The effect of vitamin E-enhanced cross-linked polyethylene on wear in shoulder arthroplasty-a wear simulator study.

BACKGROUND: Wear of the polyethylene glenoid component and subsequent particle-induced osteolysis remains one of the most important modes of failure of total shoulder arthroplasty. Vitamin E is added to polyethylene to act as an antioxidant to stabilize free radicals that exist as a byproduct of irradiation used to induce cross-linking. This study was performed to assess the in vitro performance of vitamin E-enhanced polyethylene compared with conventional polyethylene in a shoulder simulator model. METHODS: Vitamin E-enhanced, highly cross-linked glenoid components were compared with conventional ultrahigh-molecular-weight polyethylene glenoids, both articulating with a ceramic humeral head component using a shoulder joint simulator over 500,000 cycles. Unaged and artificially aged comparisons were performed. Volumetric wear was assessed by gravimetric measurement, and wear particle analysis was also subsequently performed. RESULTS: Vitamin E-enhanced polyethylene glenoid components were found to have significantly reduced wear rates compared with conventional polyethylene in both unaged (36% reduction) and artificially aged (49% reduction) comparisons. There were no differences detected in wear particle analysis between the 2 groups. CONCLUSION: Vitamin E-enhanced polyethylene demonstrates improved wear compared with conventional polyethylene in both unaged and artificially aged comparisons and may have clinically relevant benefits.

Edge loading does not increase wear rates of ceramic-on-ceramic and metal-on-polyethylene articulations.

The mal-positioning of total hip arthroplasty components can result in edge loading conditions. Purpose of this study was to determine if the wear rate of ceramic-on-ceramic and metal-on-polyethylene increases under edge loading conditions. The literature was reviewed to determine which of the commonly used hip bearings is the most forgiving to implant mal-orientation. Two 28-mm ceramic-on-ceramic articulations were tested in vitro: pure alumina (PAL) ceramic versus the new alumina-toughened zirconia (ATZ). Two 28-mm metal-on-polyethylene articulations were tested in vitro: conventional ultrahigh molecular weight polyethylene (UHMWPE) versus highly crosslinked polyethylene (HXLPE) stabilized with vitamin E. All bearings were tested at standard and at highest possible inclination angles. Hip simulator tests were run for five million cycles based on N = 3 tests per condition. The average wear rate of ATZ-on-ATZ is 0.024 mm(3) /Mcycles at 45° and 0.018 mm(3) /Mcycles at 65°. Wear rate of PAL-on-PAL is between 0.02 and 0.03 mm(3) /Mcycles at 45°, as well as 65°. The wear rate of UHMWPE was 31 ± 1 mm(3) /Mcycles at an inclination angle of 45° and 26 ± 1 mm(3) /Mcycles at 80°. The wear rate of vitamin E stabilized HXLPE was 5.9 ± 0.2 mm(3) /Mcycles at 45° and 5.8 ± 0.2 mm(3) /Mcycles at 80°. Edge loading does not increase the wear rate of ceramic-on-ceramic and metal-on-polyethylene articulations. The newest biomaterials showed markedly lower wear rates compared with their conventional counterparts. ATZ-on-ATZ showed the lowest wear rate of all tested pairings, but the vitamin E stabilized HXLPE seems to be the most forgiving material when it comes to implant mal-orientation.

Use of vitamin E to protect cross-linked UHMWPE from oxidation.

Wear and oxidative degradation may limit the life span of UHMWPE implants. Cross-linking and stabilisation by vitamin E are proposed to overcome wear and degradation. The present investigation takes a close look to the oxidative behaviour of cross-linked and stabilised UHMWPE. First, the consolidated vitamin E stabilised UHMWPE was qualified in terms of microstructure and homogeneity of the distribution of the additive to be suitable for oxidation profiles over the entire section. Then cross-linked samples with five different concentrations of vitamin E (nil to 1.0%) underwent two different ageing protocols. The first was under pressurized oxygen at 70 degrees C, as defined in the ASTM F 2003 standard with a prolonged period of 60 days, the second was in 5% aqueous hydrogen peroxide solution with iron (III) chloride as catalyst at 50 degrees C. The first accelerated ageing protocol showed that a vitamin E concentration as low as 0.05% is effective to protect irradiated highly cross-linked UHMWPE against oxidation when exposed direct to oxygen. Vitamin E stabilised, highly cross-linked UHMWPE exhibits therefore no oxidation potential origination from the irradiation treatment. Analysis of samples treated by the second chemical ageing yielded, that vitamin E is effective to prolong initial stability against a supplementary attack of hydrogen peroxide and reactive radicals. The time period of stability against the aggressive hydrogen peroxide solution increases with increasing vitamin E content. However, even 0.05% have a marked stabilisation effect. Therefore, such small additions of vitamin E are effective to protect the UHMWPE material against a supplementary exposure to in vivo oxidation after the irradiation treatment. In conclusion, vitamin E shields cross-linked UHMWPE for orthopaedic application against oxidation in the heat of consolidation, during irradiation treatment and finally while implanted in the human body.

Electrochemical corrosion and metal ion release from Co-Cr-Mo prosthesis with titanium plasma spray coating.

The corrosion behavior of CoCrMo implants with rough titanium coatings, applied by different suppliers by either sintering or vacuum plasma spraying, has been evaluated and compared with uncoated material. The open-circuit potential, corrosion current and polarization resistance were determined by electrochemical techniques. The Co, Cr and Ti ions released from the samples into the electrolyte during a potentiostatic extraction technique were analyzed using ICP-MS. The Ti coatings from the different suppliers showed a different porous morphology, and the implants exhibited a distinct corrosion activity, underlining the importance of the coating process parameters. Among the titanium coated samples, the one with the sintered overcoat turned out to be the most resistant. Yet, on an absolute scale, they all showed a corrosion resistance inferior to that of uncoated CoCrMo or wrought titanium.