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

Bart Lambert, Danielle Neut, Hugo C. van der Veen*, Sjoerd K. Bulstra

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

17 Citations (Scopus)
6 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)1549-1557
Number of pages9
JournalINTERNATIONAL ORTHOPAEDICS
Volume43
Issue number7
Early online date23-Nov-2018
DOIs
Publication statusPublished - Jul-2019

Keywords

  • Vitamin E
  • UHMWPE
  • Highly cross-linked polyethylene
  • Arthroplasty
  • Wear rates
  • Infection
  • CROSS-LINKED POLYETHYLENE
  • MOLECULAR-WEIGHT POLYETHYLENE
  • TOTAL HIP-ARTHROPLASTY
  • E-STABILIZED POLYETHYLENE
  • E-BLENDED UHMWPE
  • ALPHA-TOCOPHEROL
  • FATIGUE RESISTANCE
  • IRRADIATED UHMWPE
  • BIOFILM FORMATION
  • PARTICLES

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