Effect of oxidation on delamination of ultrahigh-molecular-weight polyethylene tibial components

Bell, Carol; Walker, Peter S.; Abeysundera, M.; Simmons, Jonathan; King, Polly M.; Blunn, Gordon

doi:10.1016/s0883-5403(98)90173-5

Cited by 95 publications

(62 citation statements)

References 11 publications

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“…The effect of contact pressure on wear has been previously reported for unidirectional motion pin-on-plate studies [2] and the effect of conformity on surface area on wear has also been reported in the hip [26]. This approach to reducing surface wear by reducing conformity and wear area contradicts the thinking of the 1980s and 1990s [5,6,8,19] that led to more conforming designs in order to avoid the risk of delamination and fatigue following oxidative degradation. The conformity of fixed-bearing knee designs has generally increased over the last two decades, partly to address concerns over fatigue failure and delamination due to oxidative degradation of polyethylene.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, the failure of gamma-in-air sterilization polyethylene in knees was due to oxidative degradation, causing a reduction in mechanical properties and fatigue failure, which has been described as delamination wear [5,6,8,19]. Oxidative degradation also increases surface wear and osteolysis [7].…”

Section: Introductionmentioning

confidence: 99%

“…Oxidative degradation also increases surface wear and osteolysis [7]. It is important to differentiate the delamination wear mechanisms, which produce fatigue failure [6,19], from the surface wear mechanisms, which produce submicron-and nanometer-sized wear particles and result in long-term osteolysis [16,17,24]. Surface wear leading to the potential of osteolysis is considered the longer-term risk factor, particularly since increased kinematics with more active patients substantially increases wear rates and the total wear volume in fixed-bearing knees [4,22].…”

Section: Introductionmentioning

confidence: 99%

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2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees

Fisher

Jennings

Galvin

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Knee arthroplasties in young and active patients place a substantial increase in the lifetime tribological demand and potential for wear-induced osteolysis. Polyethylene materials have advanced in recent years, reducing the potential for oxidative degradation and delamination failure. It is timely to consider tribological design variables and their potential to reduce surface wear and the long-term risk of osteolysis. The influence of reduced cross shear in rotating platform mobile-bearing knee designs and reduced surface wear area in low conforming fixed-bearing knees has been investigated. A reduction in cross shear substantially reduced wear in both multidirectional pin-on-plate studies and in rotating platform mobile-bearing designs in knee simulator studies. A reduction in bearing surface contact area substantially reduced surface wear in multidirectional pin-on-plate simulations and in low conforming fixed-bearing knee designs in knee simulator studies. This offers potential for a paradigm shift in knee design predicated by enhanced mechanical properties of new polymer materials. We describe two distinct low-wearing tribological design solutions: (1) a rotating platform design solution with reduced cross shear provides reduced wear with conformity and intrinsic stability; and (2) a low conformity fixed bearing with reduced surface area, provides reduced wear, but has less intrinsic stability and requires good soft tissue function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees

Fisher

Jennings

Galvin

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…In particular, several retrieval studies published in the 1990s showed ethylene oxide gassterilized knee implants effectively eliminated delamination when compared with gamma-sterilized components [30,136,140], and these retrieval observations were subsequently confirmed in vitro by wear studies [11,116]. Furthermore, seminal work on the fatigue and fracture behavior of highly crosslinked and remelted UHMWPEs in the late 1990s raised questions about the suitability of these materials for knee arthroplasty as a result of the loss in mechanical properties with increasing doses of radiation [6,7].…”

Section: History and Development Of Hxlpementioning

confidence: 99%

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

Kurtz

Gawel

Patel

2011

Clinical Orthopaedics &Amp; Related Research

411

282

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Background Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective. Questions/purposes Literature on first-generation HXLPE was summarized. We systematically reviewed the radiographic wear data and incidence of osteolysis for HXLPE in hip and knee arthroplasty. Methods PubMed identified 391 studies; 28 met inclusion criteria for a weighted-averages analysis of two-dimensional femoral head penetration rates. To determine the incidence of osteolysis, we estimated a pooled odds ratio using a random-effects model.Results Weighted-averages analyses of femoral head penetration rates in HXLPE liners and conventional UHMWPE liners resulted, respectively, in a mean twodimensional linear penetration rate of 0.042 mm/year based on 28 studies (n = 1503 hips) and 0.137 mm/year based on 18 studies (n = 695 hips). The pooled odds ratio for the risk of osteolysis in HXLPE versus conventional liners was 0.13 (95% confidence interval, 0.06-0.27) among studies with minimum 5-year followup. We identified two clinical studies of HXLPE in TKA, preventing systematic analysis of outcomes. Conclusions HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter ([ 32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.

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“…The final shape is obtained by machining the material if it is not directly molded. The fact that the material resin is not perfectly compacted caused some controversy when fusion defects were identified, but subsequent studies could not establish that these defects play a deleterious role in (Li et al 1995, Sutula et al 1995, Bell et al 1998.…”

Section: Uhmwpe Oxidationmentioning

confidence: 99%