Polyethylene Wear in Knee Arthroplasty

Abstract

Polyethylene (PE) wear and osteolysis are common causes for late revisions of knee arthroplasties. Several implant and surgical factors have been implicated in contributing to the development of wear, such as type of bearing surface used, inaccurate articular geometry, and poor knee kinematics. In addition, patient-related factors, such as younger age and higher activity levels, may also contribute to wear. Our purpose was to evaluate and compare the effect of these variables on wear rates following knee arthroplasty. Recently, technological advancements have been aimed at reducing the incidence of wear by improving the PE manufacturing process, creating implants that minimize contact stresses, and refining our surgical techniques. Furthermore, the development of newer highly cross-linked PEs (HXLPEs) and the introduction of additives, such as vitamin E, to the PEs may improve overall implant survivorship. As a result, with the advent of newer implant and PE designs, wear is no longer the most common cause of early failure, though it remains an important factor in limiting long-term implant survivorship. However, there are a few clinical studies evaluating the long-term outcomes of newer HXLPEs and implant designs, with further evaluations necessary to determine the best implant-PE combination for improved knee arthroplasty survivorship.

Wear performance of multiwalled carbon nanotube‐reinforced ultra‐high molecular weight polyethylene composite

“…[2] It has been projected that this number will increase more than seven times to about 3.5 millions by 2030 only in the USA. [3][4][5][6][7] Long-term failure has been continually related to aseptic loosening which is the weakness of the bone and implant interface. [3][4][5][6][7] Long-term failure has been continually related to aseptic loosening which is the weakness of the bone and implant interface.…”

“…In spite of the improvement of the material and design of the inserts in recent years, wear debris generated from this component is an important factor that limits the longevity of total knee replacements (TKRs). Despite the fact that UHMWPE has been proven to be a good counterpart material when articulating against cobalt-chromium-molybdenum (Co-Cr-Mo) femoral components in TKRs, [4][5][6] the wear of these components and their eventual failure is expected because of the sliding and rotating movements of the femoral component against the bearing surface. [3,4,6] UHWMPE displays a very low friction coefficient, and it is widely used in the orthopedic field as a bearing surface in different artificial joints.…”

“…[4,6,9] Polyethylene wear is considered one of the main limitations for long-term success of total knee replacements. [4,5,8,10,12] Even though laboratory studies have achieved excellent results, clinical data are not yet available to assess the performance progress of UHMWPE. The performance of these components is usually affected by high creep damage and wear sustained by the polymeric material, especially when compared to metal and bone [4,6,11] According to S.M.…”

“…[1] Nonetheless, many malfunctions of current total knee replacements are related to the failure of the ultra-high molecular weight polyethylene (UHMWPE) tibial liner. [3][4][5][6][7] Long-term failure has been continually related to aseptic loosening which is the weakness of the bone and implant interface. Various factors can cause this failure such as patient activity level, surgical technique, implant material, and its design.…”

“…[4,6,[8][9][10][11] Because of its high wear resistance and high impact strength, this material remains the material of choice for the fabrication of articular tibial components. Despite the fact that UHMWPE has been proven to be a good counterpart material when articulating against cobalt-chromium-molybdenum (Co-Cr-Mo) femoral components in TKRs, [4][5][6] the wear of these components and their eventual failure is expected because of the sliding and rotating movements of the femoral component against the bearing surface. [4,6,9] Polyethylene wear is considered one of the main limitations for long-term success of total knee replacements.…”