Aspherical Femoral Head with Highly Cross-Linked Ultra-High Molecular Weight Polyethylene Surface Cracking

Furmanski, Jevan; Chawan, Arun; Kohm, Andrew; Lannutti, John J.; Jewett, Brian A.; Pruitt, Lisa A.; Ries, Michael D.

doi:10.2106/jbjs.f.00428

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Previous RSA studies [22,41] showed wear of conventional polyethylene of 0.1 to 0.085 mm and a standard deviation less than 0.07. RSA studies on cross-linked polyethylenes support in vitro observations that wear would be less than the detection threshold of 0.80 mm.…”

Section: Methodsmentioning

confidence: 92%

“…To overcome the problems of wear associated with conventional UHMWPE, highly cross-linked polyethylene (HXLPE) was introduced [11]. The first-generation HXLPEs in clinical use have exhibited markedly less wear than conventional UHMWPE [12,14,28,30,31]; however, there have been some reports of surface cracking, mechanical failure, and oxidative damage in failed acetabular liners [5,22,25].…”

Section: Introductionmentioning

confidence: 99%

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Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study

Campbell

Field

Callary

2010

Clinical Orthopaedics &Amp; Related Research

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Background First-generation highly cross-linked polyethylene liners have reduced the incidence of wear particleinduced osteolysis. However, failed acetabular liners have shown evidence of surface cracking, mechanical failure, and oxidative damage. This has led to the development of second-generation highly cross-linked polyethylene, which has improved wear and mechanical properties and resistance to oxidation in vitro. Owing to its recent introduction, there are no publications describing its clinical performance. Questions/purposes We assessed early clinical wear of a second-generation highly cross-linked polyethylene liner and compared its clinical performance with the published results of hip simulator tests and with first-generation highly cross-linked polyethylene annealed liners. Patients and Methods Twenty-one patients were enrolled in a prospective cohort study. Clinical outcome and femoral head penetration were measured for 19 patients at 6 months and 1 and 2 years postoperatively. Results The median proximal head penetration was 0.009 mm and 0.024 mm at 1 and 2 years, respectively. The median two-dimensional (2-D) head penetration was 0.083 mm and 0.060 mm at 1 and 2 years, respectively. The median proximal wear rate between 1 and 2 years was 0.015 mm/year. Conclusions The wear rate calculated was similar to the in vitro wear rate reported for this material; however, it was less than the detection threshold for this technique. Although longer followup is required for wear to reach a clinically quantifiable level, this low level of wear is encouraging for the future clinical performance of this material.

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Section: Methodsmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study

Campbell

Field

Callary

2010

Clinical Orthopaedics &Amp; Related Research

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“…However, other than quantifying the radiographic penetration rate and incidence of osteolysis, these clinical studies provide little information about the wear and damage mechanisms associated with this new family of orthopedic biomaterials. Nearly ten years after their clinical introduction, the retrieval experience with remelted and annealed highly crosslinked polyethylene materials continues to be limited to isolated case studies [12-14] and series with relatively short implantation times [15-20]. …”

Section: Introductionmentioning

confidence: 99%

Mechanical Properties, Oxidation, and Clinical Performance of Retrieved Highly Cross-Linked Crossfire Liners After Intermediate-Term Implantation

Kurtz

Austin

Azzam

et al. 2010

The Journal of Arthroplasty

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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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“…While reports of clinical fracture or crack-related failures remain rare for crosslinked UHMWPE implants, clinically retrieved components have been reported involving catastrophically fractured bearings [4,15], intact components containing initiated subcritical cracks [6], and bearing surfaces exhibiting extensive apparently brittle surface cracking [5]. Crosslinked formulations of UHMWPE provide an excellent wear-resistant bearing surface in total joint arthroplasty, but the long-term resistance to crack-related damage phenomena in these materials is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…A relative decrease in K incep generally shifts the stable crack propagation uniformly to lower values of stress intensity [3,8,12], and such a shift is known to accompany crosslinking in UHMWPE [3,8,12]. The reduced toughness and crack propagation resistance of crosslinked formulations of UHMWPE are of interest for clinical applications, particularly in light of recently reported cases of brittle damage or catastrophic fracture of highly crosslinked THA bearings [4][5][6]15].…”

Section: Introductionmentioning

confidence: 99%

Crack Propagation Resistance Is Similar Under Static and Cyclic Loading in Crosslinked UHMWPE: A Pilot Study

Furmanski

Rimnac

2011

Clinical Orthopaedics &Amp; Related Research

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Background Recent work suggests crack phenomena (eg, crack initiation and propagation) in UHMWPE do not depend on cyclic damage mechanisms. Materials for which crack phenomena occur in static (noncyclic) mode should exhibit similar crack propagation behavior under static and cyclic loading conditions. Questions/purposes Do cracks in UHMWPE stably propagate from acute notches under static loading with a velocity dependent on crosslink density? Are materialranking evaluations for crack propagation resistance similar under static and cyclic loading conditions? Does time to failure for a notched specimen under static loads yield the same material rankings as crack propagation data? Methods Notched compact tension specimens were machined from UHMWPE gamma-irradiated with a 0-, 50-, 75-, or 100-kGy dose and subsequently remelted. Static loads were applied until failure occurred or 2 weeks had elapsed. Crack propagation rates and time to failure were recorded and compared to data from cyclic experiments. Results Static and cyclic loading both produced stable crack propagation and similar performance rankings of material groups, except in the case of the unirradiated material, which did not fail under static loads. Normalized measures of crack propagation velocities generally showed quantitative agreement between the two methods. Normalized time to failure under static loading also agreed well with crack propagation velocity. Conclusions Crack propagation under static loading produced qualitatively and quantitatively similar performance results as those under cyclic loading. Time to failure under static loads corresponded closely with the crack propagation velocity and may itself be a robust metric of crack propagation resistance. Clinical Relevance Total joint arthroplasties may experience superficial cracking in the UHMWPE bearing surface or catastrophic fracture. Quantifying resistance to crack phenomena in UHWMPE is important to design engineers and to clinicians using crosslinked UHMWPE materials under challenging mechanical conditions.

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Aspherical Femoral Head with Highly Cross-Linked Ultra-High Molecular Weight Polyethylene Surface Cracking

Cited by 15 publications

References 18 publications

Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study

Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study

Mechanical Properties, Oxidation, and Clinical Performance of Retrieved Highly Cross-Linked Crossfire Liners After Intermediate-Term Implantation

Crack Propagation Resistance Is Similar Under Static and Cyclic Loading in Crosslinked UHMWPE: A Pilot Study

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