UHMWPE Biomaterials Handbook

Ultra High Molecular Weight Polyethylene in Total Joint Replacement and Medical Devices

Steven M. Kurtz

• Publisher: Academic Press
• Year: 2009
• eBook ISBN: 9780080884448
• Edition: 2
• Topic: Technology & Engineering
• Subtopic: Materials Science
• Index: Technology & Engineering

UHMWPE Biomaterials Handbook describes the science, development, properties and application of of ultra-high molecular weight polyethylene (UHMWPE) used in artificial joints. This material is currently used in 1.4 million patients around the world every year for use in the hip, knee, upper extremities, and spine.Since the publication of the 1st edition there have been major advances in the development and clinical adoption of highly crosslinked UHMWPE for hip and knee replacement. There has also been a major international effort to introduce Vitamin E stabilized UHMWPE for patients. The accumulated knowledge on these two classes of materials are a key feature of the 2nd edition, along with an additional 19 additional chapters providing coverage of the key engineering aspects (biomechanical and materials science) and clinical/biological performance of UHMWPE, providing a more complete reference for industrial and academic materials specialists, and for surgeons and clinicians who require an understanding of the biomaterials properties of UHMWPE to work successfully on patient applications.- The UHMWPE Handbook is the comprehensive reference for professionals, researchers, and clinicians working with biomaterials technologies for joint replacement- New to this edition: 19 new chapters keep readers up to date with this fast moving topic, including a new section on UHMWPE biomaterials; highly crosslinked UHMWPE for hip and knee replacement; Vitamin E stabilized UHMWPE for patients; clinical performance, tribology an biologic interaction of UHMWPE- State-of-the-art coverage of UHMWPE technology, orthopedic applications, biomaterial characterisation and engineering aspects from recognised leaders in the field

Chapter 1. A Primer on UHMWPE

1.1. Introduction

Ultra-high molecular weight polyethylene (UHMWPE) is a unique polymer with outstanding physical and mechanical properties. Most notable are its chemical inertness, lubricity, impact resistance, and abrasion resistance. These characteristics of UHMWPE have been exploited since the 1950s in a wide range of industrial applications (Figure 1.1), including pickers for textile machinery, lining for coal chutes and dump trucks, runners for bottling production lines, as well as bumpers and siding for ships and harbors. Over 90% of the UHMWPE produced in the world is used by industry.

Figure 1.1. Dump truck liner of UHMWPE, an example of an industrial application for the polymer.

For the past 45 years, UHMWPE has also been used in orthopedics as a bearing material in artificial joints. Each year, about 2 million joint replacement procedures are performed around the world, and the majority of these joint replacements incorporate UHMWPE. Despite the success of these restorative procedures, orthopedic and spine implants have only a finite lifetime. Wear and damage of the UHMWPE components has historically been one of the factors limiting implant longevity. In the past 10 years, highly crosslinked UHMWPE biomaterials have shown dramatic reductions in wear in clinical use around the world. The orthopedic community awaits confirmation that these reductions in wear will be associated with improved long-term survival, as expected.

UHMWPE comes from a family of polymers with a deceptively simple chemical composition, consisting of only hydrogen and carbon. However, the simplicity inherent in its chemical composition belies a more complex hierarchy of organizational structures at the molecular and supermolecular length scales. At a molecular level, the carbon backbone of polyethylene can twist, rotate, and fold into ordered crystalline regions. At a supermolecular level, the UHMWPE consists of powder (also known as resin or flake) that must be consolidated at elevated temperatures and pressures to form a bulk material. Further layers of complexity are introduced by chemical changes that arise in UHMWPE due to radiation sterilization and processing.

The purpose of this Handbook is to explore the complexities inherent in UHMWPE and an increasingly diverse field of UHMWPE biomaterials that include radiation crosslinking, composites, and antioxidants such as Vitamin E. This book is intended to provide the reader with a background in the terminology, history, and recent advances related to its use in orthopedics. A monograph such as this is helpful in several respects. First, it is important that members of the surgical community have access to up-to-date knowledge about the properties of UHMWPE so that this information can be more accurately communicated to their patients. Second, members of the orthopedic research community need access to timely synthesis of the existing literature so that future studies are more effectively planned to fill in existing gaps in our current understanding. Finally, this Handbook may also serve as a resource for university students at both the undergraduate and graduate levels.

This introductory chapter starts with the basics, assuming the reader is not familiar with polymers, let alone polyethylene. The chapter provides basic information about polymers in general, describes the structure and composition of polyethylene, and explains how UHMWPE differs from other polymers (including high density polyethylene [HDPE]) and from other materials (e.g., metals and ceramics). The concepts of crystallinity and thermal transitions are introduced at a basic level. Readers familiar with these basic polymer concepts may want to consider skipping ahead to the next chapter.

1.2. What is a Polymer?

The ultra-high molecular weight polyethylene (UHMWPE) used in orthopedic applications is a type of polymer generally classified as a linear homopolymer. Our first task is to explain what is meant by all of these terms. Before proceeding to a definition of UHMWPE, one needs to first understand what constitutes a linear homopolymer.

A polymer is a molecule consisting of many (poly-) parts (-mer) linked together by chemical covalent bonds. The individual parts, or monomer segments, of a polymer can all be the same. In such a case, we have a homopolymer as illustrated in Figure 1.2. If the parts of a polymer are different, it is termed a copolymer. These differences in chemical structure are also illustrated in Figure 1.2, with generic symbols (A, B) for the monomers.

Figure 1.2. Schematics of homopolymer and copolymer structure.

Polymers can be either linear or branched as illustrated in Figure 1.3. The tendency for a polymer to exhibit branching is governed by its synthesis conditions.

Figure 1.3. Schematics of linear and branched polymer structures.

Keep in mind that the conceptual models of polymer structure illustrated in Figures 1.2 and 1.3 have been highly simplified. For example, it is possible for a copolymer to have a wide range of substructural elements giving rise to an impressive range of possibilities. In industrial practice, polyethylenes, including UHMWPE, are frequently copolymerized with other monomers (e.g., polypropylene) to achieve improved processing characteristics or to alter the physical and mechanical properties of the polymer. For example, according to ISO 11542, which is the industrial standard for UHMWPE, the polymer can contain a large concentration of copolymer (up to 50%) and still be referred to as “UHMWPE.” However, most of the UHMWPEs used to fabricate orthopedic implants are homopolymers, and so we will restrict our further discussion to polymers with only a single type of monomer.

The principal feature of a polymer that distinguishes it from other materials, such as metals and ceramics, is its molecular size. In a metallic alloy or ceramic, the elemental building blocks are individual metal atoms (e.g., Co, Cr, Mo) or relatively small molecules (e.g., metal carbides or oxides). In a polymer, however...

Table of contents

• Brief Table of Contents
• Table of Contents
• Copyright Page
• Dedication
• Foreword
• Contributors
• Chapter 1. A Primer on UHMWPE
• BibliographyReferences
• Chapter 2. From Ethylene Gas to UHMWPE Component
• BibliographyReferences
• Chapter 3. Packaging and Sterilization of UHMWPE
• BibliographyReferences
• Chapter 4. The Origins of UHMWPE in Total Hip Arthroplasty
• BibliographyReferences
• Chapter 5. The Clinical Performance of UHMWPE in Hip Replacements
• BibliographyReferences
• Chapter 6. Contemporary Total Hip Arthroplasty
• BibliographyReferences
• Chapter 7. The Origins and Adaptations of UHMWPE for Knee Replacements
• BibliographyReferences
• Chapter 8. The Clinical Performance of UHMWPE in Knee Replacements
• BibliographyReferences
• Chapter 9. The Clinical Performance of UHMWPE in Shoulder Replacements
• BibliographyReferences
• Chapter 10. The Clinical Performance of UHMWPE in Elbow Replacements
• BibliographyReferences
• Chapter 11. Applications of UHMWPE in Total Ankle Replacements
• BibliographyReferences
• Chapter 12. The Clinical Performance of UHMWPE in the Spine
• BibliographyReferences
• Chapter 13. Highly Crosslinked and Melted UHMWPE
• BibliographyReferences
• Chapter 14. Highly Crosslinked and Annealed UHMWPE
• BibliographyReferences
• Chapter 15. Highly Crosslinked UHMWPE Doped with Vitamin E
• BibliographyReferences
• Chapter 16. Vitamin-E-Blended UHMWPE Biomaterials
• BibliographyReferences
• Chapter 17. Composite UHMWPE Biomaterials and Fibers
• BibliographyReferences
• Chapter 18. UHMWPE/Hyaluronan Microcomposite Biomaterials
• BibliographyReferences
• Chapter 19. High Pressure Crystallized UHMWPEs
• BibliographyReferences
• Chapter 20. Compendium of Highly Crosslinked UHMWPEs
• BibliographyReferences
• Chapter 21. Mechanisms of Crosslinking, Oxidative Degradation and Stabilization of UHMWPE
• BibliographyReferences
• Chapter 22. In Vivo Oxidation of UHMWPE
• BibliographyReferences
• Chapter 23. Pathophysiologic Reactions to UHMWPE Wear Particles
• BibliographyRefereneces
• Chapter 24. Characterization of Physical, Chemical, and Mechanical Properties of UHMWPE
• BibliographyReferences
• Chapter 25. Tribological Assessment of UHMWPE in the Hip
• BibliographyReferences
• Chapter 26. Tribological Assessment of UHMWPE in the Knee
• BibliographyReferences
• Chapter 27. Characterization of UHMWPE Wear Particles
• BibliographyReferences
• Chapter 28. Clinical Surveillance of UHMWPE Using Radiographic Methods
• BibliographyReferences
• Chapter 29. ESR Insights into Macroradicals in UHMWPE
• BibliographyReferences
• Chapter 30. Fatigue and Fracture of UHMWPE
• BibliographyReferences
• Chapter 31. Development and Application of the Notched Tensile Test to UHMWPE
• BibliographyReferences
• Chapter 32. Development and Application of the Small Punch Test to UHMWPE
• BibliographyReferences
• Chapter 33. Nano- and Microindentation Testing of UHMWPE
• BibliographyReferences
• Chapter 34. MicroCT Analysis of Wear and Damage in UHMWPE
• BibliographyReferences
• Chapter 35. Computer Modeling and Simulation of UHMWPE
• BibliographyReferences
• Index