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García-Rey E, Saldaña L. Influence of highly cross-linked polyethylene manufacturing characteristics on femoral head penetration in total hip arthroplasty : a ten- to 22-year follow-up study. Bone Joint J 2025; 107-B:62-69. [PMID: 40306664 DOI: 10.1302/0301-620x.107b5.bjj-2024-1083.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Aims Highly cross-linked polyethylene (HXLPE) has reduced wear and revision rates in total hip arthroplasty (THA) in the long term. However, the effect of HXLPE manufacturing characteristics on femoral head penetration has not yet been clearly defined. We report this single-institution study to investigate the clinical and radiological results of various HXLPE liners in THA. Methods Between January 2001 and December 2013, 904 uncemented THAs using HXLPE liners were performed at our institution. Seven different HXLPE liner types were identified: remelted (n = 3), annealed (n = 2), sequentially annealed (n = 1), and vitamin E diffused (n = 1). A total of 746 hips were available for a minimum follow-up of ten years. The linear femoral head penetration rate was measured at six weeks and at one, five, ten, and 15 years, applying the Dorr criteria to digitized radiographs, using the Roman v. 1 70 software package for analysis. Results No patient was revised due to wear or osteolysis. The mean total femoral head penetration ten years after THA ranged from 0.14 mm (SD 0.06) to 0.20 mm (SD 0.17) for all groups (p = 0.649). Femoral head penetration > 0.40 mm at ten years was observed in 27 (3.6%) hips. From one to 15 years after surgery, mean total penetration was 0.21 mm (SD 0.13) in components with an acetabular inclination > 50° and 0.10 mm (SD 0.12) in those placed between 35° and 50° (p < 0.001). The radiological analysis did not detect osteolysis in any hip. Conclusion Although HXLPE characteristics can result in different wear performance in patients undergoing THA at a mean follow-up of 15 years, the clinical and radiological results were excellent in all groups. The position of the acetabular component can influence the femoral head penetration of modern HXLPEs.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz- IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Laura Saldaña
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz- IdiPAZ, Madrid, Spain
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Inverardi N, Serafim MF, Sekar A, Fujino K, Ferreira M, Marzouca A, Nagler E, Muratoglu OK, Oral E. Wear-resistant antibacterial UHMWPE-based implant materials obtained by radiation crosslinking. Biomater Sci 2025; 13:2422-2434. [PMID: 40131351 DOI: 10.1039/d4bm01663g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
The crosslinking of ultrahigh molecular weight polyethylenes (UHMWPEs) by irradiation has been employed for decades to enhance the wear resistance of these materials when used as a load-bearing implant component for joint arthroplasty. This surgical procedure can restore the mobility of patients affected by severe arthritis by the implantation of an artificial joint made of an articulating pair and a bearing component. While the surgery is usually successful, one of the most severe complications is peri-prosthetic joint infection (PJI), which can be extremely difficult to treat and eradicate. The use of UHMWPEs as a platform for the local delivery of antibiotics in addition to their structural function could be extremely beneficial for the improvement in the outcome of PJIs. In this study, we investigated whether irradiation can be used to sterilize and crosslink antibiotic-loaded UHMWPEs, and its effect on the drug eluting and antibacterial properties of these materials. We found that the antibiotics gentamicin sulfate and vancomycin hydrochloride were stable in irradiated UHMWPEs and did not hinder crosslinking of the UHMWPE matrix. Effective crosslinking led to optimal wear resistance, which was comparable to that of clinically available UHMWPEs. Sustained drug release was observed for an extended duration (up to six months) and both the drug eluents and eluted material surfaces showed antibacterial activity against Staphylococcus aureus, the most common causative bacterium for PJIs.
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Affiliation(s)
- Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Maria F Serafim
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Amita Sekar
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Keita Fujino
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Matheus Ferreira
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Anthony Marzouca
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Emma Nagler
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA
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Nepple CM, Blackburn AZ, Feder OI, Prasad AK, Bedair HS. Minimum 10-Y Follow-Up of Vitamin-E-Diffused Highly Crosslinked Polyethylene Liners in Total Hip Arthroplasty: A Comparative Evaluation From a Prospective, International, Multicenter Cohort Study. J Arthroplasty 2025; 40:718-724. [PMID: 39303910 DOI: 10.1016/j.arth.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a proven and effective treatment for end-stage osteoarthritis. The success of THA is due in part to highly crosslinked polyethylene (XL) implants. In 2007, a new generation of polyethylene liners entered clinical use. The new liners infused polyethylene with vitamin E and became vitamin E infused polyethylene (EP). The EP liner was hypothesized to prevent the loss of mechanical properties caused by oxidation, extending the lifetime of the implant. This international prospective study aimed to quantify the clinical outcomes of a 977 patient cohort receiving EP and XL liners 10 years after surgery. METHODS The prospective cohort study began in 2007, including eight countries and 17 centers. The final cohort included 977 patients (EP liner: n = 520; XL liner: n = 457). Patients were followed preoperatively, postoperatively, and at 1, 3, 5, 7, and 10 years. Each follow-up visit involved clinical evaluation, radiography, and survey collection. The demographics and revisions were also recorded. Mann-Whitney U tests were used to evaluate statistical differences. RESULTS At 10 years following surgery, 534 patients were eligible for follow-up. Of those eligible, 352 patients returned for clinical evaluation (65.9% eligible; 36.0% overall). No statistical differences were found (P > 0.05) in the demographics of the followed-up cohort. The linear wear rates were 0.00338 mm/year for EP liners and 0.0236 mm/year for XL liners using individual regression (P < 0.0001). No significant difference was observed in wear rates using cohort regression. Similarly, surveys suggested no significant outcomes between the EP and XL liner cohorts. The overall incidence of revision was 2.3% for EP and 2.0% for XL liners. CONCLUSIONS The EP liner demonstrated significantly lower wear than its XL counterparts at 10 years after implantation. Results are promising, as vitamin E polyethylene may improve the lifetime performance of THA implants and ensure that arthroplasty innovations reflect the changing patient population.
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Affiliation(s)
- Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Oren I Feder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Haefeli PC, Zwahlen ZM, Baumgärtner R, Link BC, Beck M. RM Pressfit vitamys: the 10-year follow-up. Hip Int 2025; 35:142-149. [PMID: 39772936 DOI: 10.1177/11207000241304659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
INTRODUCTION The RM Pressfit vitamys is an uncemented, titanium particle-coated, isoelastic monoblock cup made of vitamin E blended highly cross-linked polyethylene. We addressed the following questions: (1) What are the clinical and (2) radiographic outcomes 10 years after implantation? (3) What is the revision rate? METHODS In this prospective observational study in a tertiary care centre we investigated all consecutive cases of total hip replacement with the RM Pressfit vitamys cup between September 2009 and November 2011. It was implanted in 162 hips, 49.4% in women. The mean age was 67.2 years (standard deviation [SD] 9.5), and the mean BMI was 27.3 kg/m2 (SD 4.7). In 153 cases (94.4%), primary or secondary osteoarthritis was the diagnosis. We evaluated preoperative and follow-up data at 6 weeks, 1, 5, and 10 years. A modified Harris Hip Score (mHHS), pain and satisfaction on a visual analogue scale (VAS), radiographic evaluation, complications and revision rate were investigated. RESULTS At the 10-year follow-up (mean 120.5 months, SD 1.4, range 118-126), 99 hips were available for clinical and radiographic evaluation. (1) The mean mHHS was 94.8 (SD 9.9), rest pain 0.2 (SD 0.6), load pain 0.5 (SD 1.5), and satisfaction 9.5 (SD 1.1). The mean improvement as compared to preoperatively was +33.7 (SD 16.8), -3.3 (SD 2.7), -6.0 (SD 2.4) and +5.7 (SD 2.5), respectively. (2) In the radiographic evaluation, no loose cups, no acetabular lucent lines, or acetabular osteolysis were seen. (3) 2 cups were revised, both due to malpositioning. The 10-year cumulative revision rate was 2.0% (95%CI, 0.0-4.2%). The implant survival rate with aseptic loosening as endpoint was 100%. No adverse events were reported. CONCLUSIONS At the 10-year follow-up, the RM Pressfit vitamys cup still had promising results with good clinical and radiographic outcomes and a low revision rate.
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Affiliation(s)
- Pascal C Haefeli
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne, Switzerland
| | - Zinedine M Zwahlen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne, Switzerland
| | - Ralf Baumgärtner
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne, Switzerland
| | - Martin Beck
- Orthopaedic Clinic Lucerne, Lucerne, Switzerland
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Joyce TJ, Ouenzerfi G, Kandemir G, Trail I, Massardier V, Othmani R, Schroder AP, Granjon T, Hassler M, Trunfio-Sfarghiu AM. Significantly less wear of UHMWPE rubbing against pyrocarbon than against CoCr. J Mech Behav Biomed Mater 2024; 160:106768. [PMID: 39406038 DOI: 10.1016/j.jmbbm.2024.106768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/02/2024] [Accepted: 10/05/2024] [Indexed: 11/14/2024]
Abstract
The history of joint replacement can be framed as a battle to reduce wear. Pyrocarbon has been shown to be a low wear material, but can low wear against an ultra high molecular weight polyethylene (UHMWPE) counterface be achieved? To investigate this research question, a 50-station, clinically validated wear screening machine was used. Half the stations tested UHMWPE pins against pyrocarbon discs, and half the stations tested UHMWPE pins against cobalt chromium (CoCr) discs. The test rig ran at 1Hz, the nominal contact stress was 2.07 MPa, and testing ran to 5 million cycles. A biomimetic lubricant was used, it was replaced every 500,000 cycles. At the end of testing, the UHMWPE pins rubbing against pyrocarbon discs had a statistically significant reduced wear, compared with the UHMWPE pins rubbing against CoCr discs (p ≤ 0.01). Analysis of the discs at the end of testing showed greater adherence of phospholipids on the pyrocarbon discs than the CoCr discs. In turn, it was also seen that far less UHMWPE was attached to the pyrocarbon discs than to the CoCr discs. Based on this evidence, it is suggested that pyrocarbon surfaces are associated with reduced adhesive wear of UHMWPE compared with CoCr surfaces. In addition, at the end of testing, the CoCr discs were found to be significantly rougher than the pyrocarbon discs. Therefore, pyrocarbon maintained a smoother surface than CoCr, likely meaning that abrasive wear of UHMWPE was reduced compared with CoCr.
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Affiliation(s)
| | | | | | | | | | - Rayan Othmani
- Université Claude BERNARD LYON 1, ICBMS UMR-CNRS 5246, 69622, Villeurbanne, France
| | | | - Thierry Granjon
- Université Claude BERNARD LYON 1, ICBMS UMR-CNRS 5246, 69622, Villeurbanne, France
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Derr T, MacDonald DW, Malkani AL, Mont MA, Piuzzi NS, Kurtz SM. Oxidation and Damage Mechanisms of Second-Generation Highly Cross-Linked Polyethylene Tibial Inserts. J Arthroplasty 2024; 39:3084-3091. [PMID: 38906197 DOI: 10.1016/j.arth.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND After clinical introduction in 2005, sequentially annealed, highly cross-linked polyethylene (SA HXLPE) was studied for retrievals with short implantation times; however, long-term follow-ups are lacking. The objective of this study was to examine and compare the revision reasons, damage mechanisms, and oxidation indices of SA HXLPE and conventional gamma inert-sterilized (Gamma Inert) ultra-high-molecular-weight polyethylene tibial inserts implanted for >5 years. METHODS There were 74 total knee arthroplasty tibial inserts (46 SA HXLPEs, 28 Gamma Inerts) implanted for >5 years (mean 7 ± 2 years) retrieved as part of a multicenter retrieval program. Cruciate-retaining implants comprised 44% of the SA HXLPEs and 14% of the Gamma Inerts. Patient factors and revision reasons were collected from revision operating notes. A semiquantitative scoring method was used to assess surface damage mechanisms. Oxidation was measured using Fourier transform infrared microscopy according to American Society for Testing and Materials 2102. Differences between cohorts were assessed with Mann-Whitney U-tests. RESULTS Loosening (Gamma Inert: 17 of 28, SA HXLPE: 15 of 46) and instability (Gamma Inert: 6 of 28, SA HXLPE: 15 of 46) were the most common revision reasons for both cohorts. The most prevalent surface damage mechanisms were burnishing, pitting, and scratching, with burnishing of the condyles being higher in Gamma Inert components (P = .022). Mean oxidation was higher in the SA HXLPE inserts at the articulating surface (P = .002) and anterior-posterior faces (P = .023). No difference was observed at the backside surface (P = .060). CONCLUSIONS Revision reasons and surface damage mechanisms were comparable in the Gamma Inert and SA cohorts. Further studies are needed to continue to assess the in vivo damage and clinical relevance, if any, of oxidation in SA HXLPE over longer implantation times, particularly for implants implanted for more than 10 years.
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Affiliation(s)
- Tabitha Derr
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Michael A Mont
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Kurtz
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
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Nishimura M, Nakamura T, Nishida H, Misaki T, Aikawa T. In Vivo Oxidation and Wear in Remelted Highly Cross-Linked Polyethylene Liners Retrieved at a Minimum of 10 Years After Total Hip Arthroplasty. J Arthroplasty 2024; 39:3092-3096. [PMID: 38909854 DOI: 10.1016/j.arth.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND With the decreasing age threshold for patients undergoing total hip arthroplasty (THA), there is an escalating demand for enhanced polyethylene durability. Although reports assessing wear in remelted highly cross-linked polyethylene (HXLPE) through radiographic imaging exist, a consensus regarding its oxidation level is lacking. This study investigated the wear, oxidation levels, and degradation of remelted HXLPE that was retrieved at least 10 years after THA. METHODS Our analysis focused on 7 cases of melted HXLPE liners retrieved ≥10 years after THA. All patients were women, who had an average age of 64 ± 6.5 years at the initial operation, and the mean postoperative period after THA was 12 years and 11 months ±1 year and 5 months. The wear conditions were measured by matching the shape analysis data obtained from a coordinate-measuring machine with a spherical model. Fourier-transform infrared spectroscopy was used to study the oxidation of polyethylene, and the polyethylene structure was evaluated using scanning electron microscopy. RESULTS Osteolysis was not observed in any case on X-rays, computed tomography, or intraoperative findings during revision surgery. The average oxidation index (OI) of the sliding surface under load was 0.31 ± 0.22 in the 6 cases calculated after hexane treatment, and 0.69 for one case without hexane treatment. In the 6 cases calculated after hexane treatment, the average OI of the non-load-bearing sliding surface was 0.11 ± 0.20. Average wear values were 0.33 ± 0.11 mm at 45 degrees from the equatorial direction and 0.04 ± 0.07 mm in the opposite direction. The initial structure of the polyethylene was preserved at all sites with low oxidation levels; however, in one case with stem subsidence, morphological changes and a high OI were observed. CONCLUSIONS Long-term oxidation and wear of remelted HXLPE liners retrieved from THA patients were minimal.
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Affiliation(s)
- Manase Nishimura
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Takuya Nakamura
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Tomonori Misaki
- Department of Orthopaedic Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Takao Aikawa
- Department of Orthopaedic Surgery, Toyama Prefecture Central Hospital, Toyama, Japan
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Wahl P, Heuberger R, Pascucci A, Imwinkelried T, Fürstner M, Icken N, Schläppi M, Pourzal R, Gautier E. Correlation of cross-linking as measured by the trans-vinylene index and in vitro wear of polyethylene from various acetabular liner brands. Bone Joint Res 2024; 13:682-693. [PMID: 39588944 PMCID: PMC11590334 DOI: 10.1302/2046-3758.1311.bjr-2024-0203.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2024] Open
Abstract
Aims Highly cross-linked polyethylene (HXLPE) greatly reduces wear in total hip arthroplasty, compared to conventional polyethylene (CPE). Cross-linking is commonly achieved by irradiation. This study aimed to compare the degree of cross-linking and in vitro wear rates across a cohort of retrieved and unused polyethylene cups/liners from various brands. Methods Polyethylene acetabular cups/liners were collected at one centre from 1 April 2021 to 30 April 2022. The trans-vinylene index (TVI) and oxidation index (OI) were determined by Fourier-transform infrared spectrometry. Wear was measured using a pin-on-disk test. Results A total of 47 specimens from ten brands were included. The TVI was independent of time in vivo. A linear correlation (R2 = 0.995) was observed between the old and current TVI standards, except for vitamin E-containing polyethylene. The absorbed irradiation dose calculated from the TVI corresponded to product specifications for all but two products. For one electron beam-irradiated HXLPE, a mean dose of 241% (SD 18%) of specifications was determined. For another, gamma-irradiated HXLPE, a mean 41% (SD 13%) of specifications was determined. Lower wear was observed for higher TVI. Conclusion The TVI is a reliable measure of the absorbed irradiation dose and does not alter over time in vivo. The products of various brands differ by manufacturing details and consequently cross-linking characteristics. Absorption and penetration of electron radiation and gamma radiation differ, potentially leading to higher degrees of cross-linking for electron radiation. There is a non-linear, inverse correlation between TVI and in vitro wear. The wear resistance of the HXLPE with low TVI was reduced and more comparable to CPE.
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Affiliation(s)
- Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | | | - Andrea Pascucci
- RMS Foundation, Bettlach, Switzerland
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | | | - Markus Fürstner
- Division of Medical Radiation Physics and Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - Niels Icken
- Service for Radioprotection, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Michel Schläppi
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush Medical College, Chicago, Illinois, USA
| | - Emanuel Gautier
- Department of Orthopaedic Surgery, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
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Inverardi N, Lekkala S, Serafim MF, Sekar A, Wannomae KK, Micheli B, Bedair H, Muratoglu OK, Oral E. Diffusion doping of analgesics into UHMWPE for prophylactic pain management. J Mater Chem B 2024; 12:10332-10345. [PMID: 39192832 DOI: 10.1039/d4tb01050g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Pain management after total joint arthroplasty is often addressed by systemic delivery of opioids. Local delivery of non-opioid analgesic drugs directly in the joint space from the UHMWPE component of the prosthesis would be highly beneficial to increase the efficacy of the drugs, decreasing the overall side effects and the risk of opioid addiction. It has been shown that effective concentrations of local analgesics can be achieved by eluting from analgesic-blended UHMWPE; however, this approach is limited by the decrease in mechanical properties resulting from the extent of phase separation of the blended drugs from the polymeric matrix. Here we hypothesized that mechanical properties could be maintained by incorporating analgesics into solid form UHMWPE by diffusion as an alternative method. Lidocaine or bupivacaine were diffused in solid form UHMWPE with or without radiation crosslinking. The loaded drug content, the spatial distribution of the drugs and their chemical stability after doping were characterized by FTIR and NMR spectroscopy, respectively. Drug release kinetics, tensile mechanical properties and wear rates were assessed. The results showed that diffusion doping could be used as a promising method to obtain a therapeutic implant material without compromising its mechanical and structural integrity.
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Affiliation(s)
- Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Maria F Serafim
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Amita Sekar
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Keith K Wannomae
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Brad Micheli
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Hany Bedair
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
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10
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Callary SA, Sharma DK, D’Apollonio TM, Critchley O, Mercer G, Wilson C, Campbell DG. What is the Long-term Wear of a 5-Mrad Highly Crosslinked Polyethylene Liner? A 14-year RSA Study. Clin Orthop Relat Res 2024; 482:1789-1797. [PMID: 38546666 PMCID: PMC11419525 DOI: 10.1097/corr.0000000000003047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/27/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Lower doses of irradiation (≤ 5 Mrad) during the manufacture of highly crosslinked polyethylene acetabular liners may result in less crosslinking and an increased wear rate. Radiostereometric analysis (RSA) studies have found that wear of more highly irradiated highly crosslinked polyethylene liners (7 to 10 Mrad) decreases at longer-term follow-up compared with earlier reports of the same cohorts. Although wear of 5-Mrad irradiated liners appears to increase at midterm follow-up, it is unclear whether that remains true at longer follow-up. QUESTIONS/PURPOSES We asked: (1) In patients who underwent THA with a 5-Mrad highly crosslinked polyethylene liner, what is the wear rate evaluated with RSA during the first 14 years? (2) Does the wear rate decrease after 6 years in situ? METHODS This is a brief follow-up of prior RSA studies performed at 2 and 6 years. We prospectively reviewed the longer-term wear rate in 13 patients who underwent primary THAs with the same design of a 5-MRad irradiated crosslinked acetabular liner and a 28-mm cobalt-chromium articulation. Of the initial 30 patients who were enrolled, 13 (43%) were available at the 14-year timepoint; nine patients had died, 1 patient had withdrawn, 1 had an intraoperative fracture, 3 patients were too infirm to have radiographs, 2 had no baseline RSA radiographs, and 1 had poor-quality RSA images. Tantalum markers were inserted during surgery, and all patients had RSA radiographic examinations at 1 week, 6 months, and 1, 2, 6, and 14 years postoperatively. RESULTS The mean ± standard deviation proximal, 2D, and 3D wear rates calculated between 1 year and 14 years were 0.019 ± 0.013 mm, 0.022 ± 0.015 mm, and 0.025 ± 0.019 mm per year, respectively. No patient had proximal 2D or 3D wear rates exceeding 0.06 mm per year. An increasing wear rate over time was measured for proximal and 2D wear rates between 6 and 14 years (0.024 and 0.030 mm per year) compared with that between 1 and 6 years (0.008 and 0.010 mm per year; p = 0.03). CONCLUSION The proximal, 2D, and 3D wear of a highly crosslinked polyethylene liner produced using 5-Mrad radiation remains low in the longer-term. With the small numbers available in a long-term RSA study such as this, we confirmed that the wear rate did not decrease at longer-term follow-up, unlike previous RSA studies of more highly irradiated highly crosslinked polyethylene liners. Nevertheless, the wear rate remains very low and below the threshold typically associated with the development of osteolysis (0.1 mm/year of wear). This should provide assurance to orthopaedic surgeons monitoring patients with this 5-Mrad irradiated liner in situ, while providing useful information to manufacturers of future highly crosslinked polyethylene liners. LEVEL OF EVIDENCE Level IV therapeutic study.
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Affiliation(s)
- Stuart A. Callary
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Deepti K. Sharma
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Taisha M. D’Apollonio
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Owain Critchley
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Graham Mercer
- Department of Orthopaedics, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Christopher Wilson
- Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David G. Campbell
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia
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11
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Derr T, MacDonald DW, Malkani AL, Klein GR, Kurtz SM. Femoral Head Penetration Rates and Oxidation of Highly Cross-Linked Polyethylene Hip Liners Implanted More Than 10 Years. J Arthroplasty 2024; 39:S286-S291. [PMID: 38754708 DOI: 10.1016/j.arth.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) was introduced to improve wear in total hip arthroplasty, with manufacturers implementing different thermal treatments to reduce oxidation. It is important to understand how long-term time in vivo affects the wear of these materials. The purpose of this study was to investigate the wear and oxidative performance of first-generation HXLPE hip inserts implanted for greater than 10 years and compare annealed and remelted HXLPE formulations. METHODS There were 49 total hip arthroplasty liners retrieved during routine revision surgery as part of an institutional review board-approved implant retrieval program. Penetration rates for the liners were calculated as the difference between the thickness of the unloaded and loaded regions divided by implantation time. Oxidation indices for the rim, locking mechanism, articulating surface, and backside regions were measured using Fourier-transform infrared spectroscopy according to American Society for Testing and Materials 2102. Mann-Whitney U tests were used to determine the statistical difference between annealed and remelted components. RESULTS The cohort had an average implantation time of 13.1 ± 2.6 years for annealed and 12.1 ± 1.7 years for remelted components. The components were revised most often for polyethylene wear, instability, and loosening. The penetration rate averaged 0.0177 ± 0.014 mm/year for annealed components and 0.015 ± 0.022 mm/year for remelted components. Penetration rates did not differ between the remelted and annealed cohorts (P = .28). Oxidation indices were found to be significantly higher in the annealed cohort for all regions of interest (P < .001). CONCLUSIONS Oxidation was found to be higher in the annealed HXLPE; however, this does not seem to be associated with greater wear as we found the average penetration rates for the cohorts were low, and the penetration rates were similar between the annealed and remelted cohorts.
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Affiliation(s)
- Tabitha Derr
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Steven M Kurtz
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
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12
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Dorozhkin SV. Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications. JOURNAL OF COMPOSITES SCIENCE 2024; 8:218. [DOI: 10.3390/jcs8060218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.
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Affiliation(s)
- Sergey V. Dorozhkin
- Faculty of Physics, M.V. Lomonosov Moscow State University, Leninskie Gory 1-2, Moscow 119991, Russia
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13
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Lekkala S, Inverardi N, Grindy SC, Hugard S, Muratoglu OK, Oral E. Irradiation Behavior of Analgesic and Nonsteroidal Anti-Inflammatory Drug-Loaded UHMWPE for Joint Replacement. Biomacromolecules 2024; 25:2312-2322. [PMID: 38456765 DOI: 10.1021/acs.biomac.3c01179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Local delivery of pain medication can be a beneficial strategy to address pain management after joint replacement, as it can decrease systemic opioid usage, leading to less side and long-term effects. In this study, we used ultrahigh molecular weight polyethylene (UHMWPE), commonly employed as a bearing material for joint implants, to deliver a wide set of analgesics and the nonsteroidal anti-inflammatory drug tolfenamic acid. We blended the drugs with UHMWPE and processed the blend by compression molding and sterilization by low-dose gamma irradiation. We studied the chemical stability of the eluted drugs, drug elution, tensile properties, and wear resistance of the polymer blends before and after sterilization. The incorporation of bupivacaine hydrochloride and tolfenamic acid in UHMWPE resulted in either single- or dual-drug loaded materials that can be sterilized by gamma irradiation. These compositions were found to be promising for the development of clinically relevant drug-eluting implants for joint replacement.
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Affiliation(s)
- Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Nicoletta Inverardi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Scott C Grindy
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Shannon Hugard
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts 02114, United States
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14
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Six WR, Koenraadt-van Oost I, van Boekel LC, Bolder SBT. Polyethylene thickness does not influence aseptic revision rate with highly cross-linked liners in THA with 36-mm femoral heads. Hip Int 2024; 34:181-186. [PMID: 37661691 DOI: 10.1177/11207000231196141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND To reduce the risk of dislocation, larger head size can be used in total hip arthroplasty (THA). However, larger head size leads to thinner acetabular liners. With conventional polyethylene, thickness of >8 mm has been advocated to reduce stress and wear rate of the polyethylene. Modern polyethylene has become more wear-resistant. In this study, we investigated if the thickness of sequentially cross-linked polyethylene (XLPE) liners is associated with failure of THA in the medium term. PATIENTS AND METHODS 3654 THAs were included (2009-2016), in which THA was performed with a XLPE liner in combination with a 36-mm femoral head. Patient and surgical characteristics were collected. We compared implant survival of THA with thin liners (<7.9 mm) and thick liners (⩾7.9 mm) with a Kaplan Meier survival analysis at 5 years, median follow-up and 10 years of follow-up with and point aseptic loosening and performed a multivariate analysis to estimate hazard ratios (HR). RESULTS Median follow-up was 7.7 years (IQR 5.6-9.8). In total, 179 revision procedures were performed, where 82 revisions (46%) were performed for aseptic loosening. The survival rate at 5 years, median and 10 years of follow-up showed no statistically significant difference in implant survival. The survival rate at 10 years follow-up was for thin liners 97.1% (95% CI, 96.3-97.9) and for thick liners 98.2% (95% CI, 97.4-99.0) in the aseptic loosening group (chi-square 2.55; p = 0.11).The adjusted HR for thick liners (⩾7.9 mm) was 0.65 (95% CI, 0.38-1.08) compared with the thin liners (<7.9 mm), which was not significantly different. CONCLUSIONS From this single-centre retrospective study it appears that thinner polyethylene liners are well tolerated when using second-generation highly cross-linked polyethylene. Thickness of the XLPE liners did not influence the risk of aseptic loosening of the implants in the medium term.
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Affiliation(s)
- Willem R Six
- Amphia Ziekenhuis, Breda, North Brabant, The Netherlands
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15
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Parilla FW, Youngman TR, Layon DR, Ince DC, Pashos GE, Maloney WJ, Clohisy JC. Excellent 20-Year Results of Total Hip Arthroplasty With Highly Cross-Linked Polyethylene on Cobalt-Chromium Femoral Heads in Patients ≤50 Years. J Arthroplasty 2024; 39:409-415. [PMID: 37572728 DOI: 10.1016/j.arth.2023.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) acetabular bearing surfaces have appeared to offer excellent wear resistance, low incidence of wear-related osteolysis, and high implant survivorship at 10-year to 15-year follow-up. However, concerns over potential performance deterioration at longer-term follow-up remain - particularly in younger patients - and outcome data into the third decade have not been available. METHODS We retrospectively assessed 62 patients (68 hips) who underwent primary total hip arthroplasty (THA) at age ≤50 years with a single manufacturer's cementless components, remelted HXLPE liner, and small diameter (26 and 28 millimeter) cobalt-chromium (CoCr) femoral heads at minimum 18-year follow-up. We assessed clinical outcomes (modified Harris Hip score, University of California Los Angeles Activity Score, polyethylene wear rates, radiographic findings (osteolysis, component loosening), and implant survivorship. RESULTS At 20.6-year mean follow-up (range, 18 to 23 years) modified Harris Hip scores for surviving hips remained an average of 41 points above preoperative baseline (49 versus 90, P < .001) and UCLA scores 2.8 points above baseline (3.7 versus 6.4, P < .001). Wear analysis revealed a population linear wear rate of 0.0142 mm/y (standard deviation (SD), 0.0471) and volumetric wear rate of 10.14 mm3/y (SD, 23.41). Acetabular lysis was noted in 2 asymptomatic hips at 16.6 and 18.4 years. No components were radiographically loose. Survivorship free from wear-related revision was 100% at 20 years (97% free from any revision). CONCLUSION The HXLPE-CoCr bearing couple with small femoral heads continues to be extremely effective 20 years after primary THA in the younger patient population.
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Affiliation(s)
- Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tyler R Youngman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel R Layon
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Deniz C Ince
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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16
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Sathishkumar S, Paulraj J, Chakraborti P, Muthuraj M. Comprehensive Review on Biomaterials and Their Inherent Behaviors for Hip Repair Applications. ACS APPLIED BIO MATERIALS 2023; 6:4439-4464. [PMID: 37871169 DOI: 10.1021/acsabm.3c00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Developing biomaterials for hip prostheses is challenging and requires dedicated attention from researchers. Hip replacement is an inevitable and remarkable orthopedic therapy for enhancing the quality of patient life for those who have arthritis as well as trauma. Generally, five types of hip replacement procedures are successfully performed in the current medical market: total hip replacements, hip resurfacing, hemiarthroplasty, bipolar, and dual mobility systems. The average life span of artificial hip joints is about 15 years, and several studies have been conducted over the last 60 years to improve the performance and thereby increase the lifespan of artificial hip joints. Present-day prosthetic hip joints are linked to the wide availability of biomaterials. Metals, ceramics, and polymers are some of the most promising types of biomaterials; nevertheless, each biomaterial has advantages and disadvantages. Metals and ceramics fail in most applications owing to stress shielding and the emission of wear debris; ongoing research is being carried out to find a remedy to these unfavorable responses. Recent research found that polymers and composites based on polymers are significant alternative materials for artificial joints. With growing research and several biomaterials, recent reviews lag in effectively addressing hip implant materials' individual mechanical, tribological, and physiological behaviors. This Review comprehensively investigates the historical evolution of artificial hip replacement procedures and related biomaterials' mechanical, tribological, and biological characteristics. In addition, the most recent advances are also discussed to stimulate and guide future researchers as they seek more effective methods and synthesis of innovative biomaterials for hip arthroplasty application.
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17
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Collins AK, Sauder N, Nepple CM, Blackburn AZ, Prasad AK, Feder OI, Melnic CM, Bedair HS. Minimum 7-Year Follow-Up of Vitamin E-Diffused and Highly Cross-Linked Polyethylene Liners in Total Hip Arthroplasty: Findings From a Prospective, International, Multicenter Study of 977 Patients. J Arthroplasty 2023; 38:2373-2378. [PMID: 37207702 DOI: 10.1016/j.arth.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (VEPE) acetabular liners for total hip arthroplasty (THA) have shown favorable results in small cohort studies. However, larger studies are warranted to compare its performance to highly cross-linked polyethylene (XLPE) and demonstrate clinical significance in 10-year arthroplasty outcomes. This study compared acetabular liner wear and patient-reported outcome measures (PROMs) between patients treated with VEPE and XLPE liners in a prospective, international, multicenter study with minimum 7-year follow-up. METHODS A total of 977 patients (17 centers; 8 countries) were enrolled from 2007 to 2012. The centers were randomly assigned to implants. At 1-year, 3-year, 5-year, and 7-year postoperative visits, radiographs, PROMs, and incidence of revision were collected. Acetabular liner wear was calculated using computer-assisted vector analysis of serial radiographs. General health, disease progression, and treatment satisfaction reported by patients were scored using 5 validated surveys and compared using Mann-Whitney U tests. At 7 years, 75.4% of eligible patients submitted data. RESULTS The mean acetabular liner wear rate was -0.009 mm/y and 0.024 mm/y for the VEPE and XLPE group, respectively (P = .01). There were no statistically significant differences in PROMs. The overall revision incidence was 1.8% (n = 18). The revision incidence in VEPE and XLPE cohorts were 1.92% (n = 10) versus 1.75% (n = 8), respectively. CONCLUSION We found that VEPE acetabular liners in total hip arthroplasty led to no significant clinical difference in 7-year outcomes as measured by acetabular liner wear rate, PROMs, and revision rate. While VEPE liners showed less wear, the wear rate for both the VEPE and XLPE liners was below the threshold for osteolysis. Therefore, the difference in liner wear may indicate comparative clinical performance at 7 years, as further indicated by the lack of difference in PROMs and the low revision incidence.
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Affiliation(s)
- Austin K Collins
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Nicholas Sauder
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Cecilia M Nepple
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Oren I Feder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
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18
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Torno V, Soares P. Tribological behavior and wear mechanisms of dental resin composites with different polymeric matrices. J Mech Behav Biomed Mater 2023; 144:105962. [PMID: 37393888 DOI: 10.1016/j.jmbbm.2023.105962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
The aim of this study was to investigate the effect of different polymeric matrices and their crosslink density on the mechanical and tribological properties of three commercially available dental resin composites, including Filtek Z250XT, Charisma Classic, and Venus Diamond One. The mechanical properties of the composites were investigated by instrumented indentation. The results showed that the polymeric matrix composition has a significant effect on the hardness and elastic modulus of the resins. Wear resistance was investigated by reciprocating ball-on-plane tests in artificial saliva. Results show that the TCD-based resin composite has higher crosslinking density resulting in a more wear-resistant material. There was also a strong correlation between wear resistance and the mechanical properties of the resin composites when comparing similar fillers. These findings suggest that the wear resistance of resin composites can be improved by increasing their crosslinking density and enhancing their mechanical properties. The study provides insights into the design and development of more wear-resistant resin composites for dental applications.
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Affiliation(s)
- Vladja Torno
- Mechanical Engineering, Polytechnic School, Pontificia Universidade Católica do Paraná, Curitiba - Brazil.
| | - Paulo Soares
- Mechanical Engineering, Polytechnic School, Pontificia Universidade Católica do Paraná, Curitiba - Brazil.
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19
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Alpkaya AT, Mihcin S. Dynamic computational wear model of PEEK-on-XLPE bearing couple in total hip replacements. Med Eng Phys 2023:104006. [PMID: 37308373 DOI: 10.1016/j.medengphy.2023.104006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023]
Abstract
Understanding wear mechanisms is a key factor to prevent primary failures causing revision surgery in total hip replacement (THR) applications. This study introduces a wear prediction model of (Polyetheretherketone) PEEK-on-XLPE (cross-linked polyethylene) bearing couple utilized to investigate the wear mechanism under 3D-gait cycle loading over 5 million cycles (Mc). A 32-mm PEEK femoral head and 4-mm thick XLPE bearing liner with a 3-mm PEEK shell are modeled in a 3D explicit finite element modeling (FEM) program. The volumetric and linear wear rates of XLPE liner per every million cycles were predicted as 1.965 mm3/Mc, and 0.0032 mm/Mc respectively. These results are consistent with the literature. PEEK-on-XLPE bearing couple exhibits a promising wear performance used in THR application. The wear pattern evolution of the model is similar to that of conventional polyethylene liners. Therefore, PEEK could be proposed as an alternative material to the CoCr head, especially used in XLPE-bearing couples. The wear prediction model could be utilized to improve the design parameters with the aim of prolonging the life span of hip implants.
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Affiliation(s)
| | - Senay Mihcin
- Mechanical Engineering Department, Izmir Institute of Technology, Izmir, Turkey.
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20
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Joukar A, Creecy A, Karnik S, Noori-Dokht H, Trippel SB, Wallace JM, Wagner DR. Correlation analysis of cartilage wear with biochemical composition, viscoelastic properties and friction. J Mech Behav Biomed Mater 2023; 142:105827. [PMID: 37060715 PMCID: PMC10175217 DOI: 10.1016/j.jmbbm.2023.105827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 04/08/2023]
Abstract
Healthy articular cartilage exhibits remarkable resistance to wear, sustaining mechanical loads and relative motion for decades. However, tissues that replace or repair cartilage defects are much less long lasting. Better information on the compositional and material characteristics that contribute to the wear resistance of healthy cartilage could help guide strategies to replace and repair degenerated tissue. The main objective of this study was to assess the relationship between wear of healthy articular cartilage, its biochemical composition, and its viscoelastic material properties. The correlation of these factors with the coefficient of friction during the wear test was also evaluated. Viscoelastic properties of healthy bovine cartilage were determined via stress relaxation indentation. The same specimens underwent an accelerated, in vitro wear test, and the amount of glycosaminoglycans (GAGs) and collagen released during the wear test were considered measures of wear. The frictional response during the wear test was also recorded. The GAG, collagen and water content and the concentration of the enzymatic collagen crosslink pyridinoline were quantified in tissue that was adjacent to each wear test specimen. Finally, correlation analysis was performed to identify potential relationships between wear characteristics of healthy articular cartilage with its composition, viscoelastic material properties and friction. The findings suggest that stiffer cartilage with higher GAG, collagen and water content has a higher wear resistance. Enzymatic collagen crosslinks also enhance the wear resistance of the collagen network. The parameters of wear, composition, and mechanical stiffness of cartilage were all correlated with one another, suggesting that they are interrelated. However, friction was largely independent of these in this study. The results identify characteristics of healthy articular cartilage that contribute to its remarkable wear resistance. These data may be useful for guiding techniques to restore, regenerate, and stabilize cartilage tissue.
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Affiliation(s)
- Amin Joukar
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, 47907, USA; Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Amy Creecy
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sonali Karnik
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Hessam Noori-Dokht
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, 47907, USA; Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Stephen B Trippel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Joseph M Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Diane R Wagner
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA; Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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21
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Ebramzadeh E. Don't Throw the Baby Out with the Bathwater: Commentary on an article by Barbara H. Currier, MChE, et al.: "Oxidation in Retrieved, Never-Irradiated UHMWPE Bearings. What Can We Learn About in Vivo Oxidation?". J Bone Joint Surg Am 2023; 105:e14. [PMID: 36790394 DOI: 10.2106/jbjs.22.01261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, California
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22
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Kump J, Teeter MG, Matheson J, Klassen R, Lanting BA, Decker MM. The impact of free-radical stabilization techniques on in vivo subsurface mechanical properties in highly cross-linked polyethylene acetabular liners. J Orthop Res 2023. [PMID: 36601654 DOI: 10.1002/jor.25502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Abstract
Highly cross-linked polyethylene (HXLPE) for total hip arthroplasty was developed to improve wear resistance in vivo and associated complications in comparison to ultrahigh molecular weight polyethylene. This material typically goes through various free-radical stabilization techniques by remelting, single-annealing, or sequentially annealing the polyethylene to improve in vivo oxidation and wear properties. The purpose of this study is to determine if there is evidence of subsurface microhardness changes in retrieved HXLPE liner at the rim and articular subsurface after extended in vivo time that could be associated with oxidation and its effects on mechanical properties and implant integrity. Retrieved HXLPE liners were chosen based on peak subsurface Fourier transform infrared spectroscopy oxidation values. Each was mechanically tested for subsurface microhardness at both the rim and articular surface using a validated microindentation technique. Rim testing demonstrated a decrease in mechanical integrity that corresponded to higher subsurface oxidation values regardless of the free-radical stabilization technique. At the articular surface, a decrease in mechanical integrity was observed near the surface corresponding to peak oxidation and Vicker's hardness, which decreased with increasing depths. This was found in all groups, with the exception of the single-annealed liners, which demonstrated decreased mechanical integrity trends at greater depths between 1.0 and 2.0 mm. Our results suggest that subsurface mechanical properties do change in vivo for certain implants. Though it is likely that the mechanical failures are multifactorial, we have shown that mechanical property degradation of HXLPE liners does occur with long-term in vivo exposure and should be considered a possible risk factor.
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Affiliation(s)
- Jordan Kump
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, London, Canada.,Western University, Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - John Matheson
- Division of Orthopaedic Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert Klassen
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Michael M Decker
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
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23
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Wahl P, Mossu-Haas C, Dommann-Scherrer C, Wei K, Eschbach L, Gehr P, Benninger E. Early failure of a highly cross-linked polyethylene inlay after total hip arthroplasty probably due to insufficient irradiation. Proc Inst Mech Eng H 2022; 236:1711-1719. [DOI: 10.1177/09544119221130673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Highly cross-linked polyethylene (XLPE) is a major advance in total hip arthroplasty (THA), as it suffers from less wear and thus is associated with lower revision rates than standard ultra-high molecular weight polyethylene. Early failures are reported rarely, and associated with specific design or manufacturing issues. We report a case requiring early revision due to adverse reaction to polyethylene particles. Investigations identified insufficient irradiation as the most probable cause of failure. Here are reported the features of a clinical case with determination of the material properties of the retrieved XLPE liner and establishment of the appropriate calibration curves as reference. Periprosthetic joint infection could be ruled out with appropriate sampling as cause for the inflammatory periarticular tumour. Histology identified a massive macrophagic reaction to micrometric polyethylene particles. No component malposition was present, nor any third-body wear. The trans-vinylene index (TVI) indicated insufficient and potentially detrimental irradiation of the polyethylene, while gel content, crystallinity, melting temperature and oxidation index remained within expected ranges. Histologically proven failure of a XLPE THA liner was identifiable despite correct implantation of the components. The cause of failure most probably was an inadequate irradiation, as indicated by determination of the TVI. This case underscores the importance of histologic workup even in aseptic revisions, and of detailed analysis of retrievals. The calibration curves provided are essential for analysis of other retrievals.
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Affiliation(s)
- Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | | | - Kongchang Wei
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | | | - Peter Gehr
- Institute of Anatomy, University of Berne, Berne, Switzerland
| | - Emanuel Benninger
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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24
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Yoon BH, Park JW, Lee YK, Koo KH, Chang CB. Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty: A Meta-Analysis. J Arthroplasty 2022; 37:2308-2315.e2. [PMID: 35568139 DOI: 10.1016/j.arth.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE. METHODS We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication. RESULTS Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively. CONCLUSION The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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25
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Otten V, Wästerlund D, Lindbjörn J, Mertens C, Mukka S, Crnalic S, Nilsson KG. Evaluation of a new cemented highly cross-linked all-polyethylene cup: a prospective and randomised study assessing wear and fixation characteristics using radiostereometric analysis. Hip Int 2022; 32:779-786. [PMID: 33566703 PMCID: PMC9726741 DOI: 10.1177/1120700021989991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this prospective, randomised and controlled study was to evaluate the wear and fixation properties of a new cemented highly cross-linked all-polyethylene (HXLPE) cup in comparison with a conventional cemented ultra-high molecular weight polyethylene (ConvPE) cup using radiostereometric analysis (RSA). PATIENTS AND METHODS A total of 58 patients (58 hips) with primary osteoarthritis (OA) were enrolled in a randomised controlled trial to receive either a ConvPE cup (control) or HXLPE cup (intervention) with identical geometry. The subjects were randomised in a 1:1 ratio. The primary endpoint was proximal wear measured as femoral head penetration into the cup, secondary outcomes were 3D-wear and annual proximal wear from 1 to 5 years. Cup fixation was measured as movement of the cup in relation to the acetabular bone with proximal migration being the primary outcome measure, 3D-migration and change in inclination as secondary outcomes. The patients were followed for 5 years with RSA performed postoperatively, at 3, 12, 24, and 60 months. RESULTS The HXLPE displayed a lower median proximal femoral head penetration compared to ConvPE, with a median difference at 2 years of -0.07 mm (95% CI, -0.10 to -0.04 mm), and -0.19 mm (95% CI, -0.27 to -0.15 mm) at 5 years. Annual proximal wear between 1 and 5 years was 0.03 mm/year for HXLPE and 0.06 mm/year for ConvPE (mean difference 0.05 mm, [95% CI, 0.03-0.07 mm]). Proximal migration, 3D migration and change in inclination was numerically slightly higher for HXLPE, albeit not statistically significant. CONCLUSIONS Compared to ConvPE, the HXLPE cup displayed significantly lower polyethylene wear. Cup migration was not statistically significant different. CLINICALTRIALS.GOV IDENTIFIER NCT04322799.
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Affiliation(s)
| | | | | | | | | | | | - Kjell G Nilsson
- Kjell G Nilsson, Orthopaedics, Department of Surgical and Perioperative Sciences, Umeå University, Umeå 90185, Sweden.
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26
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CORR Insights®: No Reduction in Revision Risk Associated With Highly Cross-linked Polyethylene With or Without Antioxidants Over Conventional Polyethylene in TKA: An Analysis From the American Joint Replacement Registry. Clin Orthop Relat Res 2022; 480:1937-1939. [PMID: 36006667 PMCID: PMC9473755 DOI: 10.1097/corr.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 01/31/2023]
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27
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García-Rey E, Cruz-Pardos A, Saldaña L. New polyethylenes in total hip arthroplasty : a 20- to 22-year follow-up study. Bone Joint J 2022; 104-B:1032-1038. [PMID: 36047028 DOI: 10.1302/0301-620x.104b9.bjj-2022-0434.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade. METHODS Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package. RESULTS In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group. CONCLUSION The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J 2022;104-B(9):1032-1038.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain.,Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain
| | - Ana Cruz-Pardos
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
| | - Laura Saldaña
- Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain.,Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
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28
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Zeng S, Li Q, Liu H, Zhang Q, Wang K. Influence of crystallinity on wear behavior of ultrahigh molecular weight polyethylene and the wear mechanism. JOURNAL OF POLYMER ENGINEERING 2022. [DOI: 10.1515/polyeng-2022-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In this paper, the crystallinity (X
c) of ultra-high molecular weight polyethylene (UHMWPE) parts was adjusted within a wide range from 40 to 60%, and the influence of X
c on wear performance and its relevant mechanism were surveyed. The volume wear rate of UHMWPE parts continuously decreased with increasing X
c. Structural characterization revealed that the closely packing crystalline structure composed of high X
c and large-size lamellae improves resistance to plastic deformation, which is responsible for excellent anti-wear performance. The efficiency of improving the wear resistance by high X
c is comparable with the traditional method of irradiation-induced crosslink. But the latter may severely harm the anti-oxidation capacity. So, increasing X
c is a promising candidate to develop high-performance UHMWPE materials with superior wear resistance.
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Affiliation(s)
- Sixue Zeng
- College of Polymer Science and Engineering, Sichuan University , Chengdu 610065 , P. R. China
| | - Quan Li
- College of Polymer Science and Engineering, Sichuan University , Chengdu 610065 , P. R. China
| | - Huixuan Liu
- College of Polymer Science and Engineering, Sichuan University , Chengdu 610065 , P. R. China
| | - Qin Zhang
- College of Polymer Science and Engineering, Sichuan University , Chengdu 610065 , P. R. China
| | - Ke Wang
- College of Polymer Science and Engineering, Sichuan University , Chengdu 610065 , P. R. China
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29
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Salipas A, Poole AS, Teeter MG, Somerville LE, Naudie DD, McCalden RW. A Ten-Year Radiostereometric Analysis of Polyethylene Wear Between Oxidized Zirconium and Cobalt Chrome Articulations in Total Hip Arthroplasty. J Arthroplasty 2022; 37:S692-S696. [PMID: 35245689 DOI: 10.1016/j.arth.2022.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oxidized zirconium (OxZi) femoral heads combine the decreased abrasive properties of ceramics with the toughness of metal alloys to lower wear and increase the durability of total hip arthroplasty. The purpose of this study was to compare the 10-year polyethylene wear rates between OxZi/XLPE and cobalt chrome (CoCr)/XLPE articulations. METHODS A radiostereometric analysis (RSA) was performed on two cohorts of 23 patients who underwent total hip arthroplasty using either OxZi/XLPE or CoCr/XLPE at a minimum of 10-year follow-up. Cohorts were matched for age, gender, body mass index (BMI), and diagnosis. Polyethylene wear was measured using RSA to determine total and steady-state wear rates for both cohorts. Preoperative and postoperative patient-reported outcome measures (SF12, HHS, and Western Ontario and McMaster Universities Arthritis Index scores) were compared. RESULTS The mean total head penetration rate was found to be statistically different between the entire cohorts (OxZi 0.048 ± 0.021 mm/y, CoCr 0.035 ± 0.017 mm/y, P = .02) but not when 28-mm heads only (OxZi 0.045 ± 0.016 mm/y, CoCr 0.034 ± 0.017 mm/y, P = .066) were directly compared. The mean steady-state wear rate was not significantly different between the entire cohorts (OxZi 0.031 ± 0.021 mm/y, CoCr 0.024 ± 0.019 mm/y, P = .24) or 28-mm head cohorts (OxZi 0.028 ± 0.019 mm/y, CoCr 0.024 ± 0.019 mm/y, P = .574). Outcome measures showed no statistical difference except for the Harris Hip Score where the OxZi cohort demonstrated higher median scores. CONCLUSION Using RSA to evaluate the 10-year in-vivo head penetration, there was no statistically significant difference in steady-state wear rates between OxZi and CoCr articulations. Both bearing combinations demonstrated wear rates well below the threshold for osteolysis.
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Affiliation(s)
- Andrew Salipas
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Andrew S Poole
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Lyndsay E Somerville
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Douglas D Naudie
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
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30
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Pre-operative templating in THA using a short stem system: precision and accuracy of 2D versus 3D planning method. J Orthop Traumatol 2022; 23:16. [PMID: 35318558 PMCID: PMC8941012 DOI: 10.1186/s10195-022-00634-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background Total hip arthroplasty (THA) is the most successful orthopaedic surgery of the past century. The current study aimed to compare the accuracy of digital planning using 2D versus 3D templating. Materials and methods Ninety-five THAs in 90 patients were included in the current study. Pre- and post-operative X-rays (in two planes) and low-dose rotation computed tomography scans from hip to foot were performed. Paired t-test and regression analyses were conducted to compare 2D and 3D templating accuracy of the definitive implant. Results Cup size planned both with 2D (p < 0.0001) and 3D (p = 0.012) templating was significantly different from the definitively used cup size. The difference between the 2D-planned and implanted stem size (p < 0.0001) was statistically significant. In contrast, there were no significant differences in the 3D-planned and implanted stem size (p = 0.181). Three-dimensional templating showed significantly higher accuracy than 2D templating in terms of cup size (1.1 ± 1.4 versus 1.7 ± 1.8; p = 0.007) and stem size (0.3 ± 0.6 versus 0.7 ± 0.7; p < 0.0001). With increasing body mass index (BMI), 2D templating of the stem became more inaccurate (p = 0.041). Remarkably, 3D templating remained accurate for all components (stem, p = 0.533; cup, p = 0.479) despite increasing BMI. Conclusion Despite extended planning time and increased exposure to radiation, 3D-based planning showed higher accuracy than 2D templating, especially in obese patients. On the basis of our results, we believe that 3D-based pre-operative planning in THA is justifiable and beneficial in patients with increased BMI. Level of Evidence III.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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31
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Ebramzadeh E. CORR Insights®: A Modeling Study of a Patient-specific Safe Zone for THA: Calculation, Validation, and Key Factors Based on Standing and Sitting Sagittal Pelvic Tilt. Clin Orthop Relat Res 2022; 480:206-208. [PMID: 34525000 PMCID: PMC8673973 DOI: 10.1097/corr.0000000000001976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Edward Ebramzadeh
- Director, The J. Vernon Luck Sr. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA Department of Orthopaedic Surgery, Los Angeles, CA, USA
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32
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Rowell SL, Reyes CR, Hopper RH, Engh CA, Muratoglu OK. Do total hip arthroplasty polyethylene liners without free radicals oxidize in vivo or ex vivo? J Biomed Mater Res B Appl Biomater 2021; 110:1113-1119. [PMID: 34894062 DOI: 10.1002/jbm.b.34985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/15/2021] [Accepted: 11/13/2021] [Indexed: 11/08/2022]
Abstract
Crosslinking substantially reduces the wear of ultra-high molecular weight polyethylene (UHMWPE) used in total hip arthroplasty (THA) but some reports have indicated that first generation liners manufactured without antioxidants may be vulnerable to in vivo oxidation. This study evaluated maximum oxidation using Fourier transform infrared spectroscopy per ASTM F2102-06ε1 and linear head penetration using a coordinate measuring machine among 66 revision-retrieved THA components with in vivo durations ranging from 0.02 to 24.6 years. These included 30 liners crosslinked with 5 Mrad of gamma radiation and then melted, 13 non-crosslinked, never-irradiated liners sterilized with gas plasma and 23 non-crosslinked, never-irradiated liners sterilized with ethylene oxide. All liners were vacuum-sealed and stored at -20°C prior to analysis with the exception of three retrievals of each material type that were stored in air for 9.9 to 21.5 years. All 57 vacuum-sealed and frozen retrievals demonstrated good oxidative stability with maximum oxidation indices (OIs) less than 1.0 and 75% (43/57) of these liners had maximum OIs less than 0.1. Linear penetration measurements were lower in the crosslinked liners compared to non-crosslinked retrievals. Although instances of oxidation and embrittlement were found after ex vivo storage in air among liners that did not have free radicals at the time of implantation, in vivo oxidation does not appear to be a clinical concern through the first decade of service for crosslinked liners and at up to 25 years after surgery for non-crosslinked liners.
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Affiliation(s)
- Shannon L Rowell
- Harris Orthopaedics Laboratory at Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher R Reyes
- Harris Orthopaedics Laboratory at Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
| | - Charles A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA.,Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia, USA
| | - Orhun K Muratoglu
- Harris Orthopaedics Laboratory at Massachusetts General Hospital, Boston, Massachusetts, USA
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Sequentially Irradiated and Annealed Highly Cross-Linked Polyethylene: Linear Vector and Volumetric Wear in Total Hip Arthroplasty at 10 Years. Arthroplast Today 2021; 11:140-145. [PMID: 34541267 PMCID: PMC8435938 DOI: 10.1016/j.artd.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background There is a paucity of data on the long-term performance of highly cross-linked polyethylene (HXLPE). Therefore, this study evaluated 10-year 1) functional, 2) radiographic, and 3) surgical outcomes in patients who underwent total hip arthroplasty with sequentially irradiated and annealed HXLPE. Methods A retrospective, multicenter study was conducted on patients who underwent primary total hip arthroplasty and received HXLPE polymer (n = 151). Two-dimensional radiographic linear and volumetric wear analyses were quantified using the Martell Hip Analysis software, while functional outcomes were assessed by analyzing postoperative Short-Form-12 (SF-12) Physical and Mental Health Surveys and Harris Hip Scores. Radiographic outcomes included yearly linear (mm/y) and volumetric (mm3/y) wear rates. Surgical outcomes included additional operations and survivorship. Results SF-12 scores were within 1 standard deviation (SD) of the normal population (SF-12 Physical: 47.0; SF-12 Mental: 52.0), while the Harris Hip Scores of 89.5 was borderline between “good” and “excellent.” Total and annual linear wear rates were 0.164 mm (SD: 0.199 mm) and 0.015 mm/y (SD: 0.018 mm/y), respectively. The mean total volumetric wear rate was 141.4 mm3 (SD: 165.0) and 12.6 mm3/y (SD: 14.9 mm3/y) when broken down into a yearly rate. Eleven patients required revisions, resulting in an all-cause polyethylene survivorship of 92.7%, with a polyethylene wear survivorship of 100.0%. Conclusions Our results demonstrate clinically undetectable linear and volumetric wear rates after 10 years in those who received the unique sequentially irradiated and annealed HXLPE. Furthermore, high rates of survivorship coupled with low all-cause revision rates illustrate the polymers' capability to potentially increase implant longevity.
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Elbardesy H, Yadav H, Rabea M, Guerin S, Harty J. Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials. SICOT J 2021; 7:47. [PMID: 34515633 PMCID: PMC8436949 DOI: 10.1051/sicotj/2021045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear? PATIENTS AND METHODS We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty. RESULTS We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group. CONCLUSIONS In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Himanshu Yadav
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Mohamed Rabea
- Faculty of Pharmacy, Mansoura University, Mansoura 32216, Egypt
| | - Shane Guerin
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - James Harty
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
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35
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Nayak C, Balani K. Effects of reinforcements and
gamma‐irradiation
on wear performance of
ultra‐high
molecular weight polyethylene as acetabular cup liner in
hip‐joint
arthroplasty: A review. J Appl Polym Sci 2021. [DOI: 10.1002/app.51275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Chinmayee Nayak
- Department of Materials Science and Engineering Indian Institute of Technology Kanpur India
| | - Kantesh Balani
- Department of Materials Science and Engineering Indian Institute of Technology Kanpur India
- Advanced Centre for Materials Science Indian Institute of Technology Kanpur India
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Hemmilä M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Pamilo K, Mäkelä KT. Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register. Acta Orthop 2021; 92:316-322. [PMID: 33517823 PMCID: PMC8231410 DOI: 10.1080/17453674.2021.1879513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA.Patients and methods - We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups.Results - The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9-94.9] and 93% [CI 91.9-93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4-1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6-99.4) and for the reference group 99% (CI 98.7-99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7-2.5]).Interpretation - After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners.
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Affiliation(s)
- Matias Hemmilä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku; ,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | - Markus Matilainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu;
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
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37
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Medley JB. Highly cross‐linked polyethylene is the new ‘gold standard’ bearing material for total hip arthroplasty. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- John B. Medley
- Department of Mechanical and Mechatronics Engineering University of Waterloo Waterloo Ontario Canada
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38
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Prock-Gibbs H, Pumilia CA, Meckmongkol T, Lovejoy J, Mumith A, Coathup M. Incidence of Osteolysis and Aseptic Loosening Following Metal-on-Highly Cross-Linked Polyethylene Hip Arthroplasty: A Systematic Review of Studies with Up to 15-Year Follow-up. J Bone Joint Surg Am 2021; 103:728-740. [PMID: 33411465 DOI: 10.2106/jbjs.20.01086] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation. METHODS Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up. RESULTS Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed. CONCLUSIONS Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Teerin Meckmongkol
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - John Lovejoy
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - Aadil Mumith
- College of Medicine, University of Central Florida, Orlando, Florida.,Department of Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom
| | - Melanie Coathup
- College of Medicine, University of Central Florida, Orlando, Florida
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39
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Parekh A, Sood A, Monsef JB, Hamouda M, Hussain A, Gonzalez M. Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty. JBJS Rev 2021; 9:e20.00065. [PMID: 33982980 DOI: 10.2106/jbjs.rvw.20.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amit Parekh
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Jad Bou Monsef
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
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40
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Zaribaf FP, Hassuji TA, Cookson AN, Gill HS, Pegg EC. A practical model of the diffusion of oil‐based fluid into polyethylene. J Appl Polym Sci 2021. [DOI: 10.1002/app.50028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fedra P. Zaribaf
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Tahir A. Hassuji
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Andrew N. Cookson
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Harinderjit S. Gill
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
| | - Elise C. Pegg
- Centre for Therapeutic Innovation and Department of Mechanical Engineering University of Bath Bath UK
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41
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Minimum 10-Year Follow-Up of Cementless Total Hip Arthroplasty With a 32-mm Cobalt-Chromium Head on Highly Cross-Linked Polyethylene and a Tapered, Fiber Metal Proximally Coated Femoral Stem. J Arthroplasty 2021; 36:647-652. [PMID: 32950339 DOI: 10.1016/j.arth.2020.08.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The clinical and radiographic results of cementless total hip arthroplasty using a 32-mm cobalt-chromium head on remelted highly cross-linked polyethylene (HXLPE) and a tapered, fiber metal proximally coated femoral stem were evaluated at a mean follow-up of 12 years. METHODS A total of 57 cementless total hip arthroplasties using remelted HXLPE combined with a 32-mm cobalt-chromium head, and a tapered, fiber metal proximally coated femoral stem were performed from October 2004 to December 2006. Clinical evaluation was performed using the Merle d'Aubigné and Postel scoring system. Standardized anteroposterior and lateral radiographs of the pelvis and femur without weight-bearing were analyzed. Radiographic measurements of two-dimensional femoral head penetration into the polyethylene were performed with a computerized method. The steady-state wear rates were measured based on the radiographs from the first year after surgery to the final follow-up. RESULTS The mean Merle d'Aubigné and Postel score improved significantly from 10.7 points preoperatively to 15.6 postoperatively (P < .001). No osteolysis was found around the implant. Stem fixation in all cases showed stable bone ingrowth. Third-degree stress shielding was found in 46% of all stems. The total head penetration rate was 0.05 mm/y, and the steady-state wear rate was 0.01 mm/y. The Kaplan-Meier survivorship with the end point of revision was 95% (95% confidence interval, 85%-98%) at 12 years. CONCLUSION A 32-mm cobalt-chromium head on remelted HXLPE demonstrated low wear properties, and a tapered, fiber metal proximally coated femoral stem showed good results at long-term follow-up.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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42
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Thirteen-year results of cementless total hip arthroplasty with zirconia heads on highly cross-linked polyethylene. Mod Rheumatol 2020; 31:1045-1049. [PMID: 33153348 DOI: 10.1080/14397595.2020.1847753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Zirconia ceramic was introduced for femoral heads because of its mechanical strength and fracture toughness. Highly cross-linked polyethylene has been shown to achieve wear reduction compared to conventional polyethylene. The purpose of this study was to investigate the long-term results of cementless total hip arthroplasty with zirconia femoral heads on highly cross-linked polyethylene. METHODS Radiographic measurements of two-dimensional femoral head penetration into the polyethylene were performed with a computerized method (PolyWare) in 93 hips at a mean follow-up of 13 years. The steady-state wear rates were measured based on the radiographs from the first year after surgery to the final follow-up. RESULTS The mean Merle d'Aubigné and Postel score had improved significantly from 10.9 points preoperatively to 15.3 postoperatively (p < 0.001). Osteolysis was not found around the implant, and no zirconia heads had fractures. The total head penetration rate was 0.04 mm/year, and the steady-state wear rate was 0.02 mm/year. Kaplan-Meier survivorship with the endpoint of revision was 97% (95% confidence interval [CI], 92% to 99%) at 10 years. CONCLUSION Zirconia on highly cross-linked polyethylene demonstrated extremely low wear properties at long-term follow-up.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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43
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Comparison of macro-, micro- and nanomechanical properties of clinically-relevant UHMWPE formulations. J Mech Behav Biomed Mater 2020; 120:104205. [PMID: 34058599 DOI: 10.1016/j.jmbbm.2020.104205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
We characterized a set of eleven clinically relevant formulations of UHMWPE for total joint replacements. Although their molecular and supermolecular structure were quite similar as evidenced by IR, DSC and SAXS measurements, there were slight differences in their crystallinity (DSC crystallinity ranging from 52 to 61%), which were connected with processing conditions, such as the total radiation dose, thermal treatment and/or addition of biocompatible stabilizers. Mechanical properties were assessed at all length scales, using macroscale compression testing, non-instrumented and instrumented microindentation hardness testing (at loading forces ~500 mN), and nanoindentation hardness testing measured at both higher and lower loading (~4 mN and ~0.6 mN, respectively). In agreement with theoretical predictions, we found linear correlations between UHMWPE crystallinity and its stiffness-related properties (elastic moduli, yield stress, and hardness) at all length scales (macro-, micro- and nanoscale). Detailed statistical evaluation of our dataset showed that the accuracy and precision of the applied methods decreased in the following order: non-instrumented microindentation ≥ instrumented microindentation ≥ macromechanical properties ≥ nanoindentation measured at higher loading forces ≫ nanoindentation measured at lower loading forces. The results confirm that microindentation and nanoindentation at sufficiently high loading forces are reliable methods, suitable for UHMWPE characterization.
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44
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Ors-Unsal A, Archodoulaki VM. Comparison of In-Vivo Performance Characteristics of First-Generation and Second-Generation Cross-Linked and Conventional Explants. J Arthroplasty 2020; 35:3330-3337. [PMID: 32631726 DOI: 10.1016/j.arth.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Implants made of ultra high molecular weight polyethylene (UHMWPE) has been used for almost 60 years in hip joint arthroplasty as articulating surface. UHMWPE implants have evolved over time from conventional to cross-linked implants. Chemical, morphologic, and micromechanical characteristics play important roles in overall in vivo performance. METHODS This study aimed at comparing chemical, morphologic, and micromechanical in vivo performance characteristics of conventional and cross-linked explants. Optical damage scoring, Fourier transform infrared spectroscopy, differential scanning calorimetry, and depth sensing indentation techniques were used for the measurements. The measurement results were used to correlate oxidation index, degree of crystallinity, E-Modulus, and hardness. RESULTS Different manufacturing processes directly affect implants' in vivo performance. Conventional explants are more susceptible to oxidation in the absence of thermal treatment and air ambient gamma irradiation sterilization, whereas they have higher degree of crystallinity and E-Modulus values. Introduction of a thermal treatment step to first-generation cross-linked explants has decreased the oxidation susceptibility but degraded the crystalline structure however, such explants manufactured with moderate total cross-linking irradiation dose and a combination of both remelting and annealing thermal treatment methods are the exceptions. The second-generation cross-linked explants in general have much better E-Modulus, that is, hardness values over all other types of explants and are least susceptible to oxidation. CONCLUSION The results suggest that in vivo performances of explants could benefit from the hybrid UHMWPE implant manufacturing techniques, such as moderate cross-linking irradiation doses, remelting, followed by annealing and ethylene oxide or gas plasma sterilization.
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Affiliation(s)
- Aysenur Ors-Unsal
- Research Unit of Polymers and Composites, Faculty of Mechanical and Industrial Engineering, Institute of Materials Science and Technology, Vienna University of Technology, Vienna, Austria
| | - Vasiliki-Maria Archodoulaki
- Research Unit of Polymers and Composites, Faculty of Mechanical and Industrial Engineering, Institute of Materials Science and Technology, Vienna University of Technology, Vienna, Austria
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45
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van Loon J, Hoornenborg D, Sierevelt I, Opdam KTM, Kerkhoffs GMMJ, Haverkamp D. Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial. World J Orthop 2020; 11:442-452. [PMID: 33134107 PMCID: PMC7582113 DOI: 10.5312/wjo.v11.i10.442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polyethylene (PE) particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty (THA). As highly cross-linked polyethylene (HXLPE) is presumed to give lower wear rates, in vivo studies are needed to confirm this.
AIM To compare the wear of REXPOL, a HXPLE, with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis (RSA).
METHODS Patients were randomised to receive either a HXLPE (REXPOL) or a conventional PE insert during primary THA. RSA images were obtained directly postoperative and after 6 wk, 12 wk, 6 mo, 12 mo, 24 mo and five years. Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.
RESULTS The HXLPE (REXPOL) showed less wear in the latero-medial direction. Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume, whereas the REXPOL did not show these outcomes over time. Improvement from baseline in functional outcome did not significantly differ.
CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years. This study confirms, for the first, that the REXPOL HXLPE inlay is preferred to standard PE.
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Affiliation(s)
- Justin van Loon
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Daniël Hoornenborg
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
| | - Inger Sierevelt
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
| | - Kim TM Opdam
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Daniël Haverkamp
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
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Di Foggia M, Affatato S, Taddei P. Does the addition of vitamin E to conventional UHMWPE improve the wear performance of hip acetabular cups? Micro-Raman characterization of differently processed polyethylene acetabular cups worn on a hip joint simulator. Braz J Med Biol Res 2020; 53:e9930. [PMID: 32813853 PMCID: PMC7437989 DOI: 10.1590/1414-431x20209930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
In knee replacements, vitamin E-doped ultra-high molecular weight polyethylene (UHMWPE) shows a better wear behavior than standard UHMWPE. Therefore, different sets of polyethylene (PE) acetabular cups, i.e. standard UHMWPE and cross-linked polyethylene irradiated with 50 kGy and 75 kGy, were compared, at a molecular level, with vitamin E-doped UHMWPE to evaluate their wear performance after being tested on a hip joint simulator for five million cycles. Unworn control and worn acetabular cups were analyzed by micro-Raman spectroscopy to gain insight into the effects of wear on the microstructure and phase composition of PE. Macroscopic wear was evaluated through mass loss measurements. The data showed that the samples could be divided into two groups: 1) standard and vitamin E-doped cups (mass loss of about 100 mg) and 2) the cross-linked cups (mass loss of about 30-40 mg). Micro-Raman spectroscopy disclosed different wear mechanisms in the four sets of acetabular cups, which were related to surface topography data. The vitamin E-doped samples did not show a better wear behavior than the cross-linked ones in terms of either mass loss or morphology changes. However, they showed lower variation at the morphological level (lower changes in phase composition) than the UHMWPE cups, thus confirming a certain protecting role of vitamin E against microstructural changes induced by wear testing.
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Affiliation(s)
- M Di Foggia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Affatato
- Medical Technology Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - P Taddei
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Khoshbin A, Wu J, Ward S, Melo LT, Schemitsch EH, Waddell JP, Atrey A. Wear Rates of XLPE Nearly 50% Lower Than Previously Thought After Adjusting for Initial Creep: An RCT Comparing 4 Bearing Combinations. JB JS Open Access 2020; 5:e0066. [PMID: 33123666 PMCID: PMC7418907 DOI: 10.2106/jbjs.oa.19.00066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The ideal bearing combination for total hip arthroplasty (THA) remains debatable. Highly cross-linked polyethylene (XLPE) is widely used, but long-term wear rates are not fully known, nor is how much the initial "creep," if any, affects overall wear. Additionally, the use of oxidized zirconium (OxZir) is purported to lower polyethylene wear rates, but this has not been proven. We present the 10-year data of a cohort of patients who underwent THA. Patients were prospectively randomized to 1 of 4 bearing combinations: a conventional ultra-high molecular weight polyethylene (UHMWPE) or XLPE acetabular liner coupled with either a cobalt-chromium (CoCr) or OxZir femoral head. The aims of the study were to (1) assess the extent to which creep affected overall wear rates and (2) assess wear rates between OxZir and CoCr with polyethylene. Methods A total of 92 hips (92 patients) between the ages of 22 and 65 years (mean, 52.2 ± 9.3 years) were randomized to 4 groups. At 10 years, 70 (76%) of the hips were available for analysis; patients who had undergone revision, had died, or were lost to follow-up were excluded from final analysis. Radiographic analysis was performed using a validated digital assessment program to determine linear, volumetric, and directional wear of the polyethylene for all 4 bearing couples. Radiographic assessments were performed immediately postoperatively, at 6 and 12 weeks, and then annually for a minimum of 10 years. Results XLPE had significantly lower wear rates than UHMWPE. Once creep was eliminated, annual and overall wear rates were nearly 50% lower than have been previously reported. This was proportionally more important in the XLPE group than in the UHMWPE group. There was a nonsignificant trend toward a lower wear rate with OxZir heads. Conclusions Creep plays a notably more important role than first thought. Once creep was eliminated, the overall wear rate was even lower than previously assumed. This has important implications for the overall survivorship of hip arthroplasty implants. Level of Evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - James Wu
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sarah Ward
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Luana T Melo
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- Schulitsch School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Amit Atrey
- St. Michael's Hospital, Toronto, Ontario, Canada
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Jalali O, Scudday T, Fickenscher MC, Barnett S, Gorab R. Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty. Arthroplast Today 2020; 6:316-321. [PMID: 32514421 PMCID: PMC7267711 DOI: 10.1016/j.artd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm3/year, and there was no evidence of osteolysis. Harris hip scores increased from 50.9 preoperatively to 96.0 at the latest follow-up. The revision rate was 0.4%, with no liner rim fractures and no liner dissociations/loosenings. Femoral head material, head size, age, body mass index, and time since implantation had no effect on wear rates. Conclusion Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Influence of Irradiation Temperature on Oxidative and Network Properties of X-Ray Cross-Linked Vitamin E Stabilized UHMWPE for Hip Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2568428. [PMID: 32280683 PMCID: PMC7125449 DOI: 10.1155/2020/2568428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Previous studies have shown that increased cross-link density, reduced free radicals, and increased antioxidant grafting resulting from electron-beam irradiation at elevated temperatures improved the wear performance and the oxidative stability of vitamin E blended UHMWPE. The current study explores the impact of elevated irradiation temperature on vitamin E blended UHMWPE using X-ray. We hypothesize that the effects of temperature would be similar to those observed after electron-beam irradiation due to the relatively high dose rate of X-rays. Two X-ray doses of 80 and 100 kGy and two irradiation temperatures, that is, room temperature and 100°C were considered. The reference was Vitelene®, a vitamin E stabilized polyethylene cross-linked with 80 kGy by e-beam at 100°C. Oxidation index and oxidation induction time, as well as cross-link density, gel fraction, and trans-vinylene index, were determined, as the oxidative and network properties are decisive for the long-term implant performance. Gel fraction and oxidation induction time were significantly improved subsequently to warm irradiation in comparison with the material irradiated at room temperature. In conclusion, X-ray irradiation at elevated temperatures resulted in an increase of cross-linking and oxidative resistance of vitamin E stabilized polyethylene comparable to those of e-beam irradiated UHMWPE.
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