Total hip replacement (THR) surgery is the standard of care for advanced degenerative joint disease. However, 13-18% of all THR surgeries are reoperations, which have poorer outcomes and greater economic burden than primary THRs. Bearing technologies have undergone major changes with respect to formulation and component design over the past decade with the introduction of first-generation highly crosslinked ultra-high molecular weight polyethylene materials (remelted and annealed) and the recent introduction of second-generation materials, stabilized with sequential annealing or vitamin-E diffusion. With the advent of these more wear resistant materials, head sizes have increased to reduce the incidence of instability. Ten years ago, we began a multi-institution traceable retrieval collection to determine in vivo changes to polyethylene components and to analyze periprosthetic tissue responses to polyethylene wear debris. We have developed protocols to measure the mechanical properties, oxidation, and volumetric wear of retrieved implants, as well as the size and shape of polyethylene wear debris and the associated immunologic response through analysis of periprosthetic tissue samples. We now have evidence to show that degradation of gamma inert-sterilized, annealed, and remelted polyethylene occurs in the body for short- to intermediate-term implantation times (<10 years). There is a continued need to understand the long-term effects of in vivo degradation of highly crosslinked polyethylenes and to evaluate the performance of new material and design modifications. Through explant studies we will evaluate: the performance of retrieved annealed and remelted bearings implanted greater than 5 years;the clinical performance of second-generation highly crosslinked liners;and relationships between head size, wear, and rim damage. We hypothesize that: beyond five years of implantation, in vivo oxidation, wear and loosening as reasons for revision of annealed and remelted highly crosslinked liners will not differ;2nd-generation polyethylene formulations will preserve oxidative stability and mechanical properties comparable to remelted highly crosslinked liners;and femoral head sizes greater than 28 mm will not increase bearing surface wear and rim damage in first and second generation crosslinked liners. Achieving the proposed aims will lead to improved clinical performance of THRs through a better understanding of bearing technology factors and survivorship of polyethylene components.

Public Health Relevance

Bearing technologies have undergone major changes with respect to formulation and component design over the past decade with the introduction of first- and second- generation highly crosslinked UHMWPE materials. A fundamental objective of our device retrieval research is to understand successful implant materials and designs and assess failures through explant, tissue and clinical analysis. Thus, successful achievement of the proposed research will provide essential information on THR implant performance and clinical outcomes, which are needed for informed health care decisions.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR047904-11
Application #
8449120
Study Section
Musculoskeletal Tissue Engineering Study Section (MTE)
Program Officer
Panagis, James S
Project Start
2001-08-07
Project End
2016-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
11
Fiscal Year
2013
Total Cost
$514,220
Indirect Cost
$95,350
Name
Drexel University
Department
None
Type
Schools of Engineering
DUNS #
002604817
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Arnholt, Christina M; MacDonald, Daniel W; Malkani, Arthur L et al. (2016) Corrosion Damage and Wear Mechanisms in Long-Term Retrieved CoCr Femoral Components for Total Knee Arthroplasty. J Arthroplasty 31:2900-2906
Kocagoz, Sevi B; Underwood, Richard J; MacDonald, Daniel W et al. (2016) Ceramic Heads Decrease Metal Release Caused by Head-taper Fretting and Corrosion. Clin Orthop Relat Res 474:985-94
Gilbert, Jeremy L; Sivan, Shiril; Liu, Yangping et al. (2015) Direct in vivo inflammatory cell-induced corrosion of CoCrMo alloy orthopedic implant surfaces. J Biomed Mater Res A 103:211-23
Agne, Matthias T; Underwood, Richard J; Kocagoz, Sevi B et al. (2015) Is there material loss at the backside taper in modular CoCr acetabular liners? Clin Orthop Relat Res 473:275-85
Hanzlik, Josa A; Day, Judd S; Rimnac, Clare M et al. (2015) Is There A Difference in Bone Ingrowth in Modular Versus Monoblock Porous Tantalum Tibial Trays? J Arthroplasty 30:1073-8
Fredette, Eliza K; MacDonald, Daniel W; Underwood, Richard J et al. (2015) Does Metal Transfer Differ on Retrieved Ceramic and CoCr Femoral Heads? Biomed Res Int 2015:283038
Kurtz, Steven M; MacDonald, Daniel W; Mont, Michael A et al. (2015) Retrieval analysis of sequentially annealed highly crosslinked polyethylene used in total hip arthroplasty. Clin Orthop Relat Res 473:962-71
Steinbeck, Marla J; Jablonowski, Lauren J; Parvizi, Javad et al. (2014) The role of oxidative stress in aseptic loosening of total hip arthroplasties. J Arthroplasty 29:843-9
Kurtz, Steven M; Kocagoz, Sevi; Arnholt, Christina et al. (2014) Advances in zirconia toughened alumina biomaterials for total joint replacement. J Mech Behav Biomed Mater 31:107-16
Kurtz, Steven M; MacDonald, Daniel W; Kocagöz, Sevi et al. (2014) Can pin-on-disk testing be used to assess the wear performance of retrieved UHMWPE components for total joint arthroplasty? Biomed Res Int 2014:581812

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