Whether oxidation of ultrahigh-molecular-weight polyethylene (UHM-WPE) causes delamination of the plastic in total knee arthroplasties (TKAs) was investigated. Examination of retrieved TKAs has shown that oxidation of UHMWPE can be caused by postirradiation damage leading to a subsurface band or, to a lesser extent, by mechanical forces during use leading to surface oxidation. Delamination cracks propagated through the subsurface oxidized band. In wear tests, delamination occurred in artificially aged UHMWPE where only subsurface oxidized bands had formed. Increased surface wear predominated where oxidation was associated with the surface of the plastic. Similarly, in tensile and fatigue tests of oxidized UHMWPE, there was a significant reduction in the ultimate tensile strength and in the fatigue resistance of specimens that had developed a subsurface band. Oxidation increased fatigue crack growth rate. It was observed that UHMWPE from different manufacturers varied in its resistance to oxidation. This study demonstrates that the effect of oxidation, which results in the development of a subsurface white band, combined with high subsurface shear forces observed in TKAs, is to enhance delamination wear.
- total knee arthroplasty
- ultrahigh-molecular-weight polyethylene