Effects of Vitamin E Incorporation in Polyethylene on Oxidative Degradation, Wear Rates, Immune Response, and Infections in Total Joint Arthroplasty: a Review of the Current Literature

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 Nov 25

PMID 30470866

Citations 19

Authors

Bart Lambert

Danielle Neut

Hugo C van der Veen

Sjoerd K Bulstra

Affiliations

Soon will be listed here.

Abstract

Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this review summarizes the first clinical results of total hip and knee arthroplasties with vitamin E incorporated highly cross-linked polyethylene. Based on in vitro studies, incorporation of vitamin E in polyethylene provides good oxidative protection and preserves low wear rates. Incorporation of vitamin E may have the beneficial effect of reduced inflammatory response to its wear particles. Some microorganisms showed reduced adherence to vitamin E-incorporated UHMWPE; however, clinical relevance is doubtful. Short-term clinical studies of total hip and knee arthroplasties with vitamin E-incorporated highly cross-linked UHMWPE reported good clinical results and wear rates similar to highly cross-linked UHMWPE without vitamin E.

Citing Articles

A unique tribological inverted bearing solution for reverse shoulder arthroplasty: Vitamin E and ceramic (unique inverse pairings in rTSR).

Krishnan M, Rajaratnam J, Peiris D, Gupta M, Wigmore E, Heinrichs C Shoulder Elbow. 2024; :17585732241265627.

PMID: 39552659 PMC: 11562244. DOI: 10.1177/17585732241265627.

Vitamin E-stabilized polyethylene shows similar survival rates at minimum 7-year follow-up compared to conventional polyethylene in primary total knee arthroplasty.

Bistolfi A, Spezia M, Cipolla A, Bonera M, Mellano D, Banci L J Exp Orthop. 2024; 11(3):e12106.

PMID: 39239569 PMC: 11375329. DOI: 10.1002/jeo2.12106.

Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial.

Maier K, Selig M, Haddouche A, Haunschild M, Hauschild O, Khalili I Trials. 2024; 25(1):27.

PMID: 38183062 PMC: 10768156. DOI: 10.1186/s13063-023-07811-1.

In vivo creep and wear performance of vitamin-E-diffused highly crosslinked polyethylene in total hip arthroplasty.

Matsuoka T, Takahashi Y, Ishida T, Tateiwa T, Shishido T, Yamamoto K Arch Orthop Trauma Surg. 2023; 143(12):7195-7203.

PMID: 37438580 DOI: 10.1007/s00402-023-04972-1.

Can convertible metal-backed glenoid components replace cemented polyethylene glenoid components in anatomical total shoulder arthroplasty?.

Kim M, Ahn Y, Lee S, Jeong H, Kim Y, Oh J BMC Surg. 2023; 23(1):193.

PMID: 37407984 PMC: 10324271. DOI: 10.1186/s12893-023-02092-6.

References

Kurtz S, Manley M, Wang A, Taylor S, Dumbleton J . Comparison of the properties of annealed crosslinked (Crossfire) and conventional polyethylene as hip bearing materials. Bull Hosp Jt Dis. 2003; 61(1-2):17-26. View

McCalden R, MacDonald S, Rorabeck C, Bourne R, Chess D, Charron K . Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009; 91(4):773-82. DOI: 10.2106/JBJS.H.00244. View

Rohde H, Frankenberger S, Zahringer U, Mack D . Structure, function and contribution of polysaccharide intercellular adhesin (PIA) to Staphylococcus epidermidis biofilm formation and pathogenesis of biomaterial-associated infections. Eur J Cell Biol. 2009; 89(1):103-11. DOI: 10.1016/j.ejcb.2009.10.005. View

Grupp T, Fritz B, Kutzner I, Schilling C, Bergmann G, Schwiesau J . Vitamin E stabilised polyethylene for total knee arthroplasty evaluated under highly demanding activities wear simulation. Acta Biomater. 2016; 48:415-422. DOI: 10.1016/j.actbio.2016.10.031. View

Currier B, Currier J, Mayor M, Lyford K, Collier J, Van Citters D . Evaluation of oxidation and fatigue damage of retrieved crossfire polyethylene acetabular cups. J Bone Joint Surg Am. 2007; 89(9):2023-9. DOI: 10.2106/JBJS.F.00336. View

Sillesen N, Greene M, Nebergall A, Nielsen P, Laursen M, Troelsen A . Three Year RSA Evaluation of Vitamin E Diffused Highly Cross-linked Polyethylene Liners and Cup Stability. J Arthroplasty. 2015; 30(7):1260-4. DOI: 10.1016/j.arth.2015.02.018. View

Nguyen L, Lehil M, Bozic K . Trends in total knee arthroplasty implant utilization. J Arthroplasty. 2015; 30(5):739-42. DOI: 10.1016/j.arth.2014.12.009. View

Scemama C, Anract P, Dumaine V, Babinet A, Courpied J, Hamadouche M . Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial. Int Orthop. 2016; 41(6):1113-1118. DOI: 10.1007/s00264-016-3320-2. View

Rowell S, Oral E, Muratoglu O . Comparative oxidative stability of α-tocopherol blended and diffused UHMWPEs at 3 years of real-time aging. J Orthop Res. 2011; 29(5):773-80. DOI: 10.1002/jor.21288. View

10.

Haider H, Weisenburger J, Kurtz S, Rimnac C, Freedman J, Schroeder D . Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty?. J Arthroplasty. 2011; 27(3):461-9. DOI: 10.1016/j.arth.2011.03.024. View

11.

Salemyr M, Muren O, Ahl T, Boden H, Chammout G, Stark A . Vitamin-E diffused highly cross-linked polyethylene liner compared to standard liners in total hip arthroplasty. A randomized, controlled trial. Int Orthop. 2015; 39(8):1499-505. DOI: 10.1007/s00264-015-2680-3. View

12.

Gomez-Barrena E, Esteban J, Molina-Manso D, Adames H, Martinez-Morlanes M, Terriza A . Bacterial adherence on UHMWPE with vitamin E: an in vitro study. J Mater Sci Mater Med. 2011; 22(7):1701-6. DOI: 10.1007/s10856-011-4340-5. View

13.

Oral E, Wannomae K, Hawkins N, Harris W, Muratoglu O . Alpha-tocopherol-doped irradiated UHMWPE for high fatigue resistance and low wear. Biomaterials. 2004; 25(24):5515-22. DOI: 10.1016/j.biomaterials.2003.12.048. View

14.

Parth M, Aust N, Lederer K . Studies on the effect of electron beam radiation on the molecular structure of ultra-high molecular weight polyethylene under the influence of alpha-tocopherol with respect to its application in medical implants. J Mater Sci Mater Med. 2004; 13(10):917-21. DOI: 10.1023/a:1019892004830. View

15.

Oral E, Malhi A, Wannomae K, Muratoglu O . Highly cross-linked ultrahigh molecular weight polyethylene with improved fatigue resistance for total joint arthroplasty: recipient of the 2006 Hap Paul Award. J Arthroplasty. 2008; 23(7):1037-44. PMC: 2614333. DOI: 10.1016/j.arth.2007.09.027. View

16.

Wannomae K, Christensen S, Micheli B, Rowell S, Schroeder D, Muratoglu O . Delamination and adhesive wear behavior of alpha-tocopherol-stabilized irradiated ultrahigh-molecular-weight polyethylene. J Arthroplasty. 2009; 25(4):635-43. DOI: 10.1016/j.arth.2009.04.005. View

17.

Oral E, Beckos C, Malhi A, Muratoglu O . The effects of high dose irradiation on the cross-linking of vitamin E-blended ultrahigh molecular weight polyethylene. Biomaterials. 2008; 29(26):3557-60. PMC: 2516939. DOI: 10.1016/j.biomaterials.2008.05.004. View

18.

Bichara D, Malchau E, Sillesen N, Cakmak S, Nielsen G, Muratoglu O . Vitamin E-diffused highly cross-linked UHMWPE particles induce less osteolysis compared to highly cross-linked virgin UHMWPE particles in vivo. J Arthroplasty. 2014; 29(9 Suppl):232-7. DOI: 10.1016/j.arth.2014.03.044. View

19.

Lerf R, Zurbrugg D, Delfosse D . Use of vitamin E to protect cross-linked UHMWPE from oxidation. Biomaterials. 2010; 31(13):3643-8. DOI: 10.1016/j.biomaterials.2010.01.076. View

20.

Reno F, Cannas M . UHMWPE and vitamin E bioactivity: an emerging perspective. Biomaterials. 2006; 27(16):3039-43. DOI: 10.1016/j.biomaterials.2006.01.016. View