Highly cross-linked polyethylenes (HXLPEs) have been incorporated into the hip replacement armamentarium based on their improved wear resistance. However, two different methods of thermal treatment separate the orthopedic community as strategies to control potential long-term oxidation, and controversy remains with problems in the long-term use of acetabular liners (long-term oxidation, rim fracture after impingement, etc.). Meanwhile, the mechanical properties of HXLPEs that may alleviate these problems are still unclear. On the other hand, HXLPEs are scarcely used in knee replacements, as there exists concern about the probably reduced fatigue and fracture performances of these materials. Thus, our aim was to compare the effects of both thermal treatment regimes on mechanical properties and to associate these findings with the material microstructure. The fatigue behavior of annealed and remelted HXLPEs was characterized using short-term cyclic stress-strain, long-term fatigue, and fatigue crack propagation tests. On the other hand, impact tests, tensile experiments, and the J-integral multispecimen method allowed us to assess toughness. Microstructure features such as crosslink density, crystallinity percentage, and lamellar thickness were investigated by swelling measurements, differential scanning calorimetry, and transmission electron microscopy, respectively. This study confirms that annealing preserves mechanical properties better than remelting from both fatigue and fracture resistance points of view, and it remarks that a suitable selection of irradiation and stabilization conditions is needed to achieve optimal mechanical performances of ultra high molecular weight polyethylenes for each specific total joint replacement.

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Sixty Crossfire (Stryker Orthopaedics, Mahwah, NJ) liners were consecutively revised after an average of 2.9 years (range: 0.01 – 8.0 years) for reasons unrelated to wear or mechanical performance of the polyethylene. Femoral head penetration was measured directly from 42 retrievals implanted for over 1 year. Penetration rate results (0.04 mm/y, on average; range: 0.00-0.13 mm/y) confirmed decreasing wear rates with longer in vivo times. Overall, we observed oxidation levels at the bearing surface of the 60 liners (0.5, on average; range: 0.1-1.7) comparable to those of non-implanted liners (0.5, on average; range: 0.3-1.1) and preservation of mechanical properties. We also measured elevated oxidation of the rim (3.4, on average; range: 0.2-8.8) that was correlated with implantation time. Rim surface damage, however, was observed in only 3/60 (5%) cases. Retrieval analysis of the three rim-damaged liners did not reveal an association between surface damage and the reasons for revision.

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This study reports on the suitability of different experimental techniques to evaluate chemical, microstructural and mechanical changes associated with in vivo oxidation encountered in historical polyethylene components. To accomplish this aim, eight traceable tibial inserts were analyzed after revision surgery. The knee bearings were gamma sterilized in air and implanted for an average of 11.5 years after a shelf life no longer than one year. Characterization of oxidation and transvinylene indexes, crystallinity, amorphous and intermediate phase fractions, along with hardness and surface modulus, were performed in transverse sections of each bearing using Fourier transform infrared spectroscopy, Raman spectroscopy, and nanoindentation, respectively. Generally, subsurface maxima in the crystallinity, oxidation index, and hardness were observed at a depth of about 1 mm in all of the bearings. The superior surfaces and anterior-posterior faces of the inserts exhibited significantly higher oxidation and greater crystallinity than the inferior side. These observations suggest that the metallic tray may limit the access of molecular oxygen to the backside of the tibial inserts. We conclude that chemical, physical, and mechanical property data confirm the occurrence of in vivo degradation in the long-term implanted knee components following gamma irradiation in air. Furthermore, infrared spectroscopy alone appeared to provide excellent insight into the oxidation and crystallization state of the in vivo oxidized polyethylene.

Bacterial adherence on total joint replacement implants may lead to biofilm formation and implant-related osteoarticular infection. It is unclear if different biomaterials in the prosthetic components are more prone to facilitate this bacterial adherence, although ultrahigh molecular weight polyethylene (UHMWPE) component exchange in modular systems has been clinically utilized in the early management of these infections. To clarify if the amount of clinically adhered microorganisms was related to the material or the component, we investigated retrieved implants from infected joint replacements. Thirty-two patients were revised after confirmed implant-related infection through positive cultures. Eighty-seven total joint components (hip and knee) were obtained and separately sonicated following a previously published protocol. Cultures were quantified, and detected colony forming units (CFU) were adjusted according to the component surface and compared based on the component material and location. Variable adherence of bacteria to chrome cobalt alloys, UHMWPE, hydroxyapatite coated components, and titanium alloys. The commonest isolated organisms were Staphylococcus epidermidis (23 of 87 components) and Staphylococcus aureus (10 of 87). Twelve components did not show any microorganism adhered despite location in an infected joint, with positive cultures in other components. A mixed linear model adjusted for random effects (the random effect being the infected patient) obtained convergence for the CFU/mm(2) variable, but could not confirm a significantly higher adherence to a particular component or to a particular biomaterial. Therefore, the bacterial adherence primarily depends on the infective microorganism and the response of each individual patient, rather than materials or components.

Electron beam irradiation at doses below 150 kGy is a widely used technique to obtain highly crosslinked ultra-high-molecular-weight polyethylene (UHMWPE). Its current use in total joint replacement components may improve wear resistance and decrease UHMWPE particle debris. However, currently used post-irradiation thermal treatments, which aim to decrease the free radicals within the material, introduce microstructural changes that affect UHMWPE mechanical properties, particularly the fatigue strength. This influence may be crucial in total knee replacements, where fatigue-related damage limits the lifespan of the prosthesis. Therefore, more studies are required to understand UHMWPE fatigue after current crosslinking protocols. This study was planned to evaluate the influence of UHMWPE remelting after irradiation on the material fatigue resistance. The remelting was achieved at 150 degrees C for 2 h on UHMWPE previously irradiated at 50, 100, and 150 kGy. Fatigue evaluation included short-term tests under cyclic tensile stress with zero load ratio, R = 0, and 1 Hz. In addition, stress-life testing was performed using 12% yield as the criterion for failure. Near-threshold fatigue crack propagation experiments were also performed at a frequency of 5 Hz, and crack length was measured in nonthermally treated and remelted irradiated UHMWPE. Crystallinity percentage was calculated from DSC measurements. The results pointed out that irradiation positively contributed to total life analysis, but the further remelting process decreased the flaw initiation resistance. On the other hand, both processes negatively affected the fatigue resistance of notched components. From a clinical point of view, the results suggest that the material fatigue behavior should be carefully studied in new UHMWPE to avoid changes related to material processing.

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