Recent updates for biomaterials used in total hip arthroplasty

Abstract

BackgroundTotal hip arthroplasty (THA) is probably one of the most successful surgical interventions performed in medicine. Through the revolution of hip arthroplasty by principles of low friction arthroplasty was introduced by Sir John Charnley in 1960s. Thereafter, new bearing materials, fixation methods, and new designs has been improved. The main concern regarding failure of THA has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. To resolve these problems, the materials of the modern THA were developed since then.MethodsA literature search strategy was conducted using various search terms in PUBMED. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included ‘total hip arthroplasty’, ‘biomaterials’, ‘stainless steel’, ‘cobalt-chromium’, ‘titanium’, ‘polyethylene’, and ‘ceramic’.ResultsThe initial search retrieved 6921 articles. Thirty-two articles were selected and used in the review.ConclusionThis article introduces biomaterials used in THA and discusses various bearing materials in currentclinical use in THA as well as the newer biomaterials which may even further decrease wear and improve THA survivorship.

Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head

“…Hypersensitivity reactions to debris generated from zirconia ceramic wear are likely multifactorial [3,34,54]. With an aging population that is living longer, THA is very common [8,15,34]. Zirconia exposure and sensitization may increase as indications for ceramic-on-polyethylene THA now includes a population that is more active and requiring THA at earlier ages [8,15,55].…”

“…With an aging population that is living longer, THA is very common [8,15,34]. Zirconia exposure and sensitization may increase as indications for ceramic-on-polyethylene THA now includes a population that is more active and requiring THA at earlier ages [8,15,55]. Until clinically validated preimplant and postimplant tests are available to determine the risk of hypersensitivity, it remains important to conduct a complete workup and to consider the diagnosis of a zirconia-induced hypersensitivity reaction.…”

“…The current thought behind delayed–type IV hypersensitivity reactions in arthroplasty involves a susceptible patient encountering inorganic or organic debris small enough to be phagocytized [ 40 ]. Wear debris is formed at prosthetic joint articulations, modular interfaces, and areas of impingement [ 15 ]. The particle debris then interacts with predominately Th1-type lymphocytes of immune system inciting an inflammatory cascade and creating ALTRs [ 34 , 38 , 41 ].…”

“…Hypersensitivity reactions in total joint arthroplasty were first recognized in 1966, and since then, more cases have been documented but remain unpredictable and poorly understood [9][10][11][12][13][14]. The literature does not definitively report the prevalence or resultant hypersensitivity to zirconia ceramics in THA, and to the best of our knowledge, this is the first reported case [15]. We present a case of delayed-type hypersensitivity reaction in a patient who underwent THA with a well-fixed ceramic-on-polyethylene implant, consisting of a modern ceramic femoral head made from alumina and zirconia.…”

Overview of sterilization methods for UHMWPE through surface analysis

“…19,20 In the last 10 years, a great number of failure reports involving polymeric pieces in arthroplasty applications have been published. 10,21,22 The main factor behind this is described as oxidative degradation of the material, induced by sterilization processes. [22][23][24][25] Overall, sterilization processes remain a major problem when it comes to the use of polymeric materials in biomedical applications, since the employed energy induces rapid aging, oxidation and other surface phenomena that lead to materials fragilization.…”