In vivo analysis of polyethylene wear particles after total knee arthroplasty: the influence of improved materials and designs.

Polyethylene wear particles induce macrophages to release cytokines, which can lead to osteolysis and aseptic loosening of total joint prostheses1. The generation of polyethylene wear particles is one of the most important factors that affects the midterm and long-term clinical results associated with total knee arthroplasty2,3. The generation of polyethylene wear particles is correlated with the activity level of the patient4, and greater demands are placed on a total knee prosthesis when it is implanted in a younger, more active patient5. Therefore, to achieve better long-term results for patients who have higher activity levels, modifications of materials (i.e., highly cross-linked polyethylene and alumina ceramic) and design (i.e., mobile bearing and medial pivot) have been developed to reduce polyethylene wear after total knee arthroplasty. It takes decades to evaluate the long-term results of newly introduced total knee prostheses. Thus, it is particularly important to examine in vivo polyethylene wear generation in new prostheses before they come into widespread use. It is difficult to determine the in vivo polyethylene wear of total joint prostheses (with the exception of total hips) with use of postoperative radiographs. To measure polyethylene wear in vivo, we developed and employed a method in which we isolated and analyzed polyethylene wear particles in the synovial fluid of knees that had a well-functioning total knee prosthesis6-9. The number, size, and shape of polyethylene wear particles have been reported to be critical factors in the development of osteolysis. Greater volume, submicrometer size, and an elongated shape of polyethylene wear particles all stimulate an increased macrophage response10-12. Our hypothesis was that modification of total knee arthroplasty materials and designs can influence the generation of polyethylene wear particles in vivo. In the present study, …

[1]  T. Schmalzried,et al.  Assessing activity in joint replacement patients. , 1998, The Journal of arthroplasty.

[2]  M. Akagi,et al.  The Bisurface Total Knee Replacement: A Unique Design for Flexion Four-to-Nine-Year Follow-up Study* , 2000, The Journal of bone and joint surgery. American volume.

[3]  P. Campbell,et al.  Isolation of predominantly submicron-sized UHMWPE wear particles from periprosthetic tissues. , 1995, Journal of biomedical materials research.

[4]  D. Hahn,et al.  Characterization of submicron polyethylene wear debris from synovial-fluid samples of revised knee replacements using a light-scattering technique. , 1996, Journal of biomedical materials research.

[5]  Murali Jasty,et al.  Knee-simulator testing of conventional and cross-linked polyethylene tibial inserts. , 2004, The Journal of arthroplasty.

[6]  K. Takaoka,et al.  In vivo comparison of wear particles between highly crosslinked polyethylene and conventional polyethylene in the same design of total knee arthroplasties. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[7]  Gordon W. Blunn,et al.  Differences in wear between fixed bearing and mobile bearing knees , 1998 .

[8]  N. Parks,et al.  Separation and characterization of polyethylene wear debris from synovial fluid and tissue samples of revised knee replacements. , 1997, Journal of biomedical materials research.

[9]  J. Szivek,et al.  Polyethylene particle morphology in synovial fluid of failed knee arthroplasty. , 1999, Clinical orthopaedics and related research.

[10]  H. Oonishi,et al.  Alumina versus polyethylene in total knee arthroplasty. , 1992, Clinical orthopaedics and related research.

[11]  M. Semlitsch,et al.  Reactions of the articular capsule to wear products of artificial joint prostheses. , 1977, Journal of biomedical materials research.

[12]  C. Engh,et al.  A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners. , 2006, The Journal of arthroplasty.

[13]  A. Hofmann,et al.  Highly Crosslinked Polyethylene is Safe for Use in Total Knee Arthroplasty , 2008, Clinical orthopaedics and related research.

[14]  G. Scuderi**,et al.  Survivorship of cemented total knee arthroplasty. , 1997, Clinical orthopaedics and related research.

[15]  H. Amstutz,et al.  Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. , 1984, The Journal of bone and joint surgery. American volume.

[16]  K. Takaoka,et al.  Polyethylene Wear Particles in Synovial Fluid After Total Knee Arthroplasty , 2003, Clinical orthopaedics and related research.

[17]  M. Freeman,et al.  Number of polyethylene particles and osteolysis in total joint replacements. A quantitative study using a tissue-digestion method. , 1997, The Journal of bone and joint surgery. British volume.

[18]  Y. Minoda,et al.  Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty. , 2009, The Knee.

[19]  K. Ikeuchi,et al.  Comparison of the Wear Properties of Polyethylene Plate in Total Knee Prostheses (TKP) using Different Femoral Component Materials , 2002 .

[20]  J. Benevenia,et al.  Pathologic supracondylar fracture due to osteolytic pseudotumor of knee following cementless total knee replacement. , 1998, Journal of biomedical materials research.

[21]  K. Takaoka,et al.  Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties. , 2004, Journal of biomedical materials research. Part B, Applied biomaterials.

[22]  L. Dorr,et al.  Clinical performance of a Durasul highly cross-linked polyethylene acetabular liner for total hip arthroplasty at five years. , 2005, The Journal of bone and joint surgery. American volume.

[23]  K. Takaoka,et al.  Polyethylene wear particle generation in vivo in an alumina medial pivot total knee prosthesis. , 2005, Biomaterials.

[24]  G. Engh,et al.  Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prostheses. , 1992, The Journal of bone and joint surgery. British volume.

[25]  B. Wroblewski,et al.  Evaluation of the response of primary human peripheral blood mononuclear phagocytes to challenge with in vitro generated clinically relevant UHMWPE particles of known size and dose. , 2000, Journal of biomedical materials research.

[26]  Hiroaki Nakamura,et al.  Mid-term clinical results of alumina medial pivot total knee arthroplasty , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[27]  J. Fisher,et al.  Wear, Debris, and Biologic Activity of Cross-linked Polyethylene in the Knee: Benefits and Potential Concerns , 2004, Clinical orthopaedics and related research.

[28]  Allison L. Sieving,et al.  Diverse cellular and apoptotic responses to variant shapes of UHMWPE particles in a murine model of inflammation. , 2002, Biomaterials.

[29]  J David Blaha,et al.  Fluoroscopic Analyses of Cruciate-Retaining and Medial Pivot Knee Implants , 2003, Clinical orthopaedics and related research.