Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty

Spece, Hannah; Schachtner, Jaclyn; MacDonald, Daniel W.; Klein, Gregg R.; Mont, Michael A.; Lee, Gwo Chin; Kurtz, Steven M.

doi:10.1016/j.arth.2019.07.018

Cited by 26 publications

(19 citation statements)

References 41 publications

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“…Nevertheless, it should be noted that wear is influenced not only by lubrication and load. Other factors such as oxidation [13], position of the knee axis of rotation [74], or implant instability [75] have to be taken into account. Notwithstanding, lubrication seems to be an important contributing factor, which definitely cannot be neglected.…”

Section: Discussionmentioning

confidence: 99%

“…In order to increase the life span, more tribological fine tuning might be helpful Joint surface wear has been studied in both THA [11] and in TKA [12]. Despite the fact that the basic typology of material damage is very similar [13], [14], [15], [16], there are obvious differences regarding wear rates [17]. Generally speaking, the wear performance of TKA depends on in vivo loading, design factors of the implant, and surgical and patient-specific factors.…”

Section: Introductionmentioning

confidence: 99%

“…Although, HXLPE liners exhibit lower wear rate in comparison to non-XLPE [22], this may not always translate into fewer particles in vivo [23]. Also, a detectable surface damage of retrieved HXLPE liners from aseptically failed TKAs has been observed [13], [24]. Finally, there is an uncertainty related to a reduced inflammatory and osteolytic potential of HXLPE particles [25], [26] despite that some studies report their decreased specific biological activity [27], [28].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Towards the understanding of lubrication mechanisms in total knee replacements – Part I: Experimental investigations

Nečas

Vrbka

Marian

et al. 2021

Tribology International

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Towards the understanding of lubrication mechanisms in total knee replacements – Part I: Experimental investigations

Nečas

Vrbka

Marian

et al. 2021

Tribology International

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“…The oxidation stability enhanced with the increasing EGCG concentration (Figure 2(b)). Considering the oxidation embrittlement occurred in clinical cases, the achievement to incorporate high concentration of EGCG could reduce the risk of oxidation‐induced implant failure, fulfilling the requirement of patients 4 …”

Section: Discussionmentioning

confidence: 99%

“…Ultrahigh molecular weight polyethylene (UHMWPE) has long been the key material as bearing surface in total joint replacement, mainly because of its excellent mechanical performance, durability, and biocompatibility 2,3 . Wear of UHMWPE bearings creates small debris that reacts with bone tissues to cause osteolysis, which is the severe factor in implant instability, infection, loosening and failure 4–7 . Crosslinking has been emerged as a procedure to substantially improve wear resistance and reduce wear‐related complications 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Ultrahigh molecular weight polyethylene with improved crosslink density, oxidation stability, and microbial inhibition by chemical crosslinking and tea polyphenols for total joint replacements

Shah

Ren

Lan

et al. 2021

J of Applied Polymer Sci

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Highly crosslinked ultrahigh molecular weight polyethylene (UHMWPE) stabilized by vitamin E (VE) is widely applied in artificial joints as the bearings. Despite the approval, there is a discord that VE lowers the crosslinking efficiency, limiting its use at high concentration. In this work, we aim to obtain highly crosslinked and oxidation resistant UHMWPE through the conjunction of tea polyphenol and chemical crosslinking. We hypothesized that highly incorporated tea polyphenol with multiple reactive sites can ameliorate crosslinking efficiency of chemical crosslinked UHMWPE in comparison to VE. Epigallocatechin gallate (EGCG) as representative tea polyphenol was incorporated into UHMWPE at high concentration (2–8 wt%), followed by chemical crosslinking with 2 wt% organic peroxide. Unlike VE/UHMWPE blends as the control, chemical crosslinking achieved an increasing trend in crosslink density of EGCG/UHMWPE blends with increasing antioxidant concentration. High concentration of EGCG also enhanced the oxidation stability of UHMWPE. Intriguingly, EGCG endowed UHMWPE with an excellent antimicrobial property, which was inefficient in VE/UHMWPE. Cell viability was hardly affected by the high loaded antioxidant and peroxide. The chemically crosslinked UHMWPE blended with EGCG is proved to be a reasonable, cost effective and realistic alternative for use in artificial joints.

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

et al. 2022

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Vitamin E (VE) is currently an approved antioxidant to improve the oxidation stability of highly crosslinked ultrahigh molecular weight polyethylene (UHMWPE) insert used commercially in total joint arthroplasty. However, the decrease in crosslink density caused by VE reduces wear resistance of UHMWPE, showing an uncoordinated challenge. In this work, we hypothesized that D-sorbitol (DS) as a secondary antioxidant can improve the antioxidant efficacy of VE on chemically crosslinked UHMWPE. The combined effect of VE and DS on oxidation stability of UHMWPE was investigated at a set of controlled hybrid antioxidant content. The hybrid antioxidant strategy showed significantly synergistic enhancement on the oxidation stability of chemically crosslinked UHMWPE compared with the single VE strategy. More strikingly, the crosslink density of the blends with hybrid antioxidants stayed at a high level since DS is not sensitive to crosslinking. The relationships between oxidation stability, mechanical properties, crosslink density, and crystallinity were investigated, by which the clinically relevant overall performance of UHMWPE was optimized. This work provides a leading-edge design mean for the development of joint bearings.

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Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty

Cited by 26 publications

References 41 publications

Towards the understanding of lubrication mechanisms in total knee replacements – Part I: Experimental investigations

Towards the understanding of lubrication mechanisms in total knee replacements – Part I: Experimental investigations

Ultrahigh molecular weight polyethylene with improved crosslink density, oxidation stability, and microbial inhibition by chemical crosslinking and tea polyphenols for total joint replacements

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

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