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The effect of the surface finish of alumina and stainless steel on the wear rate of UHMW polyethylene.

The effect of the surface finish of medical grade alumina and stainless steel on the wear rate of ultra-high molecular weight (UHMW) polyethylene was studied in a six station pin-on-plate wear screening device using bovine serum as lubricant. The wear rate decreased as the surface finish of alumina improved from 0.10 to 0.015 micron Ra, with no evidence of an increasing wear rate below a particular value of surface finish. Tests with surgical grade stainless steel showed a similar polyethylene wear rate around the 0.025 micron Ra level, but there was evidence of a higher wear rate with stainless steel than with alumina between approx. 0.035 and 0.075 micron Ra.

Aluminum↗

Coating of two polyether-polyurethanes and polyethylene with a heparin-poly-(vinyl alcohol) hydrogel.

Two polyether-polyurethane elastomers (Pellethane and Biomer) and polyethylene were coated with a heparin-poly(vinyl alcohol) hydrogel. The requisite surface modification in preparation for coating consisted of glow discharge cleaning and acid treatment for the polyether-polyurethanes and glow discharge cleaning and chromic acid oxidation for polyethylene. The chemical modifications increased surface wettability. Surface analysis by attenuated total reflectance Fourier transform infrared spectroscopy indicated that the acid treatment caused hydrolysis of the polyether segments of Pellethane and Biomer. Prolonged partial thromboplastin times were observed on the coated films. The results of toluidine blue assay of heparin in the solution in which the coated films were immersed for a long time suggested that heparin was covalently bound in the coating. Such coating techniques extend the usefulness of the heparin-poly(vinyl alcohol) hydrogel to a number of medically important substrate materials.

Biocompatible Materials↗

In vivo degradation of polymers. I. Change of mechanical properties in polyethylene pacemaker lead insulations during long-term implantation in the human body.

The results of mechanical testing and microscopic examination of explanted clinically-used polyethylene pacemaker lead insulations are presented. An experimental set of 98 lead insulations implanted for times ranging from 7 d to 11 yr was evaluated for changes in mechanical properties during clinical use. The results showed that the polyethylene tubing suffered a gradual structural change, due to its exposure to the physiological environment of the human body. The decline of the mechanical properties with implantation time is described by empirical formulae. Abrasive deterioration was also observed and is discussed.

Electrodes, Implanted↗

Biodegradation of polyethylene foils by bacterial and liver homogenates.

The evaluation of structural changes of single linear and bifurcated polyethylene foils exposed to bacterial and liver homogenates was carried out by infrared spectrography, along with observations of changes of mechanical properties. Cell homogenates were fractionated by centrifugation and by coagulating the microsomal fraction using Ca2+ ions. Stimulation as well as inhibition of the presumed enzyme system were studied in bacterial cultures and liver homogenates of experiment animals. Results suggest that oxidation structures in polyethylene, after exposure to these cell homogenates, are caused by the monooxygenase hydroxylation system of the bacterial or liver cells.

Animals↗

Introduction of functional groups onto the surface of polyethylene for protein immobilization.

Amino and carboxyl groups could be introduced onto the surface of high-density polyethylene film by utilizing graft polymerization of acrylamide and the subsequent Hofmann degradation and alkaline hydrolysis of grafted polyacrylamide. Graft polymerization was carried out by immersing an argon-plasma treated film in an aqueous solution of the monomer, followed by heating after degassing the monomer/film mixture. The surface density of these functional groups could be increased up to 10(-7) mol/cm2. The surfaces having amino and carboxyl groups exhibited positive and negative zeta potentials, respectively, when contacted with KCl aqueous solution. Both of the functional groups introduced onto the polyethylene surface were found to be utilizable for covalent immobilization of protein using carbodiimide for the carboxylic group or mediators such as glutaraldehyde and ethylene glycol diglycidyl ether for the amino group.

Acrylic Resins↗

Reduction in tumour formation on porous polyethylene by collagen immobilization.

After surface modification with collagen immobilization through covalent bonding, porous polyethylene pieces with an average pore size of 400 microns were implanted subcutaneously into the back of rats for 1 yr. It was found that connective tissues with abundant blood vessels were formed clearly, filling more than 90% of the pore volume and bound firmly to the pore walls. A tumour was found in only one of 24 implanted pieces (4.2%). On the other hand, the virgin porous polyethylene pieces without collagen immobilization exhibited inflammatory reactions within the pores and the connective tissues produced filled only 15% of the pore volume. Formation of a malignant histiocytoma was observed in 11 of the 24 pieces which had been implanted (45.8%). Thus, immobilization of collagen on the surface of an artificial material through covalent bonding proved to be very effective not only for firm bonding with soft connective tissues but also for a reduction of tumour formation.

Animals↗

Molecular weight dependence of calcification of polyethylene glycol hydrogels.

In vivo calcification of polyethylene glycol diacrylate (PEG DA) hydrogels of molecular weight (MW) 400, 1000, 4000, 6000 and 10,000 and polyethylene glycol tetraacrylate (PEG TA) of MW 18,500 was investigated using a rat subcutaneous model. This study was performed in 4-wk-old rats for durations of 1, 3, 6 and 8 wk. The results indicate a strong dependence of calcification upon the MW of the PEG precursor or the MW between crosslinks. Results for gels implanted for 6 wk show that calcification was maximal at a PEG MW of 1000 (224 mg/g +/- 12.8, n = 4) (mean +/- SEM) with less at MW = 400 (23.0 mg/g +/- 9.30, n = 4) and considerably less at higher MWs, e.g. for MW = 10,000 (0.23 mg/g +/- 0.01, n = 4). Results for other time periods indicate a similar calcification trend. The extent of calcification of gels from PEG TA (MW = 18,500) was intermediate (1.09 mg/g +/- 0.43, n = 3) between PEG DA (MW = 6000) (1.39 mg/g +/- 0.42, n = 6) and PEG DA (MW = 10,000) at 6 wk, i.e. calcification depended upon the PEG MW between crosslinks. When composite gels were implanted, such that a highly calcifying gel (MW = 400 or 1000) was encapsulated within a gel of low calcification (MW = 4000), the gel inside calcified to at least the same extent as if it had not been encapsulated. Thus, direct contact with tissues is apparently not necessary for calcification to occur. Energy dispersive X-ray spectroscopy was performed on the mineral deposits in the gels and a P:Ca ratio of 0.67 +/- 0.04 (95% confidence interval) for MW 1000 gels and 0.60 +/- 0.07 for MW 400 gels was found to be consistent with deposition of Ca3(PO4)2.

Animals↗

Effect of polyol molecular weight on the physical properties and haemocompatibility of polyurethanes containing polyethylene oxide macroglycols.

The physical properties and haemocompatibility of polyurethanes containing polyethylene oxide (PEO) of varying molecular weights but constant weight fraction of hard segment are investigated. The PEO molecular weights studied were 600, 1450 and 8000. Analysis of polyurethane phase separation and crystallinity using dynamic-mechanical analysis and differential scanning calorimetry show that the degree of phase separation and crystallinity increase with polyol molecular weight, but level off at the highest molecular weights. The degree of water absorption increases substantially with increasing PEO molecular weight, levelling off at the highest molecular weight. Tensile data show a maximum in extensibility at a polyethylene glycol (PEG) molecular weight of 1450, while ultimate strength increases with increasing segment length. When the materials are hydrated, there is a significant drop in the modulus, ultimate stress and ultimate elongation. Dynamic contact angle measurements show that surface hydrophobicity decreases as the soft segment molecular weight increases. Using electron spectroscopy for chemical analysis (ESCA) to determine the surface composition of these polyurethanes, it was found that the hard segment content at the surface increases as the polyol block length decreases. The haemocompatibility of these polyurethanes was investigated in an ex vivo canine blood-contacting model. Only for the shortest block length studied, PEG-600, are differences in blood compatibility observed. This material was found to be the most thrombogenic. The PEG-1450 sample shows comparable blood compatibility to PEG-8000.

Animals↗

Detection of viral antigens by solid phase radioimmunoassay on polyethylene film.

Polyethylene film, without any pretreatment, may serve as a solid phase (SP) for RIA. Viral antigens (HBsAg, and influenza virus) are detected by SP-RIA on the film with a sensitivity of about 2-3 ng/ml or 40-60 pg/assay. The use of polyethylene film allows one to record RIA autographically. The use of micro amounts of reagents and specimens tested is an added advantage. No special equipment is necessary, the method is inexpensive, easy to perform and may be used for mass screening.

Animals↗

S'-subsite mapping of polyethylene glycol-modified alpha-chymotrypsin and alpha-chymotrypsin: a comparative study.

Nucleophile specificities of polyethylene glycol-modified alpha-chymotrypsin and the native enzyme were investigated via acyl transfer reactions using Ac-Tyr-OEt as acyl donor and a large series of peptides and amino-acid amides as nucleophiles. In acyl transfer reactions with amino-acid amides both enzymes prefer basic and bulky amino-acid residues. However, peptides with bulky aliphatic or aromatic residues in P1' position were very poor nucleophiles for both enzymes. Surprisingly, peptides having bulky aliphatic or aromatic residues in P2' were preferred by the modified enzyme and were apparently more efficient nucleophiles for both enzymes than those with such residues in P1'. Generally, peptides with a longer chain were weaker nucleophiles in the reactions catalyzed by polyethylene glycol-modified enzyme. In the series of peptides containing a positively charged amino-acid residue in various locations, the order of nucleophilic efficiency is with this location being: P1' > P3' > P2'; this is valid for both enzymes.

Amino Acid Sequence↗

Retention behaviour of some barbituric acid derivatives on a polyethylene-coated silica column.

The retention of 45 barbituric acid derivatives was determined on a polyethylene-coated silica column (PEE) in unbuffered methanol-water eluent mixtures. Each derivative showed a symmetric peak shape in each eluent and the capacity factor decreased monotonously with increasing concentration of methanol in the eluent. Stepwise regression analysis indicated that the retention of barbituric acid derivatives is mainly governed by the molecular lipopholicity and, to a lesser extent, by steric effects of the various substituents. This finding indicates that the polyethylene-coated silica behaves as a real reversed-phase chromatographic support with slightly different retention characteristics.

Barbiturates↗

Measurement of polyethylene thickness in total hip arthroplasty. A technique analysis.

Accurate radiographic measurement techniques are necessary to evaluate wear characteristics of different metals, ceramics, and plastics. This study evaluated a standard technique for radiographic measurement of acetabular component thickness. Twenty-one acetabular components retrieved after revision surgery were studied. Radiographic measurement of polyethylene thickness was performed at two points on radiographs taken within 2 months of the revision surgery. Measurements were made at the area of greatest polyethylene wear and at the center of the component, and these measurements were compared to direct measurement of the retrieved component. The 42 data points obtained revealed an average difference between the radiographic and direct measurements of 0.18 mm. A regression model demonstrated no significant difference (P = .85) between these measurements. Additionally, when comparing the central-point measurement to the thinnest wear-point measurement, no difference was noted, indicating that wear in the sagittal plane did not affect radiographic measurement accuracy. Radiographic measurement of acetabular component thickness is accurate to within 0.18 mm. This degree of accuracy allows for radiographic wear analysis, as long as the standard measurement technique is utilized.

Hip Prosthesis↗

Polyethylene post failure in posterior stabilized total knee arthroplasty.

Posterior-stabilized (PS) prostheses have been used extensively in total knee arthroplasty (TKA), with excellent long-term results. The key feature of these prostheses is the femoral cam and tibial post mechanism that limits posterior displacement and produces femoral rollback. Although articular-surface polyethylene wear of the tibial component has not been a significant clinical problem, tibial post wear has been reported. In distinction to chronic post wear, little information exists about catastrophic post failure. We present the case of a 56-year-old woman who presented 63 months after TKA with a PS prosthesis with acute fracture of the polyethylene post. The evaluation and treatment of this patient, including the previously unreported use of computed tomography arthrography to diagnose this rare problem, is reviewed.

Arthroplasty, Replacement, Knee↗

Early morbidity of modular exchange for polyethylene wear and osteolysis.

This study assessed the early morbidity associated with modular component exchange surgery for the treatment of accelerated polyethylene wear and osteolysis in 55 patients. Review of the surgical records revealed no significant intraoperative complications, little intraoperative blood loss (mean 333 mL), no allogenic blood transfusions, and no recorded postoperative deep vein thromboses. Eighteen percent of patients, however, experienced postoperative dislocation. Five patients dislocated multiple times, 3 of which required rerevision surgery. Two patients required rerevision for femoral implant fractures related to osteolysis and 1 additional patient required rerevision due to catastrophic failure of the acetabular component 5 years postoperatively. With an average follow-up of 30 months, 6 of the 55 patients treated with modular exchange required rerevision. The results of this study suggest that instability is the most prevalent early complication associated with modular component exchange. As such, we believe that more stable constructs should be emphasized, possibly at the expense of polyethylene thickness.

Acetabulum↗

Mid-term results of a polyethylene-free metal-on-metal articulation.

Beginning in December 1995, 193 patients (195 hips) were enrolled into this prospective, randomized, controlled multicenter investigational device exemption study. Ninety-eight patients (99 hips) with 46 polyethylene liners and 53 metal liners had minimum 5-year follow-up (mean, 5.7 years). Average follow-up, Harris hip score improvement, and radiographic analysis were not statistically different between groups. No stress shielding or osteolysis was observed in either group. Three polyethylene liners and no metal liners had acetabular radiolucencies <1 mm in 1 or more zones. There have been no device-related complications, no acetabular revisions performed, and none pending in either group. Based on these mid-term results, the authors conclude that a metal-on-metal articulation represents a viable alternative in young, high-demand, active patients.

Arthroplasty, Replacement, Hip↗

Premature failure of the polyethylene tibial bearing surface of the Interax knee arthroplasty.

Thirty-four patients (37 knees) were treated with the Interax knee arthroplasty. There were 31 female and 3 male patients with a mean age at surgery of 70 years (range, 53-84 years). Premature failure of the polyethylene tibial bearing surface occurred in 9 patients (9 knees). Eight patients of these required a revision operation because of early wearing out of the tibial surface 20 to 38 months after the operation. The failure was due to inadequate implant design in small component and polyethylene gamma irradiated in the air.

Aged↗

Cementation of a metal-inlay polyethylene liner into a stable metal shell in revision total hip arthroplasty.

The purpose of this study was to evaluate the results of liner cementation into a stable acetabular shell using a metal-inlay polyethylene liner in 39 revision total hip arthroplasties. After an average of 2.8 years, 1 cemented liner dislodged from its metal shell at a postoperative 4 years. In the other 38 hips, mean Harris hip scores improved from 65 preoperatively to 86.9 at the final follow-up. Eighteen patients were rated as having excellent results, 17 as good, and 3 as fair. There were no changes in cup position and no cases of osteolytic lesion progression around the femoral and acetabular components in the last follow-up radiographs. Metal-inlay polyethylene liner cementation into a stable acetabular shell was found to provide an alternative option with short-term excellent results, and it also offers more liner options, the preservation of bone stock, and lower surgical morbidity.

Acetabulum↗

Impingement of acetabular cups in a hip simulator: comparison of highly cross-linked and conventional polyethylene.

We hypothesized that the reduction in toughness that accompanies elevated levels of cross-linking in ultrahigh-molecular weight polyethylene would lead to increased wear and damage in acetabular cups under conditions of impingement with the neck of the femoral component. Test cups were exposed to 2.8, 10, and 20 Mrad of gamma irradiation and were tested in a simulator, incorporating impingement during every wear cycle. Wear behavior was compared based on wear rate, observations of damage, and the number and morphology of wear particles. The 10-Mrad cups had the lowest rate (15.2 +/- 5.1 mg/Mc), followed by the 2.8-Mrad (40.1 +/- 4.2 mg/Mc) and 20-Mrad (67.9 +/- 24.2 mg/Mc) groups. The wear damage was most severe in the 20-Mrad cups, although all 3 groups showed pitting and delaminating. Wear rates and damage of highly cross-linked polyethylene cups were significantly higher in an impingement wear test than in previous simulator studies.

Acetabulum↗