Volumetric wear is not the most important damage mechanism affecting polyethylene in knee implants.  Delamination is the primary concern. 8-10

  • S&N does not address delamination, which we believe is the most critical type of polyethylene damage in TKA, particularly with posterior stabilized tibial inserts.8-10  In a retrieval study, Puloski et al. found “severe wear” in the form of delamination of the anterior post surface in 30% of retrieved posterior stabilized tibial inserts.10
  • Resistance to delamination is determined by the oxidation resistance of the polyethylene tibial articular surface.  The process used to create Zimmer Prolong Highly Crosslinked Polyethylene results in a material that is highly oxidation resistant.11  In addition, Prolong Polyethylene has been shown to also be delamination-resistant after multiple aggressive delamination tests. 5,11-14

 

References

  1. Ries MD, Salebi A, Widding K, Hunter G. Polyethylene wear performance of oxidized zirconium and cobalt chrome knee components under abrasive conditions. Scientific Exhibit No. SE16: 69th Annual Meeting of the AmericanAcademy of Orthopaedic Surgeons; February 13-17, 2002; Dallas, Texas.
     
  2. Ries MD, Scott ML, Jani S. Relationship between gravimetric wear and particle generation in hip simulators: conventional compared with cross-linked polyethylene. J Bone Joint Surg. 2001; 83:116-122.
     
  3. McKellop H, Shen F, Lu B, Campbell P, Salovey R. Effect of sterilization method and other modifications on the wear resistance of acetabular cups made of ultra-high molecular weight polyethylene: a hip-simulator study. J Bone Joint Surg. 2000; 82-A(12):1708-1725.
     
  4. McKellop H, Shen F, Campbell P, Ota T. Effect of molecular weight, calcium stearate, and sterilization methods on the wear of ultra high molecular weight polyethylene acetabular cups in a hip joint simulator.  J Orthop Res. 1999;17(3):329-339.
     
  5. Laurent MP, Yao JQ, Bhambri S, et al. High cycle wear of highly crosslinked UHMWPE tibial articular surfaces evaluated in a knee wear simulator. 28th Annual Meeting Transactions, Society for Biomaterials. 2002:712.
     
  6. Good V, Ries MD, Barrack RL, Widding K, Gordon BH, Heuer D. Reduced wear with oxidized zirconium femoral heads. Scientific Exhibit No. SE213: 70th Annual Meeting of the AmericanAcademy of Orthopaedic Surgeons; February 5-9, 2003; New Orleans, Louisiana.
     
  7. Spector M, Ries MD, Bourne RB, Sauer WS, Long M, Hunter G. Wear performance of ultra-high molecular weight polyethylene on oxidized zirconium total knee femoral components. J Bone Joint Surg. 2001;83-A(suppl 2, pt 2):80-86.
     
  8. Haman JD, Bechtol N, Jacobs JJ, Rosenberg AG, Berger RA, Wimmer MA. Tibial post damage in TKA’s is associated with tibial plateau damage . Paper presented at: 49th Annual Meeting of the Orthopaedic Research Society; 2003.
     
  9. Banks SA, Harman MK, Hodge WA. Mechanism of anterior impingement damage in total knee arthroplasty. J Bone Joint Surg. 2002;84-A(2):37-42.
     
  10. Puloski SKT, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB. Tibial post wear in posterior-stabilized total knee arthroplasty: an unrecognized source of polyethylene debris. J Bone Joint Surg. 2001;83-A:390-397.
     
  11. Yao JQ, Blanchard CR, Lu X, et al. Improved resistance to wear, delamination and posterior loading fatigue damage of electron beam irradiated, melt-annealed, highly crosslinked UHMWPE knee inserts. Standard Technical Publication 1445. ASTM International. 2004.
     
  12. Yao JQ, Gsell R, Laurent MP, Gilbertson LN , Swarts D, Blanchard CR, Crowninshield RD. I mproved delamination resistance of melt-annealed electron-beam irradiated highly crosslinked UHMWPE knee inserts. 28th Annual Meeting Transactions, Society for Biomaterials. 2002:60.
     
  13. Yao JQ, Lu X, Laurent MP, Gilbertson LN, Crowninshield RD. Pitting/delamination resistance of melt-annealed highly crosslinked UHMWPE . 27th Annual Meeting Transactions, Society for Biomaterials. 2001:482.
     
  14. Maher SA, Furman BD, Wright TM. Reduced fracture toughness of enhanced cross-linked polyethylene is not associated with increased wear damage. 28th Annual Meeting Transactions, Society for Biomaterials. 2002:542.
     
  15. ASTM Metal Handbook: Specifications for Hot-Rolled and Cold-Finished Zirconium and Zirconium Alloy Bars, Rod, and Wire Products. 1990.
     
  16. Niki Y, Matsumoto H, Otani T, Yatabe T, Kondo M, Yoshimine F, Toyama Y. Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty. Biomaterials. 2005;26:1019-1026.
     
  17. Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg. 2001;83-A(3):428-436.