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How have new sterilization techniques and new forms of polyethylene influenced wear in total joint replacement?

Dr. Crowninshield is Adjunct Professor, Department of Orthopedic Surgery, Rush Medical College, Chicago, IL. Dr. Muratoglu is Co-Director, Harris Orthopedic Biomechanics and Biomaterials Laboratory, Massachusetts General Hospital, and Associate Professor of Orthopedic Surgery (Biomaterials), Harvard Medical School, Boston, MA.

*The Implant Wear Symposium 2007 Engineering Work Group included Donald L. Bartel, PhD, Thomas D. Brown, PhD, Ian C. Clarke, PhD, Roy D. Crowninshield, PhD, Darryl D’Lima, MD, PhD, A. Seth Greenwald, DPhil(Oxon), Steven M. Kurtz, PhD, Jack Lemons, PhD, Michael T. Manley, PhD, Harry A. McKellop, PhD, Orhun K. Muratoglu, PhD, Ebru Oral, PhD, Lisa Pruitt, PhD, Clare Rimnac, PhD, Peter S. Walker, PhD, and Timothy Wright, PhD.

Dr. Crowninshield or a member of his immediate family has received research or institutional support and royalties from Zimmer. Dr. Muratoglu or a member of his immediate family has received research or institutional support and royalties from Zimmer and Biomet; has received miscellaneous nonincome support, commercially derived honoraria, or other nonresearch-related funding from Zimmer; and is a consultant for Zimmer.

Polyethylene has undergone many changes over the past several decades, including changes in consolidation processes, resin types, sterilization methods, packaging, and the extent of cross-linking. We believe that new sterilization techniques and forms of polyethylene have generally improved wear performance. Polyethylene sterilized without the use of radiation has been shown to have relatively high rates of wear in vivo. Ram-extruded polyethylene sterilized via gamma irradiation in air has been the most commonly used bearing material in the past several decades. Recently, components molded and gamma-sterilized without oxygen as well as highly cross-linked material have found increased clinical use. Exposure of polyethylene to radiation, either to sterilize it or to intentionally cross-link it, has been shown to improve the wear performance of the material. Newer second-generation methods of cross-linking polyethylene include the use of vitamin E, which quenches free radicals and demonstrates promise in providing low wear and desirable mechanical properties.