Wear Characteristics of Conventional Ultrahigh-Molecular-Weight Polyethylene Versus Highly Cross-Linked Polyethylene in Total Ankle Arthroplasty

Schipper, Oliver N.; Haddad, Steven L.; Fullam, Spencer; Pourzal, Robin; Wimmer, Markus A.

doi:10.1177/1071100718786501

Cited by 26 publications

(11 citation statements)

References 25 publications

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“…Thus, the effects of dynamic loading were not specifically evaluated in the fatigue test. However, this approach is consistent with the approach recommended for fatigue testing of implants in other joints 2,19,20 ; previously published studies on the ankle that used fully dynamic loading did not report polyethylene fracture 8,34 ; and the testing in this study was performed at the singular point during gait of maximum bearing stress with substantially increased peak load.…”

Section: Discussionsupporting

confidence: 81%

“…Assessment of the wear performance of HXLPE in the ankle showed a 74% reduction in wear as compared to CPE in the same design, 8 and an 88% reduction in wear compared to CPE in a different design. 34 However, those studies did not specifically address potential fracture of the prosthesis. There is a well-documented reduction in fatigue properties of HXLPE as compared to CPE.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

et al. 2019

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Background: Highly crosslinked polyethylene (HXLPE) was developed for its superior wear properties in comparison to conventional polyethylene (CPE). Concern over fatigue resistance has prevented widespread adoption of HXLPE for use in total ankle arthroplasty (TAA). The aim of this study was to determine whether HXLPE has sufficient fatigue strength for total ankle arthroplasty under simulated physiologically relevant motion profiles and loading in the ankle. Methods: Physiologic load and motion profiles representative of walking gait were incorporated into a computational model of a semiconstrained, fixed-bearing TAA to determine the loading state with highest stresses in the HXLPE bearing. Subsequent fatigue testing to 10 million cycles (Mc) at 5600 N was performed to assess bearing strength. Results: Peak stresses in the bearing were predicted at peak axial load and peak dorsiflexion during gait, occurring near heel off. All samples withstood 10 Mc of fatigue loading at that orientation without polyethylene bearing fracture. Conclusion: HXLPE had sufficient fatigue strength to withstand 10 Mc of loading at more than 5 times body weight at the point of peak stresses during simulated gait in total ankle arthroplasty. Clinical Relevance: HXLPE may be mechanically strong enough to withstand the in vivo demands of the ankle. Improvements in wear afforded by HXLPE can be obtained without compromising sufficient polyethylene strength properties in total ankle arthroplasty.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

et al. 2019

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“…They are visible at × 400 and × 200 under polarized light. The equivalent shape ratio (ESR) has been used in a recent study comparing UHMWPE to HXLPE particles in total ankle arthroplasty to characterize the particles which are classified as round (ESR < 1.5), elongated (1.5 ≤ ESR ≤ 3) and fibrillary (3 < ESR) [ 40 ]. The detectable number of particles is also dependent on the polarizer and analyzer components used for the analysis.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue

et al. 2018

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BackgroundThe identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination.MethodsThe cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles.ResultsAll implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis.ConclusionsThe HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.

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“…3,6 Moreover, the lack of thorough understanding of the biomechanics, the tribology, the role of wear particles in loosening, and the slow adoption of crosslinked polyethylene (PE) of the ankle joint are the primary obstacles to design a successful ankle implant. 7 The failure mechanisms and function outcomes of the ankle implants are closely related to the in vivo load and motion of the ankle joints. Therefore, it is important to understand these biomechanical parameters of TAA in daily activities for improving the design of the artificial ankle joints.…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal modeling of total ankle arthroplasty using force-dependent kinematics for predicting in vivo joint mechanics

Zhang

Chen

Zhao

et al. 2019

Proc Inst Mech Eng H

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In vivo load and motion in the ankle joint play a key role in the understanding of the failure mechanism and function outcomes of total ankle arthroplasty. However, a thorough understanding of the biomechanics of the ankle joint in daily activities is lacking. The objective of this study was to develop a novel lower extremity musculoskeletal multibody dynamics model with total ankle arthroplasty considering the 6 degrees of freedom of the ankle joint motions and the deformable contact mechanics of the implant, based on force-dependent kinematics method. A patient who underwent total ankle arthroplasty surgery was considered. The walking gait data of the patient was measured in a gait laboratory and used as the input for the patient-specific musculoskeletal modeling. The predictions from the musculoskeletal model of total ankle arthroplasty included dorsiflexion–plantar flexion, inversion–eversion, internal–external rotation, anterior–posterior translation, inferior–superior translation, and medial–lateral translation of the tibiotalar joint, the ankle contact forces, the muscle activations, and the ligament forces. The magnitudes and tendencies of the predicted results were all within reasonable ranges, as compared with the data available in the literature. The predicted peak total ankle contact force was 6.55 body weight. In addition, the peak contact forces of the lateral and medial compartments were 4.22 body weight and 2.59 body weight, respectively. This study provides a potential new platform for the design of a better ankle prosthesis, the improvement of the operation techniques of the clinicians, and the accelerated postoperative recovery of the patients.

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Wear Characteristics of Conventional Ultrahigh-Molecular-Weight Polyethylene Versus Highly Cross-Linked Polyethylene in Total Ankle Arthroplasty

Cited by 26 publications

References 25 publications

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue

Musculoskeletal modeling of total ankle arthroplasty using force-dependent kinematics for predicting in vivo joint mechanics

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