A Highly Crosslinked UHMWPE for CR and PS Total Knee Arthroplasties

Wang, Aiguo; Yau, Shi-Shen; Essner, Aaron; Herrera, Lizeth; Manley, Michael; Dumbleton, J. H.

doi:10.1016/j.arth.2007.05.007

Cited by 83 publications

(40 citation statements)

References 26 publications

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“…Finally it may be noted that pin-on-disk wear simulations are inherently limited to the basic mechanisms of wear occurring in prosthetic joints and so features and phenomena that are specific to the implant design cannot be studied directly. For the latter purpose, various knee simulators have been built [DesJardins et al, 2000;Franta et al, 2011;McEwen et al, 2005;Muratoglu et al, 2002;Wang et al, 2008].…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, only cyclic input has been used [Kurtz, 2009]. At most, a few different activities have been included in a study [Franta et al, 2011;Muratoglu et al, 2002;Schwiesau et al, 2013;Wang et al, 2008]. Instead of including a few high demand activities in the wear test in addition to walking, the non-cyclic motion and load inputs are designed so that they can be considered to contain, within biomechanically realistic limits, all relevant activities at once [Saikko and Kostamo, 2011].…”

Section: Introductionmentioning

confidence: 99%

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In vitro wear simulation on the RandomPOD wear testing system as a screening method for bearing materials intended for total knee arthroplasty

Saikko

2014

Journal of Biomechanics

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The 16-station RandomPOD wear test system, previously validated for prosthetic hip wear, was used in the simulation of knee wear mechanisms with a ball-on-flat test configuration.This consisted of a CoCr pin with a ground and polished spherical bearing surface (radius 28 mm) against a conventional, gamma-sterilized UHMWPE disk in serum lubrication. The biaxial motion, consisting of x and y translations, and the load were non-cyclic. Relative to the disk, the center of contact wandered within a circle of 10 mm diameter, and the average sliding velocity was 15.5 mm/s (range 0 to 31 mm/s). The load varied non-cyclically between 0 and 142 N (average 73 N). In the 60-day test with 16 similar wear couples, moderate adhesive wear, the principal wear mechanism of a well-functioning prosthetic knee, dominated. This showed as a burnished, circular wear mark (diameter 13.2 mm, area 137 mm 2 ). The wear factor was 2.04 ± 0.03 × 10 -6 mm 3 /Nm (mean ± 95 per cent confidence limit). For the first time a truly multidirectional, realistic and uniform, large capacity pin-ondisk simulation of knee wear mechanisms was implemented.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vitro wear simulation on the RandomPOD wear testing system as a screening method for bearing materials intended for total knee arthroplasty

Saikko

2014

Journal of Biomechanics

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“…To address this vulnerability, UHMWPE materials have been stabilized by thermal means with varying success [6,11,13,27]. These thermally stabilized materials are generally regarded as the current benchmarks for oxidatively stable UHMWPE materials in commercial orthopaedic devices.…”

Section: Introductionmentioning

confidence: 99%

Spectroscopic and Chromatographic Quantification of an Antioxidant-stabilized Ultrahigh-molecular-weight Polyethylene

Narayan

2015

Clinical Orthopaedics &Amp; Related Research

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Background The oxidative stability of various antioxidant-containing ultrahigh-molecular-weight polyethylene (UHMWPE) formulations has been widely reported. Depending on which specific antioxidant is used, the process by which it is incorporated into UHMWPE, and the amount of the antioxidant incorporated, there could be substantial differences in the material and toxicological properties of the UHMWPE formulation. Pentaerythritol tetrakis (3-[3,5-di tertiary butyl-4-hydroxyphenyl] propionate) (PBHP) has been extensively used as an efficient antioxidant in various applications. However, it has not thus far been used to stabilize UHMWPE in orthopaedic implants. It is therefore important to characterize and verify the concentration and homogeneity of distribution of PBHP in the composition, the chemical consequence of exposure of the antioxidant to gamma irradiation, and to assess the toxicological risk of use by the identification and quantification of leachables before the use of PBHP-containing UHMWPE in implantable devices. Questions/purposes (1) Can the concentration and uniformity of distribution of the antioxidant PBHP in UHMWPE powder and in the consolidated, preirradiated formulation be verified? (2) Can the leachable compounds in the gamma radiation crosslinked PBHP/UHMWPE formulation be identified and quantified? Methods PBHP in GUR 1020 UHMWPE was quantified by Fourier transform infrared (FTIR) and ultraviolet-visible (UV-Vis) spectroscopy. The chemical byproducts generated by gamma irradiation of PBHP were identified using gas chromatography in conjunction with mass spectrometry followed by a second-stage mass spectrometry (GC-MS/ MS). When GC-MS/MS was coupled with Stir Bar Sorptive extraction, leachable components in the UHMWPE formulation were identified and quantified. Results The percent concentration of PBHP in UHMWPE powder was confirmed by UV-Vis spectroscopy and the concentration and uniform distribution of PBHP in UHMWPE after consolidation and before radiation crosslinking was verified through FTIR spectroscopy. GC-MS/ MS analysis enabled the identification and quantification of 16 gamma irradiation byproducts of PBHP. These 16 compounds were verified as potentially leachable compounds in PBHP-stabilized UHMWPE and were found to be well below the safety threshold concern of 150 ng/ device in orthopaedic knee inserts made from PBHP-stabilized UHMWPE. Conclusions Spectroscopic analysis has been successfully used to demonstrate the ability to reliably quantify the amount as well as the distribution of PBHP in UHMWPE in orthopaedic bearings. State-of-the-art chemical extraction and analytical techniques have enabled the identification of the gamma radiation-induced byproducts of PBHP and the quantification of these components as leachables from the PBHP-stabilized UHMWPE formulation. Clinical Relevance Antioxidant-stabilized UHMWPE materials being considered for orthopaedic bearings must

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“…There has been extensive in vitro biomechanical wear testing of several types of modular XLP tibial liners for TKA [6,8,[18][19][20]25]. The clinical use of XLP tibial liners and patellar components was proposed after the early success in THA, but these have not been accepted for routine use [9,14].…”

Section: Introductionmentioning

confidence: 99%

“…The clinical use of XLP tibial liners and patellar components was proposed after the early success in THA, but these have not been accepted for routine use [9,14]. There is concern that some XLP liners show reduced fracture toughness compared with SP [3,6,25] with two reports of three fractures of the tibial posterior-stabilized post of one type of highly XLP at short-term followup [11,12] and two reports of fracture of three XLP patella components [7,24]. There is also concern that the size and reactivity of XLP particles may lead to increased periprosthetic osteolysis [6].…”

Section: Introductionmentioning

confidence: 99%

Is There a Benefit to Highly Crosslinked Polyethylene in Posterior-stabilized Total Knee Arthroplasty? A Randomized Trial

Lachiewicz

Soileau

2016

Clinical Orthopaedics &Amp; Related Research

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Background Polyethylene wear and osteolysis remain a concern with the use of modular, fixed-bearing total knee arthroplasty (TKA). A variety of highly crosslinked polyethylenes (XLPs) have been introduced to address this problem, but there are few data on the results and complications of this polyethylene in posterior-stabilized knee prostheses. Questions/purposes In a randomized prospective study design comparing standard polyethylene (SP) tibial inserts with XLP inserts, we asked the following questions: (1) Are there any differences in the clinical results (as measured by the classic Knee Society scoring system) and radiographic results (as measured by an evaluation for radiolucencies and osteolysis) between these groups? (2) What is the frequency of reoperation in these two groups? (3) Are there any specific complications related to XLP liners?Methods These are preliminary data from a single surgeon of a planned interim analysis of a prospective randomized study of one modular posterior-stabilized TKA. One hundred ninety-two patients (236 knees) were randomized to receive a SP compression-molded liner or a XLP (6.5 CGy electron beam-irradiated and remelted) polyethylene liner. There was no difference in the number of knees who were lost or refused followup (14 knees . There were no differences, with the numbers available, in the presence of effusion (two of 94 XLP and five of 99 SP) with 2 years minimum followup. There were no differences in the frequency of radiolucent lines (13 knees with SP and 15 with XLP) or of osteolysis (two knees with SP and none with XLP). There was no difference in frequency of reoperation between the two groups (three infections in 110 knees allocated to the XLP group and five (two infections, one femoral loosening, one instability, one fracture plating) in

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A Highly Crosslinked UHMWPE for CR and PS Total Knee Arthroplasties

Cited by 83 publications

References 26 publications

In vitro wear simulation on the RandomPOD wear testing system as a screening method for bearing materials intended for total knee arthroplasty

In vitro wear simulation on the RandomPOD wear testing system as a screening method for bearing materials intended for total knee arthroplasty

Spectroscopic and Chromatographic Quantification of an Antioxidant-stabilized Ultrahigh-molecular-weight Polyethylene

Is There a Benefit to Highly Crosslinked Polyethylene in Posterior-stabilized Total Knee Arthroplasty? A Randomized Trial

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