August 2002 Bulletin

Highly cross-linked polyethylenes in total knee replacement

In the June 2002 issue of the Bulletin, the AAOS Biomedical Engineering Committee organized a Point/Counterpoint discussion on the use of highly cross-linked polyethylene articulating surfaces in total knee replacement. The intent of the discussion was to educate the Fellowship about the technical and scientific issues involved. As is noted in the Letter to the Editor section (page 15), an unfortunate copy-editing error occurred, resulting in incorrect titling of the discussion.

There was no intention to single out one particular product or method of manufacturing, but rather to discuss this new class of products as a whole. Furthermore, the discussion omitted the fact that highly cross-linked polyethylene tibial components have been cleared for marketing by the FDA for use in total knee replacements through the 510k process. It should also be noted that recently three studies have been presented at national research meetings and published as abstracts [1-3] that have evaluated the delamination resistance of highly cross- linked polyethylene. With regard to the use of highly cross-linked polyethylene in total knee replacement applications, the AAOS and the Biomedical Engineering Committee do not encourage or discourage the use of this class of material. We regret any confusion resulting from this Point/Counterpoint discussion.

Biomedical Engineering Committee

  1. Yao, J.Q., et al., "Improved delamination resistance of melt-annealed electron-beam irradiated highly crosslinked UMHWPE knee inserts." Transactions of the 28th Annual Meeting of the Society for Biomaterials, 2002: p. 60.
  2. Laurent, M.P., et al., "High cycle wear of highly crosslinked UMHWPE tibial articular surface evaluated in a knee wear simulator." Transactions of the 48th Annual Meeting of the Orthopaedic Research Society, 2002: Paper 0158.
  3. Maher, S.A. et al., "Reduced fracture toughness of enhanced cross-linked polyethylene is not associated with increased wear damage." Transactions of the 28th Annual Meeting of the Society for Biomaterials, 2002: p. 542.


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