Effects of knee simulator control method and radiation dose on UHMWPE wear rate, and relationship between wear rate and clinical revision rate in National Joint Registry

Abstract

The wear rate of five types of cruciate-retaining artificial knee joint ultrahigh-molecular-weight polyethylene (UHMWPE) inserts was examined using two custom-made knee joint simulators satisfying ISO 14243-1 (load control) and ISO 14243-3 (displacement control). The wear rate of knee joints composed of a UHMWPE insert and a Co-Cr-Mo alloy or oxidized zirconium femoral component linearly increased with increasing number of wear cycles, and the volumetric wear rate per million cycles was approximately 6-18 mm³/Mc. The wear rate was the lowest in the highly crosslinked knee joint irradiated at 90 kGy (Scorpio) among the five UHMWPE inserts. The extent of oxidation in UHMWPE after a knee simulator test of up to 5 × 10⁶ cycles was small. The load-controlled wear rates measured in this work were close to the displacement-controlled wear rates reported in the literature. The effect of the control method on the wear rate was small for Nexgen and Scorpio knee joints. However, it was larger for the PFC Sigma knee joint having a high curvature of the surface. The wear rate of various knee joints made of highly crosslinked UHMWPE (XLPE) markedly decreased when they were subjected to a radiation dose of 40 kGy or more. The 10-year cumulative percentage revision rate since the primary operation slightly decreased with decreasing volumetric knee simulator wear rate for conventional UHMWPE (CPE) and XLPE knee joint inserts. The XLPE knee joint was shown to exhibit reduced in vivo wear and lower rates of revision for total knee replacement. On the other hand, Nexgen and PFC Sigma (both CPE) knee joints showed the lowest revision rate in the AOA and NJR national joint replacement registries. The volumetric wear rates of 3 mm³/Mc for XLPE and 15 mm³/Mc for CPE knee joint inserts are recommended as a goal for the development of new knee joints.

Keywords: Artificial knee joint; Clinical revision rate; ISO 14243; Knee simulator; National Joint Registry; Oxidation index; Ultrahigh-molecular-weight polyethylene; Wear rate.