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Vitamin E diffused, highly crosslinked UHMWPE: a review

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Abstract

Highly crosslinked UHMWPE has become the bearing surface of choice in total hip arthroplasty. First generation crosslinked UHMWPEs, clinically introduced in the 1990s, show significant improvements compared to gamma sterilised, conventional UHMWPE in decreasing wear and osteolysis. These crosslinked UHMWPEs were thermally treated (annealed or melted) after irradiation to improve their oxidation resistance. While annealing resulted in the retention of some oxidation potential, post-irradiation melted UHMWPEs had reduced fatigue strength due to the crystallinity loss during melting. Thus, the stabilisation of radiation crosslinked UHMWPEs by the diffusion of the antioxidant vitamin E was developed to obtain oxidation resistance with improved fatigue strength by avoiding post-irradiation melting. A two-step process was developed to incorporate vitamin E into irradiated UHMWPE by diffusion to obtain a uniform concentration profile. Against accelerated and real-time aging in vitro, this material showed superior oxidation resistance to UHMWPEs with residual free radicals. The fatigue strength was improved compared to irradiated and melted UHMWPEs crosslinked using the same irradiation dose. Several adverse testing schemes simulating impingement showed satisfactory behaviour. Peri-prosthetic tissue reaction to vitamin E was evaluated in rabbits and any effects of vitamin E on device fixation were evaluated in a canine model, both of which showed no detrimental effects of the inclusion of vitamin E in crosslinked UHMWPE. Irradiated, vitamin E-diffused, and gamma sterilised UHMWPEs have been in clinical use in hips since 2007 and in knees since 2008. The clinical outcome of this material will be apparent from the results of prospective, randomised clinical studies.

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Authors and Affiliations

  1. Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit St. GRJ 1206, Boston, MA, 02114, USA

    Ebru Oral & Orhun K. Muratoglu

  2. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Ebru Oral & Orhun K. Muratoglu

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  1. Ebru Oral
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  2. Orhun K. Muratoglu
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Correspondence to Ebru Oral.

Additional information

The studies discussed here were performed by research funding in part from NIH/NIAMS AR051142, research grants from Biomet, Inc. (Warsaw, IN) and Zimmer, Inc (Warsaw, IN) and the William H. Harris Foundation. The laboratory and the department also received funding from royalties from Zimmer, Inc. and Biomet, Inc. Dr. Muratoglu received royalties from Biomet, Inc. and Zimmer, Inc. Dr. Oral received royalties from Zimmer, Inc.

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Oral, E., Muratoglu, O.K. Vitamin E diffused, highly crosslinked UHMWPE: a review. International Orthopaedics (SICOT) 35, 215–223 (2011). https://doi.org/10.1007/s00264-010-1161-y

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