UHMWPE Biomaterials for Joint Implants: Structures, Properties and Clinical Performance

347 Pages·2019·13.858 MB·English

by  Jun Fu, Zhong-Min Jin, Jin-Wu Wang

Springer Series in Biomaterials Science and
Engineering 13
Jun Fu
Zhong-Min Jin
Jin-Wu Wang Editors
UHMWPE
Biomaterials for
Joint Implants
Structures, Properties and Clinical
Performance
Springer Series in Biomaterials Science
and Engineering
Volume 13
Series editor
Prof. Min Wang
Department of Mechanical Engineering
The University of Hong Kong
Pokfulam Road, Hong Kong
e-mail: [email protected]
Aimsandscope
The Springer Series in Biomaterials Science and Engineering addresses the manu-
facture,structureandproperties,andapplicationsofmaterialsthatareincontactwith
biological systems, temporarily or permanently. It deals with many aspects of
modern biomaterials, from basic science to clinical applications, as well as host
responses.Itcoversthewholespectrumofbiomaterials–polymers,metals,glasses
and ceramics, and composites/hybrids – and includes both biological materials
(collagen, polysaccharides, biological apatites, etc.) and synthetic materials. The
materials can be in different forms: single crystals, polycrystalline materials, parti-
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developing areas of biomaterials, such as nano-biomaterials and diagnostic and
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The Springer Series in Biomaterials Science and Engineering aims to provide
critical reviews of important subjects in the field, publish new discoveries and
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goalofeachvolumeistogivereadersacomprehensiveoverviewofanareawhere
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Moreinformationaboutthisseriesathttp://www.springer.com/series/10955
(cid:129) (cid:129)
Jun Fu Zhong-Min Jin Jin-Wu Wang
Editors
UHMWPE Biomaterials
for Joint Implants
Structures, Properties and Clinical
Performance
Editors
JunFu Zhong-MinJin
NingboInstituteofMaterials TribologyResearchInstitute,Schoolof
Technology&Engineering MechanicalEngineering
ChineseAcademyofSciences SouthwestJiaotongUniversity
Ningbo,Zhejiang,China Chengdu,Sichuan,China
Jin-WuWang
ShanghaiKeyLaboratory
ofOrthopaedicImplants
DepartmentofOrthopaedicSurgery
ShanghaiNinthPeople’sHospital
ShanghaiJiaotongUniversity
SchoolofMedicine
Shanghai,China
ISSN2195-0644 ISSN2195-0652 (electronic)
SpringerSeriesinBiomaterialsScienceandEngineering
ISBN978-981-13-6923-0 ISBN978-981-13-6924-7 (eBook)
https://doi.org/10.1007/978-981-13-6924-7
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Preface
Joint arthroplasty has been the clinical choice to restore the function of
malfunctioningjoints.Artificialjointprosthesisisusedtoreplacethediseasedjoints.
In the components of contemporary joint implants, the articulating surfaces have
been widely recognized critical for the in vivo performance and longevity of the
prosthesis. The articulating surface configurations can be classified as metal-on-
metal, ceramic-on-ceramic, metal-on-polyethylene, or ceramic-on-polyethylene.
Here, the polyethylene is referred to medical-grade ultrahigh molecular weight
polyethylene, or UHMWPE, with the average molecular weight over 1,500,000 g
per mole. UHMWPE is advantageous over most other materials for its excellent
biocompatibility, bioinertness, chemical resistance, high strength and toughness,
low coefficient of friction, and low wear, which are desired for artificial joints. It
has been the material of choice for both hip and knee since the early 1960s, when
JohnCharnleyfirstintroducedUHMWPEtomanufacturethearticularlinersforhip
prosthesis.
Theaimofthisbookistogiveageneralandcomprehensiveintroductiontothe
fundamental of UHMWPE as biomaterials for joint implants, major challenges of
UHMWPEcomponentinhistory,andthemostimportantrecentprogressesofhigh-
performance UHMWPE. The chemistry, physics, and mechanisms of the strength,
toughness, wear, oxidation, and stabilization are discussed in detail. Moreover,
biomechanicsandbiotribologyofartificialprosthesisareintroduced.Italsopresents
clinical diagnostic methods to analyze the in vivo performance and to diagnose or
predictthefailureoftheprosthesis.
In history, UHMWPE implants have experienced very bad problems in clinical
use. The cyclic articulating of femoral head against the UHMWPE liner produces
numerous wear debris that migrate to the surrounding tissue and cause osteolysis.
Moreover, early sterilization by gamma has made it even worse. The free radicals
generated during radiation sterilization cause cascade oxidation of polyethylene
on-shelf and in vivo, whichseverely deteriorates thestrength and toughnessofthe
polymer and accelerates wear and failure of implants. In the 1980s, wear-related
problemsarereportedtoaccountforalargeamountoftherevisionalsurgeries.
v
vi Preface
Thebaddemandofwear-resistantmaterialshasstimulatedextensiveinnovations
toimprove thewearresistanceofUHMWPE.Inthe1990s, diverse strategies have
been developed to reduce the wear rate. Based on the wear mechanism that poly-
ethylene fibers are generated due to plastic flow and fractured upon cyclic shear,
cross-linking of the polymer chains is proposed to reduce wear by counteracting
against the mechanism. High-dose radiation cross-linking has been successfully
used to reduce the wear rate of polyethylene by 90% or more. Highly cross-linked
UHMWPEhasbeenapprovedforclinicalapplicationsin1998.Sincethen,millions
of joint implants based on highly cross-linked UHMWPE have been implanted in
patients. The 20-year clinical outcomes have become very positive. Wear-related
revisional surgeries have been largely reduced according to multicenter follow-up
studies.
Oxidationofhighlycross-linkedUHMWPEremainsachallengeforbothinvivo
service and on-shelf behavior. This book will introduce some recent progresses on
the use of very potent antioxidants, i.e., natural polyphenols, to stabilize highly
cross-linked UHMWPE, which show outstanding strength, toughness, oxidation
resistance, and low wear rate in comparison to the first-generation highly cross-
linked UHMWPE. The oxidation and antioxidation mechanisms will be analyzed
anddiscussedindetail.
The success of UHMWPE in joint implants would not be possible without the
developmentofbiomechanicsandbiotribologyofjoints.Thedailygaitingcontains
sophisticated biomechanics and tribology that can never be described by using a
simplemodel.Thisbookintroducessomefundamentalsandrecentprogressonthe
biomechanicsandtribologyoftotalhipandkneeimplants.
The clinical performance of the permanent joint prosthesis has to be regularly
monitored to evaluate their in vivo status and predict any possible problems.
Objective assessment methods based on medical imaging have been widely devel-
oped and clinically used. This book will introduce the use of Roentgen
stereophotogrammetricanalysistechniquetodetectthelooseningofhipprosthesis.
ThisbookaimstoofferstudentswithfundamentalknowledgeonUHMWPEas
biomaterials. Senior biomedical engineers, polymer scientists, joint implant pro-
fessionals,andphysicianswillfindin-depthdetailsontheresearchmethods,exper-
iments,andlatestprogressonUHMWPEmaterials.
Itwouldnotbepossibletoaccomplishthisbookwithouttheoutstandingcontri-
butions from the coeditors, Professor Zhong-Min Jin, and Professor Jin-Wu Wang
andtheirteams.Iamverygratefultotheauthorsforwritingtheimportantchapters.
ProfessorLuigiCostafromTurinUniversityisalongtimefriendandalwaysbrings
newideas,particularlyontheoxidationandantioxidationmechanisms.Hisexpertise
onFTIRspectroscopydefinitelybenefitsmeandmystudents.ProfessorShuxinQu
has made great contributions to the UHMWPE biomaterials by introducing drugs
into the polymer to depress osteolysis since wear is inevitable so far. I’m also
indebted to Professor Ebru Oral and Professor Orhun K. Muratoglu who were my
advisors during my stay in the Harris Orthopaedics Laboratory at Massachusetts
GeneralHospital.
Preface vii
Finally,Iwouldliketothankmyteammemberswhohelpmealotinthechapter
writingandexperimentsonUHMWPEbiomaterials.
Ningbo,China JunFu
December2018
Contents
1 ClinicalApplicationsofUHMWPEinJointImplants............. 1
JingChen,GuorongGao,andJunFu
2 HighlyCrosslinkedUHMWPEforJointImplants................ 21
GuorongGaoandJunFu
3 OxidationinProstheticUHMWPE.............................. 69
L.Costa
4 NaturalPolyphenol-StabilizedHighlyCross-LinkedUHMWPE
forJointImplants.............................................. 93
JunFu
5 High-TemperatureMelted,Cross-Linked,andStabilized
UltrahighMolecularWeightPolyethylene........................ 115
JunFu,EbruOral,andOrhunK.Muratoglu
6 Drug-LoadedUHMWPEtoInhibitWearParticle-Induced
Osteolysis:Processing,Characterization,andBiological
Evaluation..................................................... 151
ShuxinQu,YumeiLiu,andKemengGong
7 BiomechanicsandTribologyofArtificialKneeJoint.............. 191
ZhenxianChen,JingZhang,XiaoZhang,andZhong-MinJin
8 BiomechanicsandBiotribologyofUHMWPEArtificial
HipJoints...................................................... 241
YongchangGaoandZhong-MinJin
ix
x Contents
9 ClinicalApplicationofRoentgenStereophotogrammetric
AnalysisTechniquetoDetectHipAsepticLoosening.............. 287
Jin-WuWang,Yuan-JingXu,HanYang,andKe-RongDai
10 WearandDiagnosticAnalysisofClinicalFailures
ofArtificialHipJoints.......................................... 317
Jin-WuWang,HanYang,Cheng-TaoWang,Zhong-MinJin,
andKe-RongDai