Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty

Steiger, Richard de; Muratoglu, Orhun K.; Lorimer, Michelle; Cuthbert, Alana R.

doi:10.3109/17453674.2015.1065046

Cited by 58 publications

(35 citation statements)

References 12 publications

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“…Wear debris is a major contributor to osteolytic tissue response in total joint patients. The use of highly cross‐linked UHMWPEs have decreased the incidence of peri‐prosthetic osteolysis in total hips and reduced the cumulative revision rate in patients operated with certain total knee designs . Cross‐linking of UHMWPE results from the reaction of free radicals, generated by various methods such as exposure to ionizing radiation or the incorporation of chemical cross‐linking agents such as peroxides or silanes .…”

Section: Introductionmentioning

confidence: 99%

An antioxidant stabilized, chemically cross‐linked UHMWPE with superior toughness

et al. 2018

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Chemical cross-linking of ultrahigh molecular weight polyethylene (UHMWPE) using an organic peroxide followed by high temperature melting results in a large increase in toughness accompanied by a decrease in cross-link density, which, surprisingly does not compromise the wear resistance. We compared the mechanical properties and wear behavior of a vitamin E blended, chemically cross-linked and high temperature melted UHMWPE produced by ram extrusion (PRX HTM) to those measured with the clinically available 100-kGy irradiated and melted UHMWPE (CISM 100). We also assessed the local biocompatibility of PRX-HTM in rabbit subcutaneous pouch and osteochondral defect models. The ultimate tensile strength and pin-on-disc wear rate were similar to CISM 100; whereas the elongation-at-break and impact toughness were much higher with PRX-HTM. The stress intensity factor range at crack inception was also higher with PRX-HTM. Accelerated aging did not result in any measurable oxidation or changes in mechanical properties. Hip simulator wear rate of acetabular liners made with PRX-HTM was 0.3 AE 0.4 mg/million-cycle, similar to that reported for CISM 100 liners. The wear particles were largely spherical with a number-averaged particle size of 0.95 μm with~75% of particles below 1 μm. The subcutaneous and osteochondral rabbit implantations showed no histological differences between PRX-HTM and the control CISM 100. Preclinical wear, mechanical, and biocompatibility testing of PRX HTM showed feasibility for the use of this material as a total joint arthroplasty implant bearing surface. This process has the potential of eliminating the additional step of radiation cross-linking by combining consolidation and cross-linking while improving toughness.

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Section: Introductionmentioning

confidence: 99%

An antioxidant stabilized, chemically cross‐linked UHMWPE with superior toughness

et al. 2018

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“…Cross‐linking reduces the wear rate of ultrahigh molecular weight polyethylene (UHMWPE), which is the preferred bearing surface material in total joint arthroplasty implants Clinical follow‐up studies have shown a marked decrease in the incidence of peri‐prosthetic osteolysis in total hips and a decrease in revision rate in total knees when highly cross‐linked UHMWPE components were used.…”

Section: Introductionmentioning

confidence: 99%

Surface cross‐linked ultra high molecular weight polyethylene by emulsified diffusion of dicumyl peroxide

et al. 2017

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Cross-linking improves the wear resistance of ultrahigh molecular weight polyethylene (UHMWPE) used in hip and knee implants. Free radicals, generated by ionizing radiation or chemically, react to form cross-links. Limiting cross-linking to the articulating surface of the implant is desirable to enable high wear resistance on the surface and higher strength and toughness in the bulk. We investigated the diffusion of emulsified dicumyl peroxide (DCP) into vitamin E-blended UHMWPE (0.1 and 0.3 wt. % vitamin-E) with subsequent thermal decomposition in situ to obtain surface cross-linking with the objective of achieving surface wear rate equivalent or lower than that of current clinically available materials. We diffused emulsified DCP at 100°C followed by in situ decomposition at 150°C. We also assessed the effect of having vitamin-E in the DCP emulsion. The oxidative stability of the treated samples increased with increasing vitamin E concentration in the blend and by incorporating vitamin E into the peroxide emulsion. The impact strength of a surface cross-linked, 0.3 wt% vitamin E blended UHMWPE prepared using this method was superior to a clinically available irradiated and melted highly cross-linked UHMWPE while the wear resistance was comparable. These results showed the feasibility of surface cross-linking using emulsified peroxide diffusion as a method of making tough and wear resistant joint implant bearing surfaces. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1517-1523, 2018.

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“…In registry studies, the use of cross-linked polyethylene in TKR lowers the risk of loosening and lysis when compared with non-cross-linked polyethylene (de Steiger et al. 2015 ), presumably via a reduction in particle-related osteolysis. In our series, when the effect of XLPE was examined, it resulted in a 43% lower revision risk in the HP cohort compared with the CP cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Cross-linked-polyethylene (XLPE) was defined as ultra-high-molecular-weight polyethylene that has been irradiated with high-dose (≥ 50 kGy) radiation, regardless of re-melting or annealing (de Steiger et al. 2015 ).…”

Section: Methodsmentioning

confidence: 99%

The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

et al. 2018

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Background and purposeRecent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation.MethodsRegistry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation preferring surgeons, designated routinely hybrid (RH), and those treated by high-volume cemented fixation preferring surgeons, designated routinely cemented (RC).ResultsAt 13 years, the cumulative percentage revision of the RC cohort was 4.8% (CI 4.1–5.7) compared with 5.5% (CI 3.5–8.7) for the RH cohort. The revision risk for each cohort was the same for all causes (HR =1.0 (CI (0.84–1.20)), non-infective causes, and for infection. This finding was irrespective of patient age or sex, patella resurfacing, and with non-cross-linked polyethylene (NXLPE). The RH cohort who received cross-linked polyethylene (XLPE) had a lower revision risk than the RC cohort with XLPE (HR =0.57 (0.37–0.88), p = 0.01).InterpretationThe risk of revision for the patients of surgeons who prefer cemented fixation in minimally stabilized TKR is the same as for the patients of surgeons who prefer hybrid fixation, except when used with XLPE, where hybrid fixation has a lower revision risk.

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Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty

Cited by 58 publications

References 12 publications

An antioxidant stabilized, chemically cross‐linked UHMWPE with superior toughness

An antioxidant stabilized, chemically cross‐linked UHMWPE with superior toughness

Surface cross‐linked ultra high molecular weight polyethylene by emulsified diffusion of dicumyl peroxide

The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement

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