Six decades of UHMWPE in reconstructive surgery

Abstract

Ultra-high molecular weight polyethylene (UHMWPE) materials have played a significant role in the field of reconstructive surgery, particularly as acetabular liners/sockets for total hip joint replacement (THR), and tibial inserts for total knee joint replacement (TKR). This review aims to provide a perspective on key elements regarding the processing-structure-property relationship of UHMWPE and derivatives. Much emphasis will be provided to discuss the clinically relevant properties of UHMWPE blend/composite formulation, Vitamin-E reinforced or highly crosslinked variants. In addition, we provide clinical insights into the role of wear debris in inflammation and osteolysis. The relatively unexplored domain of UHMWPE additive manufacturing. Finally, the relatively unexplored domain of UHMWPE additive manufacturing and the opportunities associated with the next generation of UHMWPE implants are highlighted.

Early failure of a highly cross-linked polyethylene inlay after total hip arthroplasty probably due to insufficient irradiation

“…The TVI is a very reliable method to evaluate the radiation dose absorbed by the polyethylene during cross-linking or the sterilisation process [30][31][32][33][34][35][36] . The effect of irradiation on polyethylene molecules has been described in detail in a recently published review 37 . The relation between TVI and absorbed radiation dose is linear within a broad range for both gamma-and electron beam-irradiated polyethylene [30][31][32][33][34][35][36] , making the TVI a very useful quality control tool to verify proper irradiation processes during manufacture of polyethylene components.…”

“…Consequently, a defective manufacturing process of this specific product may be assumed, representing a conclusion diametrically different from the retrieval analysis report. Insufficient irradiation might even have reduced wear resistance, leading to such an early failure 19,21,[36][37][38] .…”

“…Thus, the absorbed radiation dose is not only far from the specifications, but also insufficient for proper cross-linking of polyethylene. [19][20][21]36,37 Low dose-rate during irradiation advanced by the manufacturer, can be discarded as a possible explanation, as the dose-rate has a negligible effect on the TVI. 33,36 Consequently, a defective manufacturing process of this specific product may be assumed, representing a conclusion diametrically different from the retrieval analysis report.…”

“…Insufficient irradiation might even have reduced wear resistance, leading to such an early failure. 19,21,[36][37][38] Since irradiation lots are usually much larger than production lots for arthroplasty inlays, the insufficient irradiation might have affected many more components than those with the production lot No. 155383.…”

A novel method of fabricating multi‐material acetabular liner using fused filament fabrication

“…11 UHMWPE came into use as a bearing material for the prosthesis. [12][13][14][15] However, aseptic loosening and osteolysis emerged as major problems in the orthopedic field in the 1980s and early 1990s, leading to efforts to improve the characteristics of UHMWPE for hip implants. 11,13 Hence the polymer was modified and different variants of UHMWPE evolved such as cross-linked UHMWPE.…”