artificial joints after long-term wear.

Accelerated neutral atom beam (ANAB) modified polyethylene for decreased wear and reduced bacteria colonization: An in vitro study

Ultra-high molecular weight polyethylene (UHMWPE) model implants were modified using accelerated neutral atom beam (ANAB) technology and tested for in vitro wear properties and bacteria colonization. Material characterization studies using atomic force microscopy (AFM), surface energy, and in vitro protein adsorption events were also conducted to better understand the mechanism behind such wear properties and bacteria colonization. ANAB modified UHMWPE showed significantly reduced wear properties compared to controls due to nanostructured features, greater surface energy, and improved adsorption of lubricin, a synovial fluid lubricating protein. There was significantly greater adsorption of proteins known to reduce bacteria colonization (specifically, mucin, casein, and lubricin) after 4 h on UHMWPE after ANAB treatment. Such changes in initial protein events led to significantly decreased bacteria (including methicillin resistant Staph. aureus (or MRSA), Staph. aureus, E. coli, multi-drug resistant E. coli, Pseudomonas aeruginosa and Staph. epidermidis) colonization after 24 h without resorting to antibiotic use.

Probing lubricated sliding wear properties of HDPE/UHMWPE hybrid bionanocomposite

Ultra-high molecular weight polyethylene (UHMWPE) and its derivatives have been clinically used as an acetabular liner material in total hip joint replacement (THR) over last six decades. Despite significant efforts, the longevity of UHMWPE implants is still impaired due to their compromised tribological performance, leading to osteolysis and aseptic loosening. The present study aims to critically evaluate and analyze the tribological performance, of the next generation acetabular liner material, that is, a chemically modified graphene oxide (GO) reinforced HDPE/UHMWPE (HU) bionanocomposite (HUmGO), against stainless steel (SS 316L) counterface in lubricated conditions. This work also provides a performance comparative assessment of HUmGO with respect to medical grades, UHMWPE (UC) and crosslinked UHMWPE (XL-UC). Significant attempts have been made to correlate the tribological properties (frictional behavior, wear rate, wear debris shape and size, wear mechanism) with the physicomechanical conditions (contact stresses) at sliding contact and the variation in molecular architecture of different UHMWPE materials. Additionally, an emphasis is put forward to critically anlyze the nature of lubrication regime based on the bearing characterstic parameters. HUmGO exhibited a lower COF (0.07) and specific wear rate (2.86 × 10^-8 mm³/Nm) than UC and XL-UC under identical sliding conditions. The worn surfaces on HUmGO revealed the signatures of less abrasive wear and limited deformation. Based on the estimated lambda (λ) ratio and Sommerfield number, all the investigated sliding contacts exhibited boundary lubrication. Taken together, the modified GO reinforced HDPE/UHMWPE bionanocomposite can be considered as a new generation biomaterial for the fabrication of acetabular liner for hip-joint prosthesis.

3D Neuronal Cell Culture Modeling Based on Highly Porous Ultra-High Molecular Weight Polyethylene

Cell culturing methods in its classical 2D approach have limitations associated with altered cell morphology, gene expression patterns, migration, cell cycle and proliferation. Moreover, high throughput drug screening is mainly performed on 2D cell cultures which are physiologically far from proper cell functions resulting in inadequate hit-compounds which subsequently fail. A shift to 3D culturing protocols could solve issues with altered cell biochemistry and signaling which would lead to a proper recapitulation of physiological conditions in test systems. Here, we examined porous ultra-high molecular weight polyethylene (UHMWPE) as an inexpensive and robust material with varying pore sizes for cell culturing. We tested and developed culturing protocols for immortalized human neuroblastoma and primary mice hippocampal cells which resulted in high rate of cell penetration within one week of cultivation. UHMWPE was additionally functionalized with gelatin, poly-L-lysine, BSA and chitosan, resulting in increased cell penetrations of the material. We have also successfully traced GFP-tagged cells which were grown on a UHMWPE sample after one week from implantation into mice brain. Our findings highlight the importance of UHMWPE use as a 3D matrix and show new possibilities arising from the use of cheap and chemically homogeneous material for studying various types of cell-surface interactions further improving cell adhesion, viability and biocompatibility.

A Multi-Attribute Decision-Making Model for the Selection of Polymer-Based Biomaterial for Orthopedic Industrial Applications

The potential of quantifying the variations in IR active bands was explored while using the chemometric analysis of FTIR spectra for selecting orthopedic biomaterial of industrial scale i.e., ultra-high molecular weight PE (UHMWPE). The nano composites UHMWPE with multi-walled carbon nano-tubes (MWCNTs) and Mg-silicate were prepared and irradiated with 25 kGy and 50 kGy of gamma dose. Principal component analysis (PCA) revealed that first three principal components (PCs) are responsible for explaining the >99% of variance in FTIR data of UHMWPE on addition of fillers and/or irradiation. The factor loadings plots revealed that PC-1 was responsible for explaining the variance in polyethylene characteristics bands and the IR active region induced by fillers i.e., 440 cm−1, 456 cm−1, from 900−1200 cm−1, 1210 cm−1, 1596 cm−1, PC-2 was responsible for explaining the variance in spectra due to radiation-induced oxidation and cross linking, while the PC-3 is responsible for explaining the variance induced because of IR active bands of MWCNTs. Hierarchy cluster analysis (HCA) was employed to classify the samples into four clusters with respect to similarity in their IR active bands which is further confirmed by PCA. According to multi attribute analysis with PCA and HCA, 65 kGy irradiated sample is optimum choice from the existing alternatives in the group of irradiated pristine UHMWPE, UHMWPE/Mg-silicate irradiated with 25 kGy of gamma dose was the optimum choice for UHWMPE/Mg-silicate nano composites, and UHMWPE/γMWCNTs composites containing 1.0% dof γ MWCNTs for UHMWPE/MWCNTs nanocomposites, respectively. The results show the effectiveness of quantifying the variance for decision as far as optimization of biomaterials in orthopedic industrial applications is concerned.

Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials

PURPOSE

Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA.

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool.

RESULTS

Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05).

CONCLUSIONS

There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA.

LEVEL OF EVIDENCE

II.

Exosomes From Human Urine-Derived Stem Cells Encapsulated Into PLGA Nanoparticles for Therapy in Mice With Particulate Polyethylene-Induced Osteolysis

Background: Periprosthetic osteolysis is the primary reason for arthroplasty failure after total joint replacement because of the generation of wear particles and subsequent bone erosion around the prosthesis, which leads to aseptic loosening. Periprosthetic osteolysis is often treated with revision surgery because of the lack of effective therapeutic agents. As key messengers of intercellular interactions, exosomes can be independently used as therapeutic agents to promote tissue repair and regeneration. In this study, we fabricated poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) that carry exosomes derived from human urine stem cells (USC-Exos) and explored their effects on polyethylene-induced osteolysis. Methods: USCs were identified by multipotent differentiation and flow cytometry analyses. USC-Exos were isolated and identified by transmission electron microscopy (TEM), dynamic light scattering (DLS), and western blotting. PLGA microspheres containing USC-Exos were fabricated to synthesize NPs using the mechanical double-emulsion method. The obtained NPs were characterized in terms of stability, toxicity, exosome release, and cell uptake. Then, these NPs were implanted into the murine air pouch model, and their effects on polyethylene-induced osteolysis were evaluated by microcomputed tomography (micro-CT) and histological analyses. Results: The average NP diameter was ~282 ± 0.4 nm, and the zeta potential was -2.02 ± 0.03 mV. After long-term storage at room temperature and 4°C, the NP solution was stable without significant coaggregation. In vitro release profiles indicated sustained release of exosomes for 12 days. In vivo, injection of NPs into the murine air pouch caused less osteolysis than that of USC-Exos, and NPs significantly reduced bone absorption, as indicated by histology and micro-CT scanning. Conclusion: Our findings suggest that USC-Exo-based PLGA NPs can prevent particulate polyethylene-induced osteolysis and bone loss.

Structure and Performance Attributes Optimization and Ranking of Gamma Irradiated Polymer Hybrids for Industrial Application

The selection of suitable composite material for high-strength industrial applications, from the list of available alternatives, is a tedious task as it requires an optimized structural performance-based solution. This study aimed to optimize the concentration of fillers, i.e., vinyl tri-ethoxy silane and absorbed gamma-dose, to enhance the properties of an industrial scale polymer, i.e., ultra-high molecular weight polyethylene (UHMWPE). The UHMWPE hybrids, in addition to silane, were treated with (30, 65, and 100 kGy) gamma dose and then tested for ten application-specific structural and performance attributes. The relative importance of attributes based on an 11-point fuzzy conversation was used for establishing the material assessment graph and corresponding adjacency matrix. Afterwards, the normalized values of attributes were used to establish the decision matrix for each alternative. The normalization was performed after the identification of high obligatory valued (HOV) and low obligatory valued (LOV) attributes. After this, suitability index values (SIVs) were calculated for ranking the hybrids that revealed hybrids 65 kGy irradiated the hybrid as the best choice and ranked as first among the existing alternatives. The major responsible factors were higher oxidation strength, a dense cross-linking network, and elongation at break. The values of the aforementioned factors for 65 kGy irradiated hybrids were 0.24, 91, and 360 MPa, respectively, as opposed to 0.54, 75, and 324 MPa for 100 kGy irradiated hybrids, thus placing the latter in second place regarding higher values of Yield Strength and Young Modulus. Finally, it is believed that the reported results and proposed model in this study will improve preoperative planning as far as considering these hybrids for high-strength industrial applications including total joint arthroplasty, textile-machinery pickers, dump trucks lining ships, and harbors bumpers and sliding, etc.

Ultrahigh Molecular Weight Polyethylene Lamellar-Thin Framework on Square Meter Scale

A new member of low-dimensional structures with a high aspect ratio (LDHA) is introduced. For the first time, commodity polymer is processed into LDHA, which has long been stagnated by the lack of suitable processing techniques. The key to solve the current bottleneck is to overcome the trade-off between kinetic processability and thermodynamic stability. These two factors are both highly determined by intermolecular interaction level (IIL). Thus with a wide tuning range of IIL, ultrahigh molecular weight polyethylene (UHMWPE) is selected and investigated to break through the trade-off. Polymeric LDHA preparation needs both thinning and stiffening. By focusing on one then the other sequentially, they are realized simultaneously. Thus the over sixty-year-old material is finally thinned down by seven orders of magnitude into a 65.5 nm thick and 0.64 m² large lamellar-thin framework (LTF). LTF exhibits a series of exceptional properties such as over-95% transparency, and seven times higher specific strength referred to steel. For the first time, cryogenic electron microscopy (Cryo-EM) is utilized to observe commodity polymers directly. This new LDHA material is promising to expand the scale boundaries of both fundamental research and practical applications, not only for UHMWPE, but also for more commodity polymers to come.

Extracellular Vesicles from Human Urine-Derived Stem Cells Ameliorate Particulate Polyethylene-Induced Osteolysis

Purpose

Wear debris particle-induced periprosthetic osteolysis is a severe complication of total joint replacement that results in aseptic loosening and subsequent arthroplasty failure. No effective therapeutic agents or drugs have been approved to prevent or treat osteolysis; thus, revision surgery is often needed. Extracellular vesicles (EVs) are vital nanosized regulators of intercellular communication that can be directly applied to promote tissue repair and regeneration. In this study, we assessed the therapeutic potential of EVs from human urine-derived stem cells (USCs) (USC-EVs) in preventing ultrahigh-molecular-weight polyethylene (UHMWPE) particle-induced osteolysis.

Methods

USCs were characterized by measuring induced multipotent differentiation and flow cytometry. USC-EVs were isolated and characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS) and Western blotting. RAW264.7 cells and bone marrow mesenchymal stem cells (BMSCs) were cultured with USC-EVs to verify osteoclast differentiation and osteoblast formation, respectively, in vitro. The effects of USC-EVs were investigated on a UHMWPE particle-induced murine calvarial osteolysis model by assessing bone mass, the inflammatory reaction, and osteoblast and osteoclast formation.

Results

USCs differentiated into osteogenic, adipogenic and chondrogenic cells in vitro and were positive for CD44, CD73, CD29 and CD90 but negative for CD34 and CD45. USC-EVs exhibited a cup-like morphology with a double-layered membrane structure and were positive for CD63 and TSG101 and negative for calnexin. In vitro, USC-EVs promoted the osteogenic differentiation of BMSCs and reduced proinflammatory factor production and osteoclastic activity in RAW264.7 cells. In vivo, local injection of USC-EVs around the central sites of the calvaria decreased inflammatory cytokine generation and osteolysis compared with the control groups and significantly increased bone formation.

Conclusion

Based on our findings, USC-EVs prevent UHMWPE particle-induced osteolysis by decreasing inflammation, suppressing bone resorption and promoting bone formation.

Synergy between vitamin E and D-sorbitol in enhancing oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene

Oxidative stability of radiation crosslinked ultrahigh molecular weight polyethylene (UHMWPE) artificial joints is significantly improved by vitamin E (VE), but there is a dilemma that VE hinders crosslinking and thus jeopardizes the wear of UHMWPE. In this effort, we proposed an efficient strategy to stabilize UHMWPE under limited antioxidant contents, where VE and D-sorbitol (DS) were used as the primary antioxidant and the secondary antioxidant respectively. For non-irradiated blends with fixed antioxidant contents, oxidative stability accessed by oxidation induction time (OIT) of VE/DS/UHMWPE blends was superior to that of VE/UHMWPE blends, while DS/UHMWPE blends showed no increase in OIT. The cooperation between DS and VE exhibited a synergistic effect on enhancing the oxidative stability of UHMWPE. Interestingly, the irradiated VE/DS/UHMWPE blends showed comparable OIT but a significantly higher crosslink density than the irradiated VE/UHMWPE blends. The crystallinity, melting point, and in vitro biocompatibility of the blends were not affected by VE and DS. The quantitative relationships of mechanical properties, oxidation stability, crystallinity and crosslink density were established to unveil the correlation of these key factors. The overall properties of VE/UHMWPE and VE/DS/UHMWPE blends were compared to elucidate the superiority of the antioxidant compounding strategy. These findings provide a paradigm to break the trade-off between oxidative stability, crosslink density and mechanical properties, which is constructive to develop UHMWPE bearings with upgraded performance for total joint replacements. STATEMENT OF SIGNIFICANCE: VE-stabilized UHMWPE is the most commonly used material in total joint replacements at present. However, oxidation and wear resistance of VE/UHMWPE implants cannot be unified since VE reduces the efficiency of radiation crosslinking. It limits the use of VE. Herein, we proposed a compounding stabilization by the synergy between VE and DS. The antioxidation capability of VE was revived by DS, thus enhancing the oxidation stability of unirradiated UHMWPE. The irradiated VE/DS/UHMWPE exhibited similar oxidation stability but higher crosslink density than irradiated VE/UHMWPE, which is beneficial to combat wear of UHMWPE and to inhibit the occurrence of osteolysis. This synergistic antioxidation strategy endows the UHMWPE joint material with good overall performance, which is of clinical significance.

Simulation of Neutron/Self-Emitted Gamma Attenuation and Effects of Silane Surface Treatment on Mechanical and Wear Resistance Properties of Sm2O3/UHMWPE Composites

This work reports on the simulated neutron and self-emitted gamma attenuation of ultra-high-molecular-weight polyethylene (UHMWPE) composites containing varying Sm₂O₃ contents in the range 0–50 wt.%, using a simulation code, namely MCNP-PHITS. The neutron energy investigated was 0.025 eV (thermal neutrons), and the gamma energies were 0.334, 0.712, and 0.737 MeV. The results indicated that the abilities to attenuate thermal neutrons and gamma rays were noticeably enhanced with the addition of Sm₂O₃, as seen by the increases in µ_m and µ, and the decrease in HVL. By comparing the simulated neutron-shielding results from this work with those from a commercial 5%-borated PE, the recommended Sm₂O₃ content that attenuated thermal neutrons with equal efficiency to the commercial product was 11–13 wt.%. Furthermore, to practically improve surface compatibility between Sm₂O₃ and the UHMWPE matrix and, subsequently, the overall wear/mechanical properties of the composites, a silane coupling agent (KBE903) was used to treat the surfaces of Sm₂O₃ particles prior to the preparation of the Sm₂O₃/UHMWPE composites. The experimental results showed that the treatment of Sm₂O₃ particles with 5–10 pph KBE903 led to greater enhancements in the wear resistance and mechanical properties of the 25 wt.% Sm₂O₃/UHMWPE composites, evidenced by lower specific wear rates and lower coefficients of friction, as well as higher tensile strength, elongation at break, and surface hardness, compared to those without surface treatment and those treated with 20 pph KBE903. In conclusion, the overall results suggested that the addition of Sm₂O₃ in the UHMWPE composites enhanced abilities to attenuate not only thermal neutrons but also gamma rays emitted after the neutron absorption by Sm, while the silane surface treatment of Sm₂O₃, using KBE903, considerably improved the processability, wear resistance, and strength of the composites.

The Effect of Dialkyl Peroxide Crosslinking on the Properties of LLDPE and UHMWPE

Peroxide has been considered a chemical agent that can be used to tune the properties of polymeric materials. This research evaluated the influence of different concentrations of dialkyl peroxides on the mechanical, thermal, and morphological properties of linear low-density polyethylene (LLDPE) and ultra-high molecular weight polyethylene (UHMWPE). The neat polymer, as well as those with the addition of 1% and 2% by mass of dialkyl peroxides, were subjected to compression molding and immersion in water for 1 h, under controlled temperatures of 90 °C. The values of the gel content found in the samples indicated that the addition of peroxide to the LLDPE and to the UHMWPE promoted the formation of a reticulated network. The structure obtained by the crosslinking led to less reorganization of the chains during the crystallization process, resulting in the formation of imperfect crystals and, consequently, in the reduction in melting temperatures, crystallization and enthalpy. The mechanical properties were altered with the presence of the crosslinker. The polymers presented had predominant characteristics of a ductile material, with the occurrence of crazing with an increased peroxide content.

Simulation of Light Distribution in Gamma Irradiated UHMWPE Using Monte Carlo Model for Light (MCML) Transport in Turbid Media: Analysis for Industrial Scale Biomaterial Modifications

(1) Background: This study investigated the miscibility of carbon-based fillers within industrial scale polymers for the preparation of superior quality polymer composites. It focuses on finding the light distribution in gamma irradiated ultra-high molecular weight polyethylene (UHMWPE). (2) Methods: The Kubleka–Munk model (KMM) was used to extract the optical properties, i.e., absorption coefficients (μ_a) and scattering coefficients (μ_s). Samples amounting to 30 kGy and 100 kGy of irradiated (in the open air) UHMWPE from 630 nm to 800 nm were used for this purpose. Moreover, theoretical validation of experimental results was performed while using extracted optical properties as inputs for the Monte Carlo model of light transport (MCML) code. (3) Conclusions: The investigations revealed that there was a significant decrease in absorption and scattering coefficient (μ_a & μ_s) values with irradiation, and 30 kGy irradiated samples suffered more compared to 100 kGy irradiated samples. Furthermore, the simulation of light transport for 800 nm showed an increase in penetration depth for UHMWPE after gamma irradiation. The decrease in dimensionless transport albedo  μs(μa+μs) from 0.95 to 0.93 was considered responsible for this increase in photon absorption per unit area with irradiation. The report results are of particular importance when considering the light radiation (from 600 nm to 899 nm) for polyethylene modification and/or stabilization via enhancing the polyethylene chain mobility.