Because
ultrahigh-molecular-weight polyethylene (UHMWPE) is susceptible
to frictional wear when used in sliding members of artificial joints,
it is common practice to use cross-linked UHMWPE instead. However,
cross-linked UHMWPE has low impact resistance; implant breakage has
been reported in some cases. Hence, sliding members of artificial
joints pose a major trade-off between wear resistance and impact resistance,
which has not been resolved by any UHMWPE. On the other hand, multiwall
carbon nanotubes (MWCNTs) are used in industrial products for reinforcement
of polymeric materials but not used as biomaterials because of their
unclear safety. In the present study, we attempted to solve this trade-off
issue by complexing UHMWPE with MWCNTs. In addition, we assessed the
safety of these composites for use in sliding members of artificial
joints. The results showed the equivalence of MWCNT/UHMWPE composites
to cross-linked UHMWPE in terms of wear resistance and to non-cross-linked
UHMWPE in terms of impact resistance. In addition, all MWCNT/UHMWPE
composites examined complied with the requirements of biosafety testing
in accordance with the ISO10993-series specifications for implantable
medical devices. Furthermore, because MWCNTs can occur alone in wear
dust, MWCNTs in an amount of about 1.5 times that contained in the
dust produced from 50 years of wear (in the worst case) were injected
into rat knees, which were monitored for 26 weeks. Although mild inflammatory
reactions occurred in the joints, the reactions soon became quiescent.
In addition, the MWCNTs did not migrate to other organs. Furthermore,
MWCNTs did not exhibit carcinogenicity when injected into the knees
of mice genetically modified to spontaneously develop cancer. The
MWCNT/UHMWPE composite is a new biomaterial expected to be safe for
clinical applications in both total hip arthroplasty and total knee
arthroplasty as the first sliding member of artificial joints to have
both high wear resistance and high impact resistance.