Ultra high molecular-weight polyethylene (UHMWPE) in total knee replacement: fabrication, sterilisation and wear

Blunn, Gordon; Preva, E. M. Brach del; Costa, Luigi; Fisher, John; Freeman, M. A. R.

doi:10.1302/0301-620x.84b7.13647

Cited by 35 publications

(8 citation statements)

References 28 publications

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“…We surmise that these manufacturers considered, as we do, that their expired implants were expendable, and thus only suitable for scientific study. Previous authors have cautioned surgeons to have a heightened awareness of the shelf life of UHMWPE components that were γ‐irradiated in air 2–4. The results of our study indicate that oxidation of UHMWPE during shelf storage also remains a clinically relevant concern for certain types of polymeric barrier packaging.…”

Section: Discussionmentioning

confidence: 66%

“…Oxidation and embrittlement of ultrahigh molecular weight polyethylene (UHMWPE) resulting from γ‐sterilization in air, followed by storage in air prior to implantation, has been associated with significant reduction of survivorship in unicondylar and total knee arthroplasty 1–4. The mechanism of UHMWPE oxidation, following radiation sterilization and storage in the presence of air, is now well understood, and begins with macroalkyl radical formation during irradiation 5, 6…”

Section: Introductionmentioning

confidence: 99%

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Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components

et al. 2006

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The packaging and chemical stability of both conventional and highly crosslinked polyethylene (PE) components available for clinical use in Italy were analyzed. A total of 100 sterilized PE components were entered by 18 orthopedic manufacturers into the study. Six of the manufacturers were Italian and the remaining were based in Europe or America. Hydroperoxide, oxidation, and trans-vinylene levels within the PE components were characterized using Fourier-transform infrared spectroscopy (FTIR). None of the 31 gas-sterilized components had detectable free radicals, hydroperoxide content, or oxidation. Among radiation-sterilized inserts, the highest oxidation and hydroperoxide levels were associated with gas-permeable and polymer-barrier packaging. To the authors' knowledge, this is the first study that relates elevated oxidation and hydroperoxide content in gamma-sterilized PE components to certain types of contemporary, polymeric barrier packaging.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components

et al. 2006

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“…The rationale for using vitamin E was twofold: improving oxidation resistance of irradiated UHMWPEs and improving the fatigue strength of irradiated UHMWPEs using an alternative to postirradiation melting [9,11,42,44,55,62,82].…”

Section: The Rationale For Using the Antioxidant Vitamin Ementioning

confidence: 99%

“…Oxidation and subsequent embrittlement of UHMWPE decrease the abrasive wear resistance and increase the wear debris associated with the polymer [9,27,28,49]. Radiation crosslinking of UHMWPE reduces wear in vitro [48,50,51,53] and in vivo [29,47] but also induces free radicals, which can cause oxidation.…”

Section: Introductionmentioning

confidence: 99%

Vitamin E-stabilized UHMWPE for Total Joint Implants: A Review

Bracco

Oral

2011

Clinical Orthopaedics &Amp; Related Research

256

162

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Background Osteolysis due to wear of UHMWPE limits the longevity of joint arthroplasty. Oxidative degradation of UHMWPE gamma-sterilized in air increases its wear while decreasing mechanical strength. Vitamin E stabilization of UHMWPE was proposed to improve oxidation resistance while maintaining wear resistance and fatigue strength. Questions/purposes We reviewed the preclinical research on the development and testing of vitamin E-stabilized UHMWPE with the following questions in mind: (1) What is the rationale behind protecting irradiated UHMWPE against oxidation by vitamin E? (2) What are the effects of vitamin E on the microstructure, tribologic, and mechanical properties of irradiated UHMWPE? (3) Is vitamin E expected to affect the periprosthetic tissue negatively? Methods We performed searches in PubMed, Scopus, and Science Citation Index to review the development of vitamin E-stabilized UHMWPEs and their feasibility as clinical implants.Results The rationale for using vitamin E in UHMWPE was twofold: improving oxidation resistance of irradiated UHMWPEs and fatigue strength of irradiated UHMWPEs with an alternative to postirradiation melting. Vitamin E-stabilized UHMWPE showed oxidation resistance superior to that of irradiated UHMWPEs with detectable residual free radicals. It showed equivalent wear and improved mechanical strength compared to irradiated and melted UHMWPE. The biocompatibility was confirmed by simulating elution, if any, of the antioxidant from implants.Conclusions Vitamin E-stabilized UHMWPE offers a joint arthroplasty technology with good mechanical, wear, and oxidation properties. Clinical Relevance Vitamin E-stabilized, irradiated UHMWPEs were recently introduced clinically. The rationale behind using vitamin E and in vitro tests comparing its performance to older materials are of great interest for improving longevity of joint arthroplasties.

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“…The development of novel formulations of UHMWPE to improve the mechanical properties and increase the lifespan of artificial joints is therefore essential. Gamma‐irradiation sterilization in air causes oxidative degradation and delamination of UHMWPE 1, 2. Because of the limitations of UHMWPE wear and delamination, a new generation of highly crosslinked UHMWPE (HXLPE) was introduced, which decreased free radicals within the polymer as a result of post‐irradiation melting techniques 3.…”

Section: Introductionmentioning

confidence: 99%

In vitro analysis of the cytotoxic and anti‐inflammatory effects of antioxidant compounds used as additives in ultra high‐molecular weight polyethylene in total joint replacement components

et al. 2012

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Ultra high-molecular weight polyethylene (UHMWPE) remains the most commonly used material in modern joint replacement prostheses. However, UHMWPE wear particles, formed as the bearing articulates, are one of the main factors leading to joint replacement failure via the induction of osteolysis and subsequent aseptic loosening. Previous studies have shown that the addition of antioxidants such as vitamin E to UHMWPE can improve wear resistance of the polymer and reduce oxidative fatigue. However, little is known regarding the biological consequences of such antioxidant chemicals. This study investigated the cytotoxic and anti-inflammatory effects of a variety of antioxidant compounds currently being tested experimentally for use in hip and knee prostheses, including nitroxides, hindered phenols, and lanthanides on U937 human histocyte cells and human peripheral blood mononuclear cells (PBMNCs) in vitro. After addition of the compounds, cell viability was determined by dose response cytotoxicity studies. Anti-inflammatory effects were determined by quantitation of TNF-α release in lipopolysaccharide (LPS)-stimulated cells. This study has shown that many of these compounds were cytotoxic to U937 cells and PBMNCs, at relatively low concentrations (micromolar), specifically the hindered phenol 3,5-di-tert-butyl-4-hydroxyhydrocinnamate (HPAO1), and the nitroxide 2,2,6,6-Tetramethylpiperidine 1-oxyl (TEMPO). Lanthanides were only cytotoxic at very high concentrations and were well tolerated by the cells at lower concentrations. Cytotoxic compounds also showed reduced anti-inflammatory effects, particularly in PBMNCs. Careful consideration should therefore be given to the use of any of these compounds as potential additives to UHMWPE. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 101B: 407–413, 2013.

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Ultra high molecular-weight polyethylene (UHMWPE) in total knee replacement: fabrication, sterilisation and wear

Cited by 35 publications

References 28 publications

Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components

Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components

Vitamin E-stabilized UHMWPE for Total Joint Implants: A Review

In vitro analysis of the cytotoxic and anti‐inflammatory effects of antioxidant compounds used as additives in ultra high‐molecular weight polyethylene in total joint replacement components

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