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J Knee Surg 2015; 28(05): 370-375
DOI: 10.1055/s-0035-1551833
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Polyethylene Wear in Knee Arthroplasty

Rajit Chakravarty
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Randa D. K. Elmallah
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Jeffrey Jai Cherian
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Steven M. Kurtz
2   Implant Research Center, Drexel University, Philadelphia, Pennsylvania
,
Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

19 February 2015

26 February 2015

Publication Date:
01 June 2015 (online)

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Abstract

Polyethylene (PE) wear and osteolysis are common causes for late revisions of knee arthroplasties. Several implant and surgical factors have been implicated in contributing to the development of wear, such as type of bearing surface used, inaccurate articular geometry, and poor knee kinematics. In addition, patient-related factors, such as younger age and higher activity levels, may also contribute to wear. Our purpose was to evaluate and compare the effect of these variables on wear rates following knee arthroplasty. Recently, technological advancements have been aimed at reducing the incidence of wear by improving the PE manufacturing process, creating implants that minimize contact stresses, and refining our surgical techniques. Furthermore, the development of newer highly cross-linked PEs (HXLPEs) and the introduction of additives, such as vitamin E, to the PEs may improve overall implant survivorship. As a result, with the advent of newer implant and PE designs, wear is no longer the most common cause of early failure, though it remains an important factor in limiting long-term implant survivorship. However, there are a few clinical studies evaluating the long-term outcomes of newer HXLPEs and implant designs, with further evaluations necessary to determine the best implant–PE combination for improved knee arthroplasty survivorship.

Keywords

knee arthroplasty - polyethylene - wear - TKA - knee arthroplasty
 

  • References

  • 1 Glassman AH, Paul F, Tanzer M. Orthopaedic Knowledge Update: Hip and Knee Reconstruction. AAOS 2011; 408
    PubMedSearch in Google Scholar
  • 2 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
    PubMedSearch in Google Scholar
  • 3 Lachiewicz MP, Lachiewicz PF. Are the relative indications for revision total knee arthroplasty changing?. J Surg Orthop Adv 2009; 18 (2) 74-76
    PubMedSearch in Google Scholar
  • 4 Miller MDT . S.R.; Hart, J.A. Catastrophic Wear in TKA. In: Elsevier, ed. Review of Orthopaedics. Philadelphia: Elsevier; 2012
    Search in Google Scholar
  • 5 Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement. J Bone Joint Surg Am 1986; 68 (7) 1041-1051
    CrossrefPubMedSearch in Google Scholar
  • 6 Paxton EW, Inacio MC, Kurtz S, Love R, Cafri G, Namba RS. Is there a difference in total knee arthroplasty risk of revision in highly crosslinked versus conventional polyethylene?. Clin Orthop Relat Res 2015; 473 (3) 999-1008
    CrossrefPubMedSearch in Google Scholar
  • 7 Schwiesau J, Fritz B, Kutzner I, Bergmann G, Grupp TM. CR TKA UHMWPE wear tested after artificial aging of the vitamin E treated gliding component by simulating daily patient activities. Biomed Res Int 2014; ; doi: 10.1155/2014/567374
    PubMedSearch in Google Scholar
  • 8 Lerf R, Zurbrügg D, Delfosse D. Use of vitamin E to protect cross-linked UHMWPE from oxidation. Biomaterials 2010; 31 (13) 3643-3648
    CrossrefPubMedSearch in Google Scholar
  • 9 Kurtz SM, Dumbleton J, Siskey RS, Wang A, Manley M. Trace concentrations of vitamin E protect radiation crosslinked UHMWPE from oxidative degradation. J Biomed Mater Res A 2009; 90 (2) 549-563
    PubMedSearch in Google Scholar
  • 10 Naudie DD, Ammeen DJ, Engh GA, Rorabeck CH. Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg 2007; 15 (1) 53-64
    PubMedSearch in Google Scholar
  • 11 Muratoglu OK, Ruberti J, Melotti S, Spiegelberg SH, Greenbaum ES, Harris WH. Optical analysis of surface changes on early retrievals of highly cross-linked and conventional polyethylene tibial inserts. J Arthroplasty 2003; 18 (7) (Suppl. 01) 42-47
    CrossrefPubMedSearch in Google Scholar
  • 12 Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL. Factors influencing wear and osteolysis in press-fit condylar modular total knee replacements. Clin Orthop Relat Res 2004; (428) 40-50
    PubMedSearch in Google Scholar
  • 13 Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 2010; 81 (4) 413-419
    CrossrefPubMedSearch in Google Scholar
  • 14 Essner A, Herrera L, Hughes P, Kester M. The influence of material and design on total knee replacement wear. J Knee Surg 2011; 24 (1) 9-17
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Nishikawa K, Okazaki K, Matsuda S , et al. Improved design decreases wear in total knee arthroplasty with varus malalignment. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2635-2640
    CrossrefPubMedSearch in Google Scholar
  • 16 Kwon OR, Kang KT, Son J , et al. Biomechanical comparison of fixed- and mobile-bearing for unicomparmental knee arthroplasty using finite element analysis. J Orthop Res 2014; 32 (2) 338-345
    CrossrefPubMedSearch in Google Scholar
  • 17 Utzschneider S, Harrasser N, Schroeder C, Mazoochian F, Jansson V. Wear of contemporary total knee replacements—a knee simulator study of six current designs. Clin Biomech (Bristol, Avon) 2009; 24 (7) 583-588
    CrossrefPubMedSearch in Google Scholar
  • 18 Kurtz SM, Muratoglu OK, Evans M, Edidin AA. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials 1999; 20 (18) 1659-1688
    CrossrefPubMedSearch in Google Scholar
  • 19 Brach Del Prever EM, Bistolfi A, Bracco P, Costa L. UHMWPE for arthroplasty: past or future?. J Orthop Traumatol 2009; 10 (1) 1-8
    PubMedSearch in Google Scholar
  • 20 Patel AK, Balani K. Dispersion fraction enhances cellular growth of carbon nanotube and aluminum oxide reinforced ultrahigh molecular weight polyethylene biocomposites. Mater Sci Eng C Mater Biol Appl 2015; 46: 504-513
    CrossrefPubMedSearch in Google Scholar
  • 21 Takahashi Y, Masaoka T, Yamamoto K , et al. Vitamin-E blended and infused highly cross-linked polyethylene for total hip arthroplasty: a comparison of three-dimensional crystalline morphology and strain recovery behavior. J Mech Behav Biomed Mater 2014; 36: 59-70
    CrossrefPubMedSearch in Google Scholar
  • 22 Berry DJ, Abdel MP, Callaghan JJ ; Members of the Clinical Research Group. What are the current clinical issues in wear and tribocorrosion?. Clin Orthop Relat Res 2014; 472 (12) 3659-3664
    CrossrefPubMedSearch in Google Scholar
  • 23 Rajpura A, Kendoff D, Board TN. The current state of bearing surfaces in total hip replacement. Bone Joint J 2014; 96-B (2) 147-156
    CrossrefPubMedSearch in Google Scholar
  • 24 Kobayashi K, Kakinoki T, Sakamoto M, Tanabe Y. The effects of strain rate and low-gamma irradiation on the compressive properties of UHMWPE. Biomed Mater Eng 2007; 17 (2) 87-95
    PubMedSearch in Google Scholar
  • 25 Abdelgaied A, Brockett CL, Liu F, Jennings LM, Jin Z, Fisher J. The effect of insert conformity and material on total knee replacement wear. Proc Inst Mech Eng H 2014; 228 (1) 98-106
    CrossrefPubMedSearch in Google Scholar
  • 26 Bradford L, Baker D, Ries MD, Pruitt LA. Fatigue crack propagation resistance of highly crosslinked polyethylene. Clin Orthop Relat Res 2004; (429) 68-72
    PubMedSearch in Google Scholar
  • 27 Cole JC, Lemons JE, Eberhardt AW. Gamma irradiation alters fatigue-crack behavior and fracture toughness in 1900H and GUR 1050 UHMWPE. J Biomed Mater Res 2002; 63 (5) 559-566
    CrossrefPubMedSearch in Google Scholar
  • 28 Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 2011; 469 (8) 2262-2277
    CrossrefPubMedSearch in Google Scholar
  • 29 Muratoglu OK, Bragdon CR, O'Connor DO, Merrill EW, Prenath V, Jasty M, Harris WH. Long term stability of radiation and peroxide cross-linked UHMWPE. Paper presented at the 23rd Annual Meeting of the Society for Biomaterials; New Orleans, LA; April 30–May 4, 1997
    PubMed
  • 30 Shen FW, McKellop H, Salovey R. Improving the resistance to wear and oxidation of acetabular cups of UHMWPE by gamma radiation crosslinking and remelting. Trans 24th Soc Biomater 1998; 21: 3-3
    PubMedSearch in Google Scholar
  • 31 Minoda Y, Aihara M, Sakawa A , et al. Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty. Knee 2009; 16 (5) 348-351
    CrossrefPubMedSearch in Google Scholar
  • 32 Hodrick JT, Severson EP, McAlister DS, Dahl B, Hofmann AA. Highly crosslinked polyethylene is safe for use in total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2806-2812
    CrossrefPubMedSearch in Google Scholar
  • 33 Ries MD, Pruitt L. Effect of cross-linking on the microstructure and mechanical properties of ultra-high molecular weight polyethylene. Clin Orthop Relat Res 2005; 440 (440) 149-156
    CrossrefPubMedSearch in Google Scholar
  • 34 Medel FJ, Peña P, Cegoñino J, Gómez-Barrena E, Puértolas JA. Comparative fatigue behavior and toughness of remelted and annealed highly crosslinked polyethylenes. J Biomed Mater Res B Appl Biomater 2007; 83 (2) 380-390
    PubMedSearch in Google Scholar
  • 35 Kurtz SM, Villarraga ML, Herr MP, Bergström JS, Rimnac CM, Edidin AA. Thermomechanical behavior of virgin and highly crosslinked ultra-high molecular weight polyethylene used in total joint replacements. Biomaterials 2002; 23 (17) 3681-3697
    CrossrefPubMedSearch in Google Scholar
  • 36 Wang A, Yau SS, Essner A, Herrera L, Manley M, Dumbleton J. A highly crosslinked UHMWPE for CR and PS total knee arthroplasties. J Arthroplasty 2008; 23 (4) 559-566
    CrossrefPubMedSearch in Google Scholar
  • 37 Tsukamoto R, Williams PA, Shoji H , et al. Wear of sequentially enhanced 9-Mrad polyethylene in 10 million cycle knee simulation study. J Biomed Mater Res B Appl Biomater 2008; 86 (1) 119-124
    PubMedSearch in Google Scholar
  • 38 Utzschneider S, Paulus A, Datz JC , et al. Influence of design and bearing material on polyethylene wear particle generation in total knee replacement. Acta Biomater 2009; 5 (7) 2495-2502
    CrossrefPubMedSearch in Google Scholar
  • 39 Harwin SF, Greene KA, Hitt K. Early experience with a new total knee implant: maximizing range of motion and function with gender-specific sizing. Surg Technol Int 2007; 16: 199-205
    PubMedSearch in Google Scholar
  • 40 Oral E, Wannomae KK, Rowell SL, Muratoglu OK. Diffusion of vitamin E in ultra-high molecular weight polyethylene. Biomaterials 2007; 28 (35) 5225-5237
    CrossrefPubMedSearch in Google Scholar
  • 41 Rowell SL, Oral E, Muratoglu OK. Comparative oxidative stability of α-tocopherol blended and diffused UHMWPEs at 3 years of real-time aging. J Orthop Res 2011; 29 (5) 773-780
    CrossrefPubMedSearch in Google Scholar
  • 42 Haider H, Weisenburger JN, Kurtz SM , et al. Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty?. J Arthroplasty 2012; 27 (3) 461-469
    CrossrefPubMedSearch in Google Scholar
  • 43 Bichara DA, Malchau E, Sillesen NH, Cakmak S, Nielsen GP, Muratoglu OK. Vitamin E-diffused highly cross-linked UHMWPE particles induce less osteolysis compared to highly cross-linked virgin UHMWPE particles in vivo. J Arthroplasty 2014; 29 (9, Suppl): 232-237
    CrossrefPubMedSearch in Google Scholar
  • 44 Collier MB, Engh Jr CA, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 2007; 89 (6) 1306-1314
    CrossrefPubMedSearch in Google Scholar
  • 45 Feng EL, Stulberg SD, Wixson RL. Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. Clin Orthop Relat Res 1994; (299) 60-71
    PubMedSearch in Google Scholar
  • 46 Benjamin J, Szivek J, Dersam G, Persselin S, Johnson R. Linear and volumetric wear of tibial inserts in posterior cruciate-retaining knee arthroplasties. Clin Orthop Relat Res 2001; (392) 131-138
    PubMedSearch in Google Scholar
  • 47 Lewis P, Rorabeck CH, Bourne RB, Devane P. Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop Relat Res 1994; (299) 11-17
    PubMedSearch in Google Scholar
  • 48 Pang HN, Jamieson P, Teeter MG, McCalden RW, Naudie DD, MacDonald SJ. Retrieval analysis of posterior stabilized polyethylene tibial inserts and its clinical relevance. J Arthroplasty 2014; 29 (2) 365-368
    CrossrefPubMedSearch in Google Scholar
  • 49 Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 1994; (299) 31-43
    PubMedSearch in Google Scholar
  • 50 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    Search in Google Scholar
  • 51 Mont MA, Mahoney OM. Commentary on an article by Sebastien Parratte, MD, PhD, et al.: “Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements”. J Bone Joint Surg Am 2010; 92 (12) e16
    CrossrefPubMedSearch in Google Scholar
  • 52 Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 2003; 85-A (2) 259-265
    PubMedSearch in Google Scholar