The UHMWPE Handbook – Ultra-High Molecular Weight Polyethylene in Total Joint Replacement

The UHMWPE Handbook – Ultra-High Molecular Weight Polyethylene in Total Joint Replacement
Steven M. Kurtz, Ph.D.
Principal Engineer, Exponent, Inc.
Research Associate Professor, Drexel University
3401 Market Street, Suite 300
Philadelphia, PA 19104
Contents
Contributors xi
Preface xiii

1. A Primer on UHMWPE 1
   Introduction 1
   What Is a Polymer? 2
   What Is Polyethylene? 4
   Crystallinity 6
   Thermal Transitions 7
   Overview of the Handbook 9
2. From Ethylene Gas to UHMWPE Component: The Process
   of Producing Orthopedic Implants 13
   Introduction 13
   Polymerization: From Ethylene Gas to UHMWPE Powder 14
   Conversion: From UHMWPE Powder to Consolidated Form 22
   Machining: From Consolidated Form to Implant 31
   Conclusion 32
3. Packaging and Sterilization of UHMWPE 37
   Introduction 37
   Gamma Sterilization in Air 38
   Gamma Sterilization in Barrier Packaging 41
   Ethylene Oxide Gas Sterilization 44
   Gas Plasma Sterilization 45
   Shelf Life of UHMWPE Components for Total Joint Replacement 47
   Overview of Current Trends 48
4. The Origins of UHMWPE in Total Hip Arthroplasty 53
   Introduction and Timeline 53
   The Origins of a Gold Standard (1958–1982) 55
   Charnley’s First Hip Arthroplasty Design with PTFE (1958) 56
   Implant Fixation with Pink Dental Acrylic Cement (1958–1966) 56
   Interim Hip Arthroplasty Designs with PTFE (1958–1960) 58Final Hip Arthroplasty Design with PTFE (1960–1962) 58
   Implant Fabrication at Wrightington 61
   The First Wear Tester 62
   Searching to Replace PTFE 64
   UHMWPE Arrives at Wrightington 66
   Implant Sterilization Procedures at Wrightington 66
   Overview 68
5. The Clinical Performance of UHMWPE in Hip Replacements 71
   Introduction 71
   Joint Replacements Do Not Last Forever 73
   Range of Clinical Wear Performance in Cemented
   Acetabular Components 75
   Wear Versus Wear Rate of Hip Replacements 77
   Comparing Wear Rates Between Different Clinical Studies 79
   Comparison of Wear Rates in Clinical and Retrieval Studies 82
   Current Methods for Measuring Clinical Wear in
   Total Hip Arthroplasty 83
   Range of Clinical Wear Performance in Modular Acetabular
   Components 85
   Conclusion 86
6. Alternatives to Conventional UHMWPE for Hip Arthroplasty 93
   Introduction 93
   Metal-on-Metal Alternative Hip Bearings 94
   Ceramics in Hip Arthroplasty 101
   Highly Crosslinked and Thermally Stabilized UHMWPE 109
   Summary 114
7. The Origins and Adaptations of UHMWPE for Knee
   Replacements 123
   Introduction 123
   Frank Gunston and the Wrightington Connection to
   Total Knee Arthroplasty 126
   Polycentric Knee Arthroplasty 129
   Unicondylar Polycentric Knee Arthroplasty 132
   Bicondylar Total Knee Arthroplasty 134
   Patello–Femoral Arthroplasty 141
   UHMWPE with Metal Backing 142
   Conclusion 146
8. The Clinical Performance of UHMWPE in Knee Replacements 151
   Introduction 151
   Biomechanics of Total Knee Arthroplasty 153
   Clinical Performance of UHMWPE in Knee Arthroplasty 160
   Osteolysis and Wear in Total Knee Arthroplasty 172
   UHMWPE Is the Only Alternative for Knee Arthroplasty 182
   viii Contents9. The Clinical Performance of UHMWPE in Shoulder
   Replacements 189
   Stefan Gabriel
   Introduction 189
   The Shoulder Joint 190
   Shoulder Replacement 191
   Biomechanics of Total Shoulder Replacement 195
   Contemporary Total Shoulder Replacements 197
   Clinical Performance of Total Shoulder Arthroplasty 203
   Controversies in Shoulder Replacement 207
   Future Directions in Total Shoulder Arthroplasty 211
   Conclusion 213
9. The Clinical Performance of UHMWPE in the Spine 219
   Marta L. Villarraga and Peter A. Cripton
   Introduction 219
   Biomechanical Considerations for UHMWPE in the Spine 222
   Total Disc Replacement Designs Using UHMWPE 226
   Clinical Performance of UHMWPE in the Spine 237
   Alternatives to UHMWPE for Total Disc Arthroplasty in the Spine 239
   Conclusion 240
10. Mechanisms of Crosslinking and Oxidative Degradation
    of UHMWPE 245
    Luigi Costa and Pierangiola Bracco
    Introduction 245
    Mechanisms of Crosslinking 245
    UHMWPE Oxidation 250
    Oxidative Degradation after Implant Manufacture 256
    In Vivo Absorption of Lipids 257
11. Characterization of Physical, Chemical, and Mechanical
    Properties of UHMWPE 263
    Stephen Spiegelberg
    Introduction 263
    What Does the Food and Drug Administration Require? 264
    Physical Property Characterization 265
    Intrinsic Viscosity 269
    Chemical Property Characterization 274
    Mechanical Property Characterization 280
    Other Testing 284
    Conclusion 284
12. Development and Application of the Small Punch Test to
    UHMWPE 287
    Avram Allan Edidin
    Introduction 287
    Contents ixOverview and Metrics of the Small Punch Test 288
    Accelerated and Natural Aging of UHMWPE 291
    In Vivo Changes in Mechanical Behavior of UHMWPE 294
    Effect of Crosslinking on Mechanical Behavior and Wear 295
    Shear Punch Testing of UHMWPE 298
    Fatigue Punch Testing of UHMWPE 301
    Conclusion 305
13. Computer Modeling and Simulation of UHMWPE 309
    Jörgen Bergström
    Introduction 309
    Overview of Available Modeling and Simulation Techniques 310
    Characteristic Material Behavior of UHMWPE 311
    Material Models for UHMWPE 317
    Discussion 334
14. Compendium of Highly Crosslinked and Thermally Treated
    UHMWPEs 337
    Introduction 337
    Honorable Mention 338
    Crossfire 339
    DURASUL 342
    Longevity 345
    Marathon 348
    Prolong 351
    XLPE 352
    Current Trends and Prevalence in Total Hip and
    Total Knee Arthroplasty 353
    The Future for Highly Crosslinked UHMWPE 357
    Appendix 365
    Index 369
    A
    Accelerated aging tests, 284, 291–293
    Acid formation, 252
    Aeonian™, 338–339
    Aequalis™/Aequalis™ Fracture
    shoulder prosthesis system
    components, 202
    Aging tests, 284, 291–293
    Air permeable packaging. See Gas
    permeable packaging
    Alkyl macroradicals (R•), 254–256
    Alumina ceramic(s)
    femoral heads, 105–106
    in vivo fracture risk, 108–109
    hip bearings, 102, 103t, 104
    introduction of, 53
    Alumina composite material, 103t, 105
    American Society for Testing and
    Materials (ASTM)
    standard D4020-01A, 265
    standard F648, 15, 265
    Analytical closed-form solution
    methods, 310, 311t
    Anatomical Shoulder™ system
    components, 198f, 199
    Anterior-posterior (A-P) radiographs,
    176–177, 178f
    A-P radiographs, 176–177, 178f
    ArCom™
    barrier packaging, 42f
    processing, 27, 28f, 29
    Arthritis
    osteoarthritis
    hip complications, 132
    shoulder complications, 190–191
    shoulder complications, 193
    Arthritis (Continued)
    osteoarthritis, 190–191
    rheumatoid arthritis, 190
    Artificial disc replacement. See Total disc
    arthroplasty/replacement
    (TDA/TDR)
    Aseptic loosening, 73–74
    ASTM standard D4020-01A, 265
    ASTM standard F648, 15, 265
    Average radiographic wear, 78
    Averill, Robert, 194
    B
    Balloon lesions, 176
    Barrier packaging
    air permeable packaging, replacement
    of, 39
    gamma sterilization in, 41–44
    Basell Polyolefins, 16–17
    Bi-Angular® shoulder prosthesis system
    components, 197f, 198
    Bicondylar knee arthroplasty, 125
    cruciate-sacrificing designs, 134,
    136–141
    cruciate-sparing designs,
    134–136
    Bigliani/Flatow® humeral prostheses,
    202
    Bio-Modular® shoulder prosthesis
    system components, 197
    BiPolar shoulder prosthesis system
    components, 198
    Bolland’s cycle, 250
    “Bow-tie” wear scar, 182, 183f
    Branched polymers, 3
    Bryan, Richard, 129
    IndexC
    Calcium stearate, 21–22
    Ceramic-on-ceramic (COC) alternative
    hip bearings, 93–94, 101
    alumina ceramics, 102, 103t, 104
    femoral heads, 105–106
    in vivo fracture risk, 108–109
    alumina composite material,
    103t, 105
    contemporary designs, 106–108
    historical overview, 101–102
    in vivo fracture risk, 108–109
    zirconia, 102, 103t, 104–105
    failure rate, 109
    Chain folding, 6
    Change in enthalpy, 8
    Characteristic material response, 311–317
    Charnley, Sir John, 53. See also
    Wrightington Hospital
    artificial joint design, 55
    filled PTFE experimentation, 64–65
    hip arthroplasty
    pink dental acrylic cement, use of,
    56–57
    wear performance study, 79–82
    hip arthroplasty designs
    first design with PTFE, 56
    second, third and fourth designs
    with PTFE, 58
    fifth and final design with PTFE,
    58–60
    knee replacement design, 129, 135f
    Thompson prostheses, implantation
    of, 65
    UHMWPE, first reaction to, 66
    Chas. F. Thackray Ltd., 67
    Chemical characterization, 274
    Chemical testing
    electron spin resonance spectroscopy,
    276–277, 278f
    Fourier transform infrared
    spectroscopy, 274–276
    gel permeation chromatography,
    270–271
    swell ratio testing, 278–280
    trace element analysis, 274
    CHIRULEN®, 16–17, 24
    SB Charité™ III implants, 227
    COC alternative hip bearings.
    See Ceramic-on-ceramic (COC)
    alternative hip bearings
    Cofield™/Cofield2™, Monoblock
    shoulder prosthesis system
    components, 201
    Compression molding, 24–25
    direct compression molding, 27, 29
    Compressive response, 313–314
    Computer-assisted radiographic wear
    measurement
    Martell technique, 84
    three-dimensional techniques,
    83–84
    Computer modeling and simulation,
    310–311
    analytical closed-form solution
    methods, 310, 311t
    characteristic material response,
    311–317
    FE analysis, 310–311
    handbook solution, 311t
    hybrid model, 326–332, 333f
    hyperelasticity, 320–321
    isotropic J2-plasticity, 324–326
    linear elasticity, 318–320
    linear viscoelasticity, 321–324
    material modeling, 317–334
    Consolidation. See Conversion/
    consolidation
    Consolidation defects, 24
    Conversion/consolidation, 22–24
    ArCom™ UHMWPE processing, 27,
    28f, 29
    compression molding, 24–25
    defects, 24
    direct compression molding, 27, 29
    extruded versus molded UHMWPE,
    29–31
    grain boundaries, 23
    intergranular diffusion, 22–23
    ram extrusion, 25–27
    self-diffusion, 22
    Copolymers, 3
    Craven, H.
    UHMWPE cup machine(s), 61–62
    UHMWPE testing, 66
    wear testing rig, 62–64
    Creep, 283
    Crossfire™, 339–342
    Crosslinked HDPE components, 53–54
    Crosslinking, 245–246
    H-crosslinking mechanism,
    249–250
    370 IndexCrosslinking (Continued)
    highly crosslinked UHMWPE.
    See Highly crosslinked/thermally
    stabilized UHMWPE
    isolated radicals, reaction of, 247–248
    mechanical behavior and wear, effect
    on, 295–298
    radicals
    formation during irradiation,
    246–247
    isolated radicals, reaction of,
    247–248
    Y-crosslinking mechanism, 248–249
    Cruciate and collateral knee ligaments,
    153, 154f
    Crystalline lamellae, 6–7, 8f
    D
    DCM (direct compression molding),
    27, 29
    Delta® shoulder prosthesis, 212
    Density measurements, 272–273
    Density properties, 30
    Differential scanning calorimetry
    (DSC), 8
    Dilute solution viscometry, 266t
    Direct compression molding (DCM),
    27, 29
    Disc replacement. See Total disc arthroplasty/replacement (TDA/TDR)
    Disk bend test. See Small punch test(ing)
    Dislocated shoulder, 191
    DSC (differential scanning calorimetry),
    8, 266–267, 268f
    Duracon total knee prostheses, 152f
    DURASUL™, 342–345
    Duration™, 338–339
    E
    E-beam irradiation-induced oxidation,
    253
    Eius unicondylar prostheses, 152f
    Electron spin resonance (ESR)
    spectroscopy, 276–277, 278f
    Equibiaxial small punch data, 314,
    317f
    ESR (electron spin resonance)
    spectroscopy, 276–277, 278f
    Ester formation, 252
    Ethylene gas, 4
    polymerization to UHMWPE powder.
    See Polymerization
    Ethylene oxide sterilization (EtO), 38t,
    44–45
    Extruded UHMWPE
    versus molded UHMWPE, 29–31
    ram extrusion, 25–27
    F
    Fatigue testing, 282–283
    small punch, 301–304, 305f
    FDA testing guidelines, 264–265
    FE analysis, 310–311
    Fick’s law, 255
    Fixed-bearing knee designs, 144, 151,
    152f
    FLEXICORE™ TDR, 239
    Flow temperature (Tf), 7–9
    Fluoroscopy-guided A-P radiographs,
    177–178
    Food and Drug Administration (FDA)
    testing guidelines, 264–265
    Foundation®/Foundation® fracture
    humeral prostheses, 199–200
    Fourier transform infrared (FTIR)
    spectroscopy, 274–276
    Freeman-Swanson knee prosthesis, 134f,
    135f, 140–141
    FTIR (Fourier transform infrared)
    spectroscopy, 274–276
    Fusion assessment, 271
    Fusion defects, 24
    G
    Gamma irradiation-induced oxidation,
    253
    Gamma sterilization
    in air permeable packaging, 38–41
    in barrier packaging, 41–44
    Gamma Vacuum Foil (GVF) barrier
    packaging, 43f
    Gas permeable packaging
    barrier packaging, replacement
    with, 39
    ethylene oxide sterilization, 38t
    gamma sterilization in, 38–41
    gas plasma sterilization, 38t
    Gas plasma sterilization, 38t, 44–47
    Gel permeation chromatography (GPC),
    270–271
    Geomedic knee prosthesis, 132, 133f,
    134f, 135
    Geometric knee, 135–136
    Geometric strain hardening, 289
    Index 371Geometric strain softening, 289
    Glass transition temperature (Tg), 7–8
    Glenohumeral forces, 195
    Global™ Advantage® humeral
    prostheses, 199
    Global™ FX humeral prostheses, 199
    Global™ humeral prostheses, 199, 206
    Gluck, 123
    GPC (gel permeation chromatography),
    270–271
    Grain boundaries, 23
    Griffith wear performance study, 79–82
    Guépar hinged knee replacement, 127f
    Gunston, Frank, 123
    GUR resins, 16–17
    versus 1900 resin, 19–20
    GVF (Gamma Vacuum Foil) barrier
    packaging, 43f
    H
    H-crosslinking mechanism, 249–250
    HDPE (high-density polyethylene), 4
    crosslinked HDPE components, 53–54
    Hemiarthroplasties. See also Shoulder
    arthroplasty/replacement
    bipolar prosthesis, 209
    procedures, 191–192
    results and rates, 209
    UHMWPE’s role in, 209
    Hercules Powder Company, 17
    High-density polyethylene (HDPE), 4
    crosslinked HDPE components, 53–54
    Highly crosslinked/thermally stabilized
    UHMWPE, 93, 337–338
    Aeonian™, 338–339
    Crossfire™, 339–342
    current trends, 353
    DURASUL™, 342–345
    Duration™, 338–339
    future for, 357–358
    hip arthroplasty/replacement. See Hip
    arthroplasty/replacement
    knee arthroplasty/replacement,
    182, 184
    Longevity™, 345–348
    Marathon™, 348–351
    prevalence
    in total hip arthroplasty, 354–356
    in total knee arthroplasty, 356–357
    Prolong™, 351–352
    XLPE™, 352, 353t
    Hip arthroplasty/replacement
    age of persons receiving, 71, 72f
    alumina ceramics, 102, 103t, 104
    femoral heads, 105–106
    in vivo fracture risk, 108–109
    alumina composite material, 103t, 105
    aseptic loosening, 73–74
    average radiographic wear, 78
    ceramic-on-ceramic alternative
    bearings, 93, 94, 101
    alumina ceramics, 102, 103t, 104
    alumina composite material, 103t,
    105
    contemporary designs, 106–108
    historical overview, 101–102
    in vivo fracture risk, 108–109
    zirconia, 102, 103t, 104–105, 109
    ceramic on UHMWPE, 105–106
    highly crosslinked/thermally
    stabilized UHMWPE, 53,
    109–110
    contemporary designs, 110, 111f
    current clinical outlook, 114
    historical clinical experience, 110
    prevalence in THA, 354
    thermal treatment, effect of,
    111–114
    historical developments, 53–55. See
    also Charnley, Sir John;
    Wrightington Hospital
    alumina ceramic, 53
    crosslinked HDPE components,
    53–54
    highly crosslinked UHMWPE, 53
    Hylamer, 54
    McKee-Farrar prosthesis, 97, 99f
    McKee prostheses, 96–97, 98f
    Wiles, 96
    linear wear rate, 77, 85t
    metal-on-metal alternative bearings,
    93–96
    biological risks, 100–101
    contemporary designs, 98–99, 100f
    historical overview, 96–97, 98f
    osteolysis, 74, 93
    projected increase in, 72, 73f, 74
    radiographic lysis, 74
    stresses in UHMWPE components,
    156–157
    timeline of developments, 54t
    volumetric wear rate, 78, 85t
    372 IndexHip arthroplasty/replacement
    (Continued)
    wear measurement
    computer-assisted radiographic
    wear measurement, 83–84
    Livermore circular templates, 83
    radiostereometric analysis, 83–84
    wear performance/rates
    average radiographic wear, 78
    in cemented acetabular components,
    75–77
    Charnley/Griffith studies, 79–82
    Isaac study, 82–83
    linear wear rate, 77, 85t
    in modular acetabular components,
    85–86
    volumetric wear rate, 78, 85t
    zirconia, 102, 103t, 104–105
    failure rate, 109
    HIPing (hot isostatic pressing), 27,
    28f, 29
    Hip simulators, 284
    HM (hybrid model), 326–332, 333f
    Hoechst, 16
    Homopolymers, 3
    Hot isostatic pressing (HIPing), 27,
    28f, 29
    H radicals, 246–247
    H transfer reactions, 246–248
    Hybrid model (HM), 326–332, 333f
    Hydroperoxide decomposition (ROOH),
    254–255
    Hydroperoxides, 251–252
    decomposition, 254–255
    Hylamer, 54
    glenoid component wear, 206
    Hyperelasticity, 320–321
    I
    Insall-Burstein (IB) knee prosthesis,
    160, 161f
    Inspection of knee UHMWPE
    components, 180
    Integral work to failure (WTF), 288–289
    Integrated® shoulder prosthesis system
    components, 198
    Intergranular diffusion, 22–23
    Intrinsic viscosity (IV) measurements,
    17–18, 269
    Irradiation. See Sterilization
    Isaac study (wear performance), 82–83
    Isolated radicals, reaction of, 247–248
    ISO standard 5834-1, 15
    Isotropic J2-plasticity, 324–326
    IV (intrinsic viscosity) measurements,
    17–18, 269
    J
    J-integral testing, 280–281
    K
    Kenmore, 194
    Ketone formation, 251
    Knee anatomy, 153–154
    Knee arthroplasty/replacement
    abrasion, 171–172
    age of persons receiving, 71, 72f
    anatomical considerations, 153–154
    articulating surface damage modes,
    167–172
    backside wear, 180–181
    bicondylar knee arthroplasty, 125
    cruciate-sacrificing designs, 134,
    136–141
    cruciate-sparing designs, 134–136
    biomechanics of, 153–160
    burnishing, 171
    deformation at surface, 170–172
    delamination, 170, 172
    embedded debris, 168, 169f, 170, 172
    fixed-bearing knee designs, 144, 151,
    152f
    Gunston’s cemented implant design,
    123, 127–129
    highly crosslinked and thermally
    stabilized UHMWPE, 182, 184
    historical developments, 126–129
    infections, 165
    loosening, 165
    metal backing, incorporation of, 142,
    143f
    fixed bearing designs, 144
    mobile bearing designs, 139f,
    144–146
    mobile bearing knee designs, 139f,
    144–146, 151
    osteolysis, 172–176
    patellar complications, 165
    patellar component implants, 125
    patellar resurfacing, 125
    patello-femoral arthroplasty, 141–142
    pitting, 167–168, 169f, 172
    polycentric knee arthroplasty, 129–132
    Index 373Knee arthroplasty/replacement
    (Continued)
    post damage, in posterior-stabilized
    tibial components, 181–182, 183f
    projected increase in, 72, 73f, 74
    revision surgery, reasons for, 165–166
    scratching, 169f, 170, 172
    semiconstrained hinged knee design,
    125
    survivorship of, 162–163, 163f–165f
    total condylar knee, 135f, 136–141
    “tufting,” 171–172
    UHMWPE component stresses, 156–160
    unicondylar knee arthroplasty, 125
    unicondylar polycentric knee
    arthroplasty, 132–134
    wear or surface damage, 165–167
    articulating surface damage modes,
    167–172
    backside wear, 180–181
    post damage, in posterior-stabilized
    tibial components, 181–182, 183f
    in vivo wear assessment methods,
    176–180
    “wear polishing,” 171
    Knee joint loading, 154–156
    L
    LCS mobile bearing knees, 145–146
    LDPE (low-density polyethylene), 4
    Linear elasticity, 318–320
    Linear low-density polyethylene
    (LLDPE), 4
    “Linear lytic defect,” 176
    Linear polymers, 3
    Linear viscoelasticity, 321–324
    Linear wear rate (LWR), 77, 85t
    Lipid absorption, 257, 258f
    Livermore circular templates, 83
    LLDPE (linear low-density
    polyethylene), 4
    Longevity™, 345–348
    Low-density polyethylene (LDPE), 4
    LWR (linear wear rate), 77, 85t
    M
    Machining, 31–32
    Machining marks, 31
    MacIntosh tibial plateau, 126, 127f
    Macroradicals, 246–247, 250
    alkyl, 254–256
    peroxy, 254
    Marathon™, 348–351
    Mark-Houwink equation, 18
    Marmor knee prosthesis, 132, 135f
    Martell technique, 84
    Material behavior
    computer modeling, 311–317
    testing of. See Chemical testing;
    Mechanical testing; Physical
    testing
    Material modeling, 317–318, 334
    hybrid model, 326–332, 333f
    hyperelasticity, 320–321
    isotropic J2-plasticity, 324–326
    linear elasticity, 318–320
    linear viscoelasticity, 321–324
    MAVERICK TDR, 239
    McKee-Farrar prosthesis, 97, 99f
    McKee prostheses, 96–97, 98f
    McKeever tibial plateau, 126, 127f
    Mechanical characterization, 280
    Mechanical testing
    creep, 283
    fatigue testing, 282–283
    J-integral testing, 280–281
    Poisson’s ratio, 280
    small punch. See Small punch test(ing)
    tensile testing, 281, 282f
    Medical grade powder requirements, 15
    Melt temperature (Tm), 7–8
    Meniscal knee bearings, 144–145
    Metal-on-metal (MOM) alternative hip
    bearings, 93–96
    biological risks, 100–101
    contemporary designs, 98–99, 100f
    historical overview, 96–97, 98f
    METASUL, 98, 100f
    Miller-Gallante (MG) knee prosthesis,
    160, 161f
    Mobile bearing knee designs, 139f,
    144–146, 151
    Modeling. See Computer modeling and
    simulation
    Modular Shoulder System, 201
    Molded UHMWPE
    compression molding, 24–25
    direct compression molding, 27, 29
    versus extruded UHMWPE, 29–31
    Molecular weight, 17–19
    MOM alternative hip bearings. See
    Metal-on-metal (MOM) alternative
    hip bearings
    374 IndexMonomers, 3
    Montell Polyolefins, 17
    MV (viscosity average molecular
    weight), 18
    N
    Neer, Charles, II, 193–194
    Neer II/Neer III shoulder prosthesis
    system components, 194,
    200–201
    Nu-Life dental cement, 56–57
    N2-Vac barrier packaging, 43f
    O
    OA (osteoarthritis)
    hip complications, 132
    shoulder complications, 190–191
    OIT (oxidation induction time)
    measurements, 267
    Osteoarthritis (OA)
    hip complications, 132
    shoulder complications, 190–191
    Osteolysis, 74, 93
    Oxidation, 250–251
    after implant manufacture, 256–257,
    258f
    aging tests, 284, 291–293
    critical products of, 251–252
    E-beam irradiation-induced, 253
    gamma irradiation-induced, 253
    rate, 255–256
    sterilization, effects of, 253–257
    in vivo oxidation, 294, 295f
    Oxidation induction time (OIT)
    measurements, 267
    P
    Packaging, 37–38
    barrier
    gamma sterilization in, 41–44
    replacement of air permeable
    packaging, 39
    gas permeable
    barrier packaging, replacement
    with, 39
    ethylene oxide sterilization, 38t
    gamma sterilization in, 38–41
    gas plasma sterilization, 38t
    Patellar component implants, 125
    Patellar resurfacing, 125
    Patello-femoral arthroplasty,
    141–142
    Patello-femoral joint loading, 155t
    PCL (posterior cruciate ligament),
    153–154
    Péan, 193
    Peroxy macroradicals (ROO•), 254
    Perplas Medical, 24
    Peterson, Lowell, 129
    Photo-oxidation, 250
    Physical properties
    HDPE, 5t
    UHMWPE, 5t, 265
    Physical testing
    density measurements, 272–273
    differential scanning calorimetry,
    266–267, 268f
    dilute solution viscometry, 266t
    fusion assessment, 271
    intrinsic viscosity, 269
    oxidation induction time
    measurements, 267
    scanning electron microscopy, 267,
    268f, 269
    transmission electron microscopy,
    271–272
    Poisson’s ratio, 280
    Polycentric knee arthroplasty, 129–132
    Polyethylene, 4–5
    Poly Hi Solidur Meditech, 24
    Polymerization, 14–16
    calcium stearate, 21–22
    GUR resins, 16–17
    GUR resins versus 1900 resin, 19–20
    and molecular weight, 17–19
    1900 resins, 16–17
    Polymers, 2–4
    Polytetrafluoroethylene (PTFE)
    Charnley’s hip arthroplasty designs.
    See Charnley, Sir John
    debacle, 71
    Posterior cruciate ligament (PCL),
    153–154
    Posterior-stabilized total condylar
    prosthesis II (TCP II), 140
    PRODISC implants, 226–227
    biomaterials, 234–235
    biomechanics of performance, 236–237
    clinical performance, 238–239
    design concept, 234, 235f
    historical development, 234
    shock absorption capacity, 235–236
    Prolong™, 351–352
    Index 375PTFE (polytetrafluoroethylene)
    Charnley’s hip arthroplasty designs.
    See Charnley, Sir John
    debacle, 71
    R
    Radicals
    formation during irradiation, 246–247
    H radicals, 246–247
    isolated radicals, reaction of, 247–248
    macroradicals, 246–247, 250
    alkyl, 254–256
    peroxy, 254
    Radiographic lysis, 74
    Radiostereometric analysis (RSA), 83–84
    R• (alkyl macroradicals), 254–256
    Ram extrusion, 25–27
    RA (rheumatoid arthritis), 190
    RCH-1000, 5, 24
    Resins
    conversion to consolidated form.
    See Conversion/consolidation
    GUR resins, 16–17
    GUR resins versus 1900 resins, 19–20
    1900 resins, 16–17
    Reverse™ Shoulder Prosthesis system,
    211f, 212
    Reverse total shoulder prosthesis design
    concept, 211–212
    Revision
    knee arthroplasty/replacement,
    165–166
    rate(s), 73–74
    shoulder arthroplasty/replacement,
    193
    Rheumatoid arthritis (RA), 190
    ROOH (hydroperoxide decomposition),
    254–255
    ROO• (peroxy macroradicals), 254
    Rotating platform knees, 144
    RSA (radiostereometric analysis), 83–84
    Ruhrchemie AG, 14–15
    S
    Savastano knee prosthesis, 132, 133f
    SB Charité™ III implants, 226–227
    abrasive wear on contact zones, 230,
    231f, 232f
    biomaterials, 227–229
    biomechanics of performance, 230,
    233, 234t
    clinical performance, 237–238
    SB Charité™ III implants (Continued)
    core deformation, 229–230
    design concept, 227
    historical development, 227
    Scanning electron microscopy (SEM),
    267, 268f, 269
    Scorpio PS total knee prostheses, 152f
    Select® shoulder prosthesis system
    components, 199
    Self-diffusion, 22
    Semiconstrained hinged knee
    design, 125
    Semiconstrained reverse shoulder
    prosthesis, 212
    SEM (scanning electron microscopy),
    267, 268f, 269
    Shear punch testing, 298–301
    Shelf life of components, 47–48
    Shelf storage, oxidation during, 256, 258f
    small punch tests, 291–293
    Shiers knee, 126, 127f
    Shoulder arthroplasty/replacement, 189
    annual number of, 192
    biomechanics of, 195–196
    controversies in, 207, 209–210
    glenoid component materials, 209–210
    hemiarthroplasties
    bipolar prosthesis, 209
    procedures, 191–192
    results and rates, 209
    UHMWPE’s role in, 209
    history of, 193–195
    load magnitudes and directions,
    195–196
    patient age, 193, 203
    procedures, 191–192
    revision of, 193
    stresses in UHMWPE components,
    195–196
    success rates, 203–204, 209
    total. See Total shoulder
    arthroplasty/replacement
    (TSA/TSR)
    Shoulder complications
    arthritis, 193
    osteoarthritis, 190–191
    rheumatoid arthritis, 190
    TSA success rates, 203
    dislocations, 191
    fractures/trauma, 191, 193
    TSA success rates, 203
    376 IndexShoulder complications (Continued)
    ligament abrasions and ruptures, 190
    osteoarthritis, 190–191
    rheumatoid arthritis, 190
    tendon abrasions and ruptures, 190
    Shoulder joint, 190
    Simulation
    generally. See Computer modeling and
    simulation
    hip simulators, 284
    Small punch test(ing), 283, 288–291
    aging of UHMWPE, 291–293
    crosslinking’s effect on mechanical
    behavior and wear, 295–298
    fatigue punch testing, 301–304, 305f
    geometric strain hardening, 289
    geometric strain softening, 289
    metrics of, 288–289
    shear punch testing, 298–301
    in vivo changes of UHMWPE, 294, 295f
    Solar® humeral prostheses, 200
    Song’s model, 32
    Spinal discectomy, 219
    Spinal disc replacement. See Total disc
    arthroplasty/replacement
    (TDA/TDR)
    Spinal fusion, 219–221
    Sterilization, 37–38
    ethylene oxide sterilization, 38t, 44–45
    gamma sterilization
    in air permeable packaging, 38–41
    in barrier packaging, 41–44
    gas plasma sterilization, 38t, 44–47
    and oxidation, 253–257
    radical formation during, 246–247
    temperature effects during, 253–255
    at Wrightington Hospital, 66–67
    Stillbrink, 194
    Sulzer Orthopedics’ MOM hip designs,
    98, 100f
    Swedish Knee Arthroplasty Register,
    163
    Swell ratio testing, 278–280
    T
    TCP (total condylar prosthesis), 139
    TCP II (total condylar prosthesis II),
    140
    TDA/TDR. See Total disc
    arthroplasty/replacement
    (TDA/TDR)
    TEM (transmission electron microscopy),
    271–272
    crystalline lamellae, 6–7, 8f
    Tensile properties, 30
    Tensile testing, 281, 282f
    Tf (flow temperature), 7–9
    T
    g (glass transition temperature), 7–8
    Thackray, 67
    THA/THR. See Total hip
    arthroplasty/replacement
    (THA/THR)
    Thermally stabilized UHMWPE. See
    Highly crosslinked/thermally
    stabilized UHMWPE
    Thermal transitions, 7–8
    “3-D/2-D matching,” 178
    Tibiofemoral joint
    anterior shear, 155t
    compression, 155t
    Ticona, 15–17, 24
    TKA/TKR. See Total knee
    arthroplasty/replacement
    (TKA/TKR)
    Total condylar knee, 135f, 136–141
    Total condylar prosthesis (TCP), 139
    Total condylar prosthesis II (TCP II),
    139–140
    Total disc arthroplasty/replacement
    (TDA/TDR), 219–221
    biomechanical considerations, 222–226
    design goals, 221
    FLEXICORE™ TDR, 239
    indications for, 221
    interfaces for devices, 222
    kinematic considerations, 222–223,
    224f
    kinetic considerations, 223, 225
    load-sharing considerations, 225–226
    MAVERICK TDR, 239
    PRODISC implants, 226–227
    biomaterials, 234–235
    biomechanics of performance,
    236–237
    clinical performance, 238–239
    design concept, 234, 235f
    historical development, 234
    shock absorption capacity, 235–236
    SB Charité™ III implants, 226–227
    abrasive wear on contact zones, 230,
    231f, 232f
    biomaterials, 227–229
    Index 377Total disc arthroplasty/replacement
    (Continued)
    biomechanics of performance, 230,
    233, 234t
    clinical performance, 237–238
    core deformation, 229–230
    design concept, 227
    historical development, 227
    versus spinal discectomy, 219
    versus spinal fusion, 219–221
    UHMWPE alternatives, 239
    UHMWPE designs, 226–239
    Total hip arthroplasty/replacement
    (THA/THR), 71, 73
    generally. See Hip
    arthroplasty/replacement
    highly crosslinked UHMWPE,
    prevalence of, 354–356
    Total knee arthroplasty/replacement
    (TKA/TKR), 123, 124f. See also Knee
    arthroplasty/replacement
    evolutionary stages for UHMWPE in,
    125
    highly crosslinked UHMWPE,
    prevalence of, 356–357
    osteolysis, 172–176
    tricompartmental, 124f, 125
    in vivo wear assessment in, 176–180
    Total shoulder arthroplasty/replacement
    (TSA/TSR)
    abrasion, 207
    Aequalis™/Aequalis™ Fracture
    system components, 202
    Anatomical Shoulder™ system
    components, 198f, 199
    Bi-Angular® system components, 197f,
    198
    Bigliani/Flatow® humeral prostheses,
    202
    biomechanics of, 195–196
    Bio-Modular® system components, 197
    BiPolar system components, 198
    burnishing, 207
    cobalt chromium alloy, use of, 212
    Cofield™/Cofield2™, Monoblock
    system components, 201
    complete wear-through, 207
    complications with, 204t
    glenoid loosening, 204–205
    instability, 204t, 205
    wear or damage, 205–207, 208f
    Total shoulder arthroplasty/replacement
    (Continued)
    contemporary designs, 197–203
    deformation, 207
    delamination, 207
    Delta® prosthesis, 212
    embedded debris, 207
    Foundation®/Foundation® fracture
    humeral prostheses, 199–200
    fractures, 207
    future directions
    in design, 211–212
    in materials, 212
    glenoid loosening, 204–205
    Global™ humeral prostheses, 199, 206
    history of, 193–195
    instability, 204t, 205
    Integrated® system components, 198
    Modular Shoulder System, 201
    Neer II/Neer III system components,
    200–201
    pitting, 207
    procedures, 192
    Reverse™ Shoulder Prosthesis system,
    211f, 212
    reverse total shoulder prosthesis
    design concept, 211–212
    scratching, 207
    Select® system components, 199
    semiconstrained reverse prosthesis,
    212
    Solar® humeral prostheses, 200
    success rates, 203–204, 209
    wear or damage, 205–207, 208f
    Townley knee prosthesis, 134f, 135f, 136
    Trace element analysis, 274
    Transmission electron microscopy
    (TEM), 271–272
    TSA/TSR. See Total shoulder
    arthroplasty/replacement
    (TSA/TSR)
    U
    Ubbelohde viscometer, 269, 270f
    UKA (unicondylar knee arthroplasty),
    125
    Ultrasound for knee wear assessment,
    178–179
    Uniaxial compressive response, 313–314
    Uniaxial tension response, 313
    Unicondylar disease, 132
    378 IndexUnicondylar knee arthroplasty (UKA), 125
    Unicondylar polycentric knee
    arthroplasty, 132–134
    VV
    iscosity average molecular weight
    (MV), 18
    Volumetric wear rate (VWR), 78, 85t
    von Mises stresses
    hip replacements, 156
    knee replacements, 158–159
    VWR (volumetric wear rate), 78, 85t
    WW
    alldius knee, 126, 127f
    Wear performance/rates
    crosslinking, effect of, 295–298
    HDPE, 5, 6f
    hip arthroplasty. See Hip
    arthroplasty/replacement
    knee arthroplasty/replacement,
    165–167
    articulating surface damage modes,
    167–172
    in vivo wear assessment methods,
    176–180
    from machining, 32
    total shoulder arthroplasty/
    replacement, 205–207, 208f
    UHMWPE, 5, 6f
    Wrightington Hospital
    hip arthroplasty/replacement. See also
    Craven, H.
    implant fabrication at, 61–62
    UHMWPE cup sterilization at,
    66–67
    knee arthroplasty/replacement
    Charnley’s design, development
    of, 129
    Gunston’s design, development of,
    123, 127–129
    UHMWPE’s arrival at, 66
    WTF (integral work to failure), 288–289
    X
    XLPE™, 352, 353t
    YY
    -crosslinking mechanism, 248–249
    Z
    Zipple, 194
    Zirconia, 102, 103t, 104–105
    failure rate, 109
    Index 379

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