UHMWPE in total knee arthroplasty: successes and failures
DOI:
https://doi.org/10.17533/udea.rcm.n16a01Keywords:
UHMWPE, UHMWPE wear, UHMWPE composites, total knee replacementAbstract
Ultra-high-molecular weight polyethylene (UHMWPE) has been the gold standard for total knee replacements for over five decades and has been modified continuously to diminish its wear rate. Today, total knee replacements have a survival rate of 95 % after ten years, 88.7 after 15 years, and 82 % after 25 years. However, the UHMWPE tibial component service life is often limited to 15 to 20 years, since the wear damage to UHMWPE articulating surfaces is inevitable due to the constant movement of the femoral component over the UHMWPE spacer. UHMWPE wear can be highly accelerated for younger and more active patients, generating a considerable amount of wear debris and leading to premature failure of the component. Adverse reactions in the knee joint surrounding tissue have been reported due to the presence of particles in the range of 0.3 to 2 μm, often leading to osteolysis-induced aseptic loosening of the prosthesis components. Research efforts have focused on improving the wear resistance and overall performance of this material. This review discusses the wear behavior and clinical performance of UHMWPE from a materials science point of view and the existing attempts to improve the wear resistance of this polymer, such as cross-linking through gamma irradiation, vitamin E-stabilization, and incorporation of different nanoparticles.
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