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

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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

كتاب The UHMWPE Handbook - Ultra-High Molecular Weight Polyethylene in Total Joint Replacement  T_u_h_10
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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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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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