Plastics in Total Knee Replacement: Processing to Performance

Cheppalli, Naga Suresh; Metikala, Sreenivasulu; Albertson, Benjamin; Yaw, Kenneth

doi:10.7759/cureus.12969

Cited by 3 publications

(4 citation statements)

References 48 publications

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“…The HXLPE demonstrated less osteolysis, catastrophic fracture absence, reasonable mechanical properties, and long-term survival potential in this retrospective study. Therefore, as reported by other authors [6], the HXLPE could be cost-effective in younger patients to prevent future revisions.…”

Section: Discussionsupporting

confidence: 55%

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Giustra

Bistolfi

Bosco

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Highly crosslinked polyethylene (HXLPE) was introduced in total knee arthroplasty (TKA) to reduce wear and consequent revisions for loosening due to conventional polyethylene (CPE) wear. This study aims to analyse whether HXLPE is as safe as CPE and could improve the TKA clinical and radiological results in a long-term follow-up. Methods This retrospective study included all consecutive starting series of 223 patients with severe primary knee osteoarthritis (OA), with a minimum follow-up of 10 years treated between July 1st, 2007, and July 31st, 2010. After excluding patients who did not respect the inclusion and exclusion criteria, 128 patients were included in the analysis of this study. The patients were then divided into two groups according to the type of polyethylene (PE) implanted: CPE or HXLPE liners. All patients were evaluated for clinical and radiological parameters, causes and revision rates related to the type of PE implanted. Results HXLPE appears to be as safe as CPE in TKA, reporting no higher revisions for osteolysis, prosthesis loosening, infection, and mechanical failure. Nevertheless, no statistically significant differences were found between the two groups in the clinical and radiological outcomes evaluated. Conclusions Clinical, radiological results, and revision rates are similar between HXLPE and CPE in TKA after 10 years of follow-up, although HXLPE benefits remain controversial. Level of evidence III.

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Section: Discussionsupporting

confidence: 55%

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Giustra

Bistolfi

Bosco

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Zaribaf et al took a different approach, devising a method to enable radiographic visualization of the entire UHMWPE insert of a TKR using Lipiodol Ultra Fluid, an iodized oil used as a clinically injectable contrast agent. ,, This was achieved by diffusing the oil into the polyethylene at an elevated temperature of 105 °C but below the melting point of the polymer (135 °C) . This method had previously been used by Oral et al to diffuse vitamin E oil into UHMWPE. ,,, Due to the load-bearing application of UHMWPE joint components, it was important that the mechanical properties of the insert remained unaltered by the diffusion of the oil. No significant changes in the mechanical and physical properties (i.e., tensile modulus, elongation at failure, ultimate tensile strength, crystallinity, and oxidative stability) were observed.…”

Section: Resultsmentioning

confidence: 99%

“… 67 This method had previously been used by Oral et al to diffuse vitamin E oil into UHMWPE. 65 , 66 , 68 , 69 Due to the load-bearing application of UHMWPE joint components, it was important that the mechanical properties of the insert remained unaltered by the diffusion of the oil. No significant changes in the mechanical and physical properties (i.e., tensile modulus, elongation at failure, ultimate tensile strength, crystallinity, and oxidative stability) were observed.…”

Section: Resultsmentioning

confidence: 99%

Radiopacity Enhancements in Polymeric Implant Biomaterials: A Comprehensive Literature Review

Emonde,

Eggers,

Wichmann

et al. 2024

ACS Biomater. Sci. Eng.

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Polymers as biomaterials possess favorable properties, which include corrosion resistance, light weight, biocompatibility, ease of processing, low cost, and an ability to be easily tailored to meet specific applications. However, their inherent low X-ray attenuation, resulting from the low atomic numbers of their constituent elements, i.e., hydrogen (1), carbon (6), nitrogen (7), and oxygen (8), makes them difficult to visualize radiographically. Imparting radiopacity to radiolucent polymeric implants is necessary to enable noninvasive evaluation of implantable medical devices using conventional imaging methods. Numerous studies have undertaken this by blending various polymers with contrast agents consisting of heavy elements. The selection of an appropriate contrast agent is important, primarily to ensure that it does not cause detrimental effects to the relevant mechanical and physical properties of the polymer depending upon the intended application. Furthermore, its biocompatibility with adjacent tissues and its excretion from the body require thorough evaluation. We aimed to summarize the current knowledge on contrast agents incorporated into synthetic polymers in the context of implantable medical devices. While a single review was found that discussed radiopacity in polymeric biomaterials, the publication is outdated and does not address contemporary polymers employed in implant applications. Our review provides an up-to-date overview of contrast agents incorporated into synthetic medical polymers, encompassing both temporary and permanent implants. We expect that our results will significantly inform and guide the strategic selection of contrast agents, considering the specific requirements of implantable polymeric medical devices.

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“…The latter uses an ultra high molecular weight polyethylene (UHMWPE) insert, 13 made from Granular-UHMWPE-Ruhrchemie (GUR) 1020 and sterilized with ethylene oxide (EtO). 14 Several smaller studies have shown good clinical results in terms of function, kinematics, and longevity of these implants. 15 - 18 Our primary aim was to assess the migration pattern of the tibial tray of the GMK Sphere using radiostereometric analysis (RSA), and to compare this with previously known limits of safe migration patterns with respect to aseptic loosening.…”

Section: Introductionmentioning

confidence: 99%

Early migration of a medially stabilized total knee arthroplasty

et al. 2021

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Aims Medial pivot (MP) total knee arthroplasties (TKAs) were designed to mimic native knee kinematics with their deep medial congruent fitting of the tibia to the femur almost like a ball-on-socket, and a flat lateral part. GMK Sphere is a novel MP implant. Our primary aim was to study the migration pattern of the tibial tray of this TKA. Methods A total of 31 patients were recruited to this single-group radiostereometric analysis (RSA) study and received a medial pivot GMK Sphere TKA. The distributions of male patients versus female patients and right versus left knees were 21:10 and 17:14, respectively. Mean BMI was 29 kg/m2 (95% confidence interval (CI) 27 to 30) and mean age at surgery was 63 years (95% CI 61 to 66). Maximum total point motions (MTPMs), medial, proximal, and anterior translations and transversal, internal, and varus rotations were calculated at three, 12, and 24 months. Patient-reported outcome measure data were also retrieved. Results MTPMs at three, 12, and 24 months were 1.0 mm (95% CI 0.8 to 1.2), 1.3 mm (95% CI 0.9 to 1.7), and 1.4 mm (0.8 to 2.0), respectively. The Forgotten Joint Score was 79 (95% CI 39 to 95) and Knee Injury and Osteoarthritis Outcome Score obtained at two years was 94 (95% CI 81 to 100), 86 (95% CI 75 to 93), 94 (95% CI 88 to 100), 69 (95% CI 48 to 88), and 81 (95% CI59 to 100) for Pain, Symptoms, Activities of Daily Living, Sport & Recreation, and Quality of Life, respectively. Conclusion In conclusion, we found that the mean increase in MTPM was lower than 0.2 mm between 12 and 24 months and thus apparently stable. Yet the GMK Sphere had higher migration at one and two years than anticipated. Based on current RSA data, we therefore cannot conclude on the long-term performance of the implant, pending further assessment. Cite this article: Bone Jt Open 2021;2(9):737–744.

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Plastics in Total Knee Replacement: Processing to Performance

Cited by 3 publications

References 48 publications

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Radiopacity Enhancements in Polymeric Implant Biomaterials: A Comprehensive Literature Review

Early migration of a medially stabilized total knee arthroplasty

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