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Journal article
Oxidation and Damage Mechanisms of 2nd Generation Highly Cross-Linked Polyethylene Tibial Inserts
The journal of arthroplasty, v 39(12)
18 Jun 2024
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Abstract
Introduction
After clinical introduction in 2005, sequentially annealed, highly crosslinked polyethylene (SA HXLPE) was studied for retrievals with short implantation times; however, long-term follow-ups are lacking. The objective of this study was to examine and compare the revision reasons, damage mechanisms, and oxidation indices (OI) of SA HXLPE and conventional gamma-inert sterilized (Gamma Inert) ultra-high molecular weight polyethylene tibial inserts implanted for > 5 years.
Methods
There were 74 total knee arthroplasty (TKA) tibial inserts (46 SA HXLPEs, 28 Gamma Inerts) implanted for > 5 years (mean 7 ± 2 years) retrieved as part of a multicenter retrieval program. Cruciate-retaining implants comprised 44% of the SA HXLPEs and 14% of the Gamma Inerts. Patient factors and revision reasons were collected from revision operating notes. A semi-quantitative scoring method was used to assess surface damage mechanisms. Oxidation was measured using Fourier transform infrared microscopy according to American Society for Testing and Materials (ASTM) 2102. Differences between cohorts were assessed with Mann-Whitney U-Tests.
Results
Loosening (Gamma Inert: 17 of 28, SA HXLPE: 15 of 46) and instability (Gamma Inert: 6 of 28, SA HXLPE: 15 of 46) were the most common revision reasons for both cohorts. The most prevalent surface damage mechanisms were burnishing, pitting, and scratching, with burnishing of the condyles being higher in Gamma Inert components (P = 0.022). Mean oxidation was higher in the SA HXLPE inserts at the articulating surface (P = 0.002) and anterior-posterior (AP) faces (P = 0.023). No difference was observed at the backside surface (P = 0.060).
Conclusions
Revision reasons and surface damage mechanisms were comparable in the Gamma Inert and SA cohorts. Further studies are needed to continue to assess the in vivo damage and clinical relevance, if any, of oxidation in SA HXLPE over longer implantation times, particularly for implants implanted for more than 10 years.
Metrics
Details
- Title
- Oxidation and Damage Mechanisms of 2nd Generation Highly Cross-Linked Polyethylene Tibial Inserts
- Creators
- Tabitha Derr (Corresponding Author) - Drexel University, Graduate School of Biomedical Sciences and Professional StudiesDaniel W MacDonald - Drexel University, School of Biomedical Engineering, Science, and Health SystemsArthur L. Malkani - University of LouisvilleMichael A. Mont - Sinai HospitalNicolas S. Piuzzi - Cleveland ClinicSteven M Kurtz - Drexel University, School of Biomedical Engineering, Science, and Health Systems
- Publication Details
- The journal of arthroplasty, v 39(12)
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Academic Unit
- Graduate School of Biomedical Sciences and Professional Studies; School of Biomedical Engineering, Science, and Health Systems
- Web of Science ID
- WOS:001356214200001
- Scopus ID
- 2-s2.0-85199266890
- Other Identifier
- 991021886514804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Orthopedics