Abstract
In vitro studies demonstrating excessive wear in polyethylene cups sterilized using gamma irradiation and stored in air led to the abandonment of this sterilization technique. We evaluated the clinical wear performance of a metal femoral component on a polyethylene cup in a hip prosthesis from a selected subset of implants in a group of patients followed for at least 20 years and assessed the time dependency of variation in penetration rates. We measured penetration in 33 polyethylene cups in 25 patients who had a Charnley low-friction arthroplasty between 1982 and 1984. All patients had Charnley Ogee® cups implanted for more than 20 years and sterilized using the gamma irradiation in air technique. If degradation occurred over time in vivo, it was not reflected by an increased penetration rate with increasing time in vivo; even after 20 years of implantation, the degree of wear remained low. This suggests gamma irradiation affects wear on ultra-high-molecular-weight polyethylene by reducing wear secondary to the crosslinking, by increasing wear as shown through in vitro studies of heavily oxidized samples, or by oxidation resulting from prolonged shelf life. The effect of progressive oxidation in vivo does not appear to affect wear in vivo.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Acknowledgments
We thank Laura McCann (iMBE, University of Leeds) and David Sharples (Leeds Teaching Hospitals) for assistance in digitizing the radiographs and Drs Richard Hall and Ruth Wilcox in using the measurement method described.
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Four authors (SW, JF, NP, JO) certify they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. One author (GI) is an employee of DePuy International.
Each author certifies that his or her institution did not require approval for this investigation and that all investigations were conducted in conformity with the ethical principles of research.
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Williams, S., Isaac, G., Porter, N. et al. Long-term Radiographic Assessment of Cemented Polyethylene Acetabular Cups. Clin Orthop Relat Res 466, 366–372 (2008). https://doi.org/10.1007/s11999-007-0072-8
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DOI: https://doi.org/10.1007/s11999-007-0072-8