Ultra-high molecular weight polyethylene is a semi-crystalline polymer (45–60%) with six decades of orthopaedic applications. This polymer has a high fracture toughness (30 kJ m−2) which comes from the molecular weight and the chain entanglements. Adverse alteration of the properties may lead to the part's pre-mature failure. This paper reviews the current manufacturing methods, and their effect on the properties of the polymer. The review also focused on the attempts of enhancing the polymer properties. The main cause of failure is implant loosing owing to the polymeric wear particles. Many manufacturers have attempted to enhance the wear and oxidation properties of the polymer, and the outcome of the new technologies is critically reviewed. Finally, the review explores the potential for future developments.
This review was submitted as part of the 2018 Materials Literature Review Prize of the Institute of Materials, Minerals and Mining run by the Editorial Board of MST. Sponsorship of the prize by TWI Ltd is gratefully acknowledged.
WrightTM.Polyethylene in knee arthroplasty: what is the future?Clin Orthop Relat Res. 2005;440:141–148.
2.
HolmbergK, WickströmG.Friction and wear tests of polymers. Wear. 1987;115(1–2):95–105.
3.
KurtzSM, MuratogluOK, EvansM, et al. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials. 1999;20(18):1659–1688.
4.
RuggieroA, D'AmatoR, GómezE, et al. Experimental comparison on tribological pairs UHMWPE/TIAL6V4 alloy, UHMWPE/AISI316L austenitic stainless and UHMWPE/ALO ceramic, under dry and lubricated conditions. Tribol Int. 2016;96:349–360.
5.
GeringerJ, TatkiewiczW, RouchouseG.Wear behavior of PAEK, poly(aryl-ether-ketone), under physiological conditions, outlooks for performing these materials in the field of hip prosthesis. Wear. 2011;271(11–12):2793–2803.
6.
DerbyshireB, FisherJ, DowsonD, et al. Comparative study of the wear of UHMWPE with zirconia ceramic and stainless steel femoral heads in artificial hip joints. Med Eng Phys. 1994;16(3):229–236.
7.
StandardizationIO.ISO 5834-1, implants for surgery – ultra-high-molecular-weight polyethylene – part 1: powder form; 2005.
8.
National-Joint-Registry. Annual reports. Technical report, National Joint Registry for England, Wales, Northern Ireland and the Isle of Man; 2017.
9.
BozicKJ, KurtzSM, LauE, et al. The epidemiology of revision total hip arthroplasty in the united states. J Bone Joint Surg Am. 2009;91(1):128–133.
10.
KurtzSM, editor. The origins of UHMWPE in total hip arthroplasty. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 4.
11.
KurtzSM, editor. The origins and adaptations of UHMWPE for knee replacements. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 7.
12.
KurtzSM, editor. The clinical performance of UHMWPE in shoulder replacements. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 11.
13.
KurtzSM, editor. The clinical performance of UHMWPE in elbow replacements. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 12.
14.
KurtzSM, editor. Applications of UHMWPE in total ankle replacements. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 13.
15.
WoodP, DeakinS.Total ankle replacement. Bone Joint J. 2003;85(3):334–341.
16.
BellCJ, FisherJ.Simulation of polyethylene wear in ankle joint prostheses. J Biomed Mater Res B Appl Biomater. 2007;81(1):162–167.
17.
GreySG, WrightTW, FlurinP -H, et al. Preliminary results of a novel hybrid cage glenoid compared to an all-polyethylene glenoid in total shoulder arthroplasty. Bull Hosp Joint Dis (2013). 2015;73:S86–S91.
18.
YamamotoN, TakahashiM, HibinoN, et al. Ultra-high molecular weight polyethylene tape applied for distal humeral condyle fracture around total elbow arthroplasty in patients with rheumatoid arthritis: report of two cases. Open J Orthop. 2015;5(9):283–287.
19.
JoyceTJ, UnsworthA.The wear of artificial finger joints using different lubricants in a new finger wear simulator. Wear. 2001;250(1–12):199–205.
20.
WattsA, TrailI.Anatomical small joint replacement in the hand. J Bone Joint Surg. 2011;1:1–6.
21.
SiblyTF, UnsworthA.Wear of cross-linked polyethylene against itself: a material suitable for surface replacement of the finger joint. J Biomed Eng. 1991;13(3):217–220.
22.
KurtzSM, editor. The clinical performance of UHMWPE in the Spine. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 14.
23.
KurtzSM, editor. UHMWPE homocomposites and fibers. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 22.
24.
BogieR, RothA, FaberS, Novel radiopaque UHMWPE sublaminar wires in a growth-guidance system for the treatment of early onset scoliosis: feasibility in a large animal study. Spine (Phila Pa 1976). 2014;39(25):E1503-9. https://doi.org/10.1097/BRS.0000000000000637
25.
van der VeenAJ, Rob BogieM, WillemsPC.Range of motion in segmental versus nonsegmental uhwmpe sublaminar wire growth guidance type constructs for early onset scoliosis correction. Spine (Phila Pa 1976). 2015;40(23):E1212-8. https://doi.org/10.1097/BRS.0000000000001078
26.
Binte WahedS.Synthetic anterior cruciate ligament implants utilising UHMWPE-polyethylene fibre doped with bioactivity enhancing additives [Master's thesis]. University of Sydney; 2016.
27.
AlinejadM, PeggE, DoddC, et al. Artificial anterior cruciate ligament (ACL) reconstruction for more natural knee kinematics. In: 4th Joint Meeting of the Bone Research Society & the British Orthopaedic Research Society; University of Bath; 2013.
CarboniA, CerulliG, PeruginiM, et al. Long-term follow-up of 105 porous polyethylene implants used to correct facial deformity. Eur J Plast Surg. 2002;25(6):310–314.
30.
GosauM, DraenertFG, IhrlerS.Facial augmentation with porous polyethylene (Medpor) histological evidence of intense foreign body reaction. J Biomed Mater Res B Appl Biomater. 2008;87(1):83–87.
31.
MaksimkinAV, SenatovFS, AnisimovaNY, et al. Multilayer porous UHMWPE scaffolds for bone defects replacement. Mater Sci Eng C. 2017;73:366–372.
32.
MohammadiS, GhourchianS, IzadiF, et al. Porous high-density polyethylene in facial reconstruction and revision rhinoplasty: a prospective cohort study. Head Face Med. 2012;8(1):17.
33.
GosauM, SchielS, DraenertGF, et al. Craniofacial augmentation with porous polyethylene implants (Medpor: first clinical results. Mund-, Kiefer-und Gesichtschirurgie. 2006;10(3):178–184.
KurtzS.From ethylene gas to UHMWPE component: the process of producing orthopedic implants. UHMWPE: Biomaterials Handbook. Elsevier; 2009. p. 7–19.
36.
KurtzSM.1 - A primer on UHMWPE. Oxford: William Andrew Publishing; 2016.1–6.
37.
LancinP, EssnerA, YauS-S, et al. Wear performance of 1900 direct compression molded, 1020 direct compression molded, and 1020 sheet compression molded UHMWPE under knee simulator testing. Wear. 2007;263(7):1030–1033.
38.
BursteinAH.Process for forming shaped articles of ultra high molecular weight polyethylene suitable for use as a prosthetic device or a component thereof. US Patent 6,503,439. 2003.
39.
SongJ, LiuP, CremensM, et al. Effects of machining on tribological behavior of ultra high molecular weight polyethylene (UHMWPE) under dry reciprocating sliding. Wear. 1999;225–229:716–723.
40.
SallesJ, GonçalvesM.Effects of machining parameters on surface quality of the ultra high molecular weight polyethylene (UHMWPE). Matéria. 2003;8(1):1–10.
41.
ASTM F648 - 14. Standard specification for ultra-high-molecular-weight polyethylene powder and fabricated form for surgical implants; 2012.
42.
PruittL, BaileyL.Factors affecting near-threshold fatigue crack propagation behavior of orthopedic grade ultra high molecular weight polyethylene. Polymer. 1998;39(8–9):1545–1553.
43.
SunD, StarkC, DumbletonJ.The origin of the white band observed in direct compression molded UHMWPE inserts. In: Annual meeting-society for biomaterials in conjunction with the international biomaterials symposium. Vol. 17. Society for Biomaterials; 1994. p. 121–121.
44.
WuJJ, BuckleyCP, O'ConnorJJ.Mechanical integrity of compression-moulded ultra-high molecular weight polyethylene: effects of varying process conditions. Biomaterials. 2002;23(17):3773–3783.
45.
RitterMA.Direct compression molded polyethylene for total hip and knee replacements. Clin Orthop Relat Res. 2001;393:94–100.
46.
BankstonBA, KeatingME, RanawatC, et al. Comparison of polyethylene wear in machined versus molded polyethylene. Clin Orthop Relat Res. 1995;317:37–43.
47.
McKellopHA, ShenF-W.Wear resistant surface-gradient crosslinked polyethylene. US Patent 6,165,220. 2000.
48.
CurrierBH, CurrierJH, CollierJP, et al. Effect of fabrication method and resin type on performance of tibial bearings. J Biomed Mater Res A. 2000;53(2):143–151.
49.
RiesMD, PruittL.Effect of cross-linking on the microstructure and mechanical properties of ultra-high molecular weight polyethylene. Clin Orthop Relat Res. 2005;440:149–156.
50.
KangL, GalvinAL, BrownTD, et al. Quantification of the effect of cross-shear on the wear of conventional and highly cross-linked UHMWPE. J Biomech. 2008;41(2):340–346.
51.
MuratogluOK, BragdonCR, O'ConnorDO, et al. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties: recipient of the 1999 HAP Paul Award. J Arthroplasty. 2001;16(2):149–160.
52.
MuratogluOK, BragdonCR, O'ConnorD, et al. Unified wear model for highly crosslinked ultra-high molecular weight polyethylenes (UHMWPE). Biomaterials. 1999;20(16):1463–1470.
53.
GomollAH, FitzW, ScottRD, et al. Nanoparticulate fillers improve the mechanical strength of bone cement. Acta Orthop. 2008;79(3):421–427.
54.
DumbletonJH, D'antonioJA, ManleyMT, et al. The basis for a second-generation highly cross-linked UHMWPE. Clin Orthop Relat Res. 2006;453:265–271.
55.
Del PreverEMB, BistolfiA, BraccoP, et al. UHMWPE for arthroplasty: past or future?J Orthop Traumatol. 2009;10(1):1–8.
56.
BertinEP.Principles and practice of X-ray spectrometric analysis. 2nd ed. Princeton (NJ): Springer Science & Business Media; 2012.
57.
FurmanskiJ, AndersonM, BalS, et al. Clinical fracture of cross-linked UHMWPE acetabular liners. Biomaterials. 2009;30(29):5572–5582.
58.
IngramJH, StoneM, FisherJ, et al. The influence of molecular weight, crosslinking and counterface roughness on TNF-alpha production by macrophages in response to ultra high molecular weight polyethylene particles. Biomaterials. 2004;25(17):3511–3522.
59.
FisherJ, McEwenHMJ, TipperJL, et al. Wear, debris, and biologic activity of cross-linked polyethylene in the knee: benefits and potential concerns. Clin Orthop Relat Res. 2004;428:114–119.
60.
BakerD, BellareA, PruittL.The effects of degree of crosslinking on the fatigue crack initiation and propagation resistance of orthopedic-grade polyethylene. J Biomed Mater Res A. 2003;66(1):146–154.
61.
GulRM, OralE, MuratogluOK.Oxidation resistant peroxide cross-linked UHMWPE produced by blending and surface diffusion. In: IOP Conference Series: Materials Science and Engineering. Vol. 60. IOP Publishing; 2014. p. 012015.
62.
EdidinAA, PruittL, JewettCW, et al. Plasticity-induced damage layer is a precursor to wear in radiation-cross-linked UHMWPE acetabular components for total hip replacement. J Arthroplasty. 1999;14(5):616–627.
63.
JahanMS, WangC, SchwartzG, et al. Combined chemical and mechanical effects on free radicals in UHMWPE joints during implantation. J Biomed Mater Res A. 1991;25(8):1005–1017.
64.
O'NeillP, BirkinshawC, LeahyJJ, et al. The role of long lived free radicals in the ageing of irradiated ultra high molecular weight polyethylene. Polym Degrad Stab. 1999;63(1):31–39.
65.
KurtzSM, editor. Highly cross-linked and melted UHMWPE. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 15.
66.
MuratogluOK, BragdonC, O'ConnorD, et al. A comparison of 5 different types of highly crosslinked UHMWPE: physical properties and wear behavior. In: Annual Meeting-Society for Biomaterials in Conjunction with International Biomaterials Symposium. Vol. 22; 1999. p. 326–326.
67.
KurtzSM, GawelHA, PatelJD.History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469(8):2262–2277.
68.
RanawatAS, TsailisP, MeftahM, et al. Minimum 5-year wear analysis of first-generation highly cross-linked polyethylene in patients 65 years and younger. J Arthroplasty. 2012;27(3):354–357.
69.
OralE, MalhiAS, WannomaeKK, et al. 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):1037–1044.
70.
OralE, MalhiAS, MuratogluOK.Mechanisms of decrease in fatigue crack propagation resistance in irradiated and melted UHMWPE. Biomaterials. 2006;27(6):917–925.
71.
SimisKS, BistolfiA, BellareA, et al. The combined effects of crosslinking and high crystallinity on the microstructural and mechanical properties of ultra high molecular weight polyethylene. Biomaterials. 2006;27(9):1688–1694.
72.
ZhaoY, LuoY, JiangB.Effect of irradiation on crystallinity and mechanical properties of ultrahigh molecular weight polyethylene. J Appl Polym Sci. 1993;50(10):1797–1801.
73.
MouradA-H, FouadH, ElleithyR.Impact of some environmental conditions on the tensile, creep-recovery, relaxation, melting and crystallinity behaviour of UHMWPE-GUR 410-medical grade. Mater Des. 2009;30(10):4112–4119.
74.
SloufM, SynkovaH, BaldrianJ, et al. Structural changes of UHMWPE after e-beam irradiation and thermal treatment. J Biomed Mater Res B Appl Biomater. 2008;85(1):240–251.
75.
LewisG.Properties of crosslinked ultra-high-molecular-weight polyethylene. Biomaterials. 2001;22(4):371–401.
76.
BaxterRM, MacDonaldDW, KurtzSM, et al. Characteristics of highly cross-linked polyethylene wear debris in vivo. J Biomed Mater Res B. 2013;101(3):467–475.
77.
ScottML, JaniSC.Cross-linked ultra-high molecular weight polyethylene for medical implant use. US Patent 6,547,828. 2003.
78.
CallarySA, SolomonLB, HolubowyczOT, et al. Wear of highly crosslinked polyethylene acetabular components: a review of RSA studies. Acta Orthop. 2015;86(2):159–168.
79.
CostaL, BraccoP, Del PreverEB, et al. Analysis of products diffused into UHMWPE prosthetic components in vivo. Biomaterials. 2001;22(4):307–315.
80.
CostaL, LudaMP, TrossarelliL, et al. Oxidation in orthopaedic UHMWPE sterilized by gamma-radiation and ethylene oxide. Biomaterials. 1998;19(7–9):659–668.
81.
BragdonCR, GreeneME, FreibergAA, et al. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36-vs 28-mm femoral heads. J Arthroplasty. 2007;22(6):125–129.
82.
BitschRG, LoidoltT, HeiselC, et al. Reduction of osteolysis with use of marathon cross-linked polyethylene: a concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am. 2008;90(7):1487–1491.
83.
ZaribafP, GillH, PeggE.Fatty-acid absorption detrimentally changes the physical properties of ultra-high molecular weight polyethylene. In: 16th UK Society for Biomaterials Annual Conference. University of Bath; 2017.
84.
JamesSP, BlazkaS, MerrillEW, et al. Challenge to the concept that UHMWPE acetabular components oxidize in vivo. Biomaterials. 1993;14(9):643–647.
85.
WannomaeKK, BhattacharyyaS, FreibergA, et al. In vivo oxidation of retrieved cross-linked ultra–high-molecular-weight polyethylene acetabular components with residual free radicals. J Arthroplasty. 2006;21(7):1005–1011.
Am JungK, LeeSC, HwangSH, et al. Fracture of a second-generation highly cross-linked UHMWPE tibial post in a posterior-stabilized scorpio knee system. Orthopedics. 2008;31(11):137.
88.
DigasG, KärrholmJ, ThannerJ, et al. 5-year experience of highly cross-linked polyethylene in cemented and uncemented sockets: two randomized studies using radiostereometric analysis. Acta Orthop. 2007;78(6):746–754.
89.
TurnerA, OkuboY, TeramuraS, et al. The antioxidant and non-antioxidant contributions of vitamin E in vitamin E blended ultra-high molecular weight polyethylene for total knee replacement. J Mech Behav Biomed Mater. 2014;31:21–30.
90.
OralE, MuratogluOK.Vitamin E diffused, highly crosslinked UHMWPE: a review. Int Orthop. 2011;35(2):215–223.
91.
BraccoP, BrunellaV, ZanettiM, et al. Stabilisation of ultra-high molecular weight polyethylene with vitamin E. Polym Degrad Stab. 2007;92(12):2155–2162.
92.
BraccoP, OralE.Vitamin E-stabilized UHMWPE for total joint implants: a review. Clin Orthop Relat Reső. 2011;469(8):2286–2293.
93.
OralE, BeckosCG, MalhiAS, et al. The effects of high dose irradiation on the cross-linking of vitamin E-blended ultrahigh molecular weight polyethylene. Biomaterials. 2008;29(26):3557–3560.
94.
OralE, ChristensenSD, MalhiAS, et al. Wear resistance and mechanical properties of highly cross-linked, ultrahigh–molecular weight polyethylene doped with vitamin E. J Arthroplasty. 2006;21(4):580–591.
95.
OralE, RowellSL, MuratogluOK.The effect of α-tocopherol on the oxidation and free radical decay in irradiated UHMWPE. Biomaterials. 2006;27(32):5580–5587.
96.
OralE, WannomaeKK, HawkinsN, et al. α-tocopherol-doped irradiated UHMWPE for high fatigue resistance and low wear. Biomaterials. 2004;25(24):5515–5522.
97.
WolfC, MachoC, LedererK.Accelerated ageing experiments with crosslinked and conventional ultra-high molecular weight polyethylene (UHMWPE) stabilised with α-tocopherol for total joint arthroplasty. J Mater Sci. 2006;17(12):1333–1340.
98.
TeramuraS, SakodaH, TeraoT, et al. Reduction of wear volume from ultrahigh molecular weight polyethylene knee components by the addition of vitamin E. J Orthop Res. 2008;26(4):460–464.
99.
OralE, BeckosCAG, LozynskyAJ, et al. Improved resistance to wear and fatigue fracture in high pressure crystallized vitamin E-containing ultra-high molecular weight polyethylene. Biomaterials. 2009;30(10):1870–1880.
100.
MutterR, StilleW, StroblG.Transition regions and surface melting in partially crystalline polyethylene: a raman spectroscopic study. J Polym Sci B. 1993;31(1):99–105.
101.
MedelFJ, Martínez-MorlanesMJ, AlonsoPJ, et al. Microstructure, thermooxidation and mechanical behavior of a novel highly linear, vitamin E stabilized, UHMWPE. Mater Sci Eng C. 2013;33(1):182–188.
102.
JarrettBT, CofskeJ, RosenbergAE, et al. In vivo biological response to vitamin E and vitamin-E-doped polyethylene. J Bone Joint Surg Am. 2010;92(16):2672–2681.
103.
ScemamaC, AnractP, DumaineV, et al. Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial. Int Orthop. 2017;41(6):1113–1118.
104.
BruckSD, MuellerEP.Radiation sterilization of polymeric implant materials. J Biomed Mater Res. 1988;22(S13):133–144.
105.
CollierJP, SperlingDK, CurrierJH, et al. Impact of gamma sterilization on clinical performance of polyethylene in the knee. J Arthroplasty. 1996;11(4):377–389.
106.
PremnathV, HarrisWH, JastyM, et al. Gamma sterilization of UHMWPE articular implants: an analysis of the oxidation problem. Biomaterials. 1996;17(18):1741–1753.
107.
BuchananF, SimB, DownesS.Influence of packaging conditions on the properties of gamma-irradiated UHMWPE following accelerated ageing and shelf ageing. Biomaterials. 1999;20(9):823–837.
108.
BargmannLS, BargmannBC, CollierJP, et al. Current sterilization and packaging methods for polyethylene. Clin Orthop Relat Res. 1999;369:49–58.
109.
RiesMD, WeaverK, BealsN.Safety and efficacy of ethylene oxide sterilized polyethylene in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:159–163.
110.
KurtzSM, editor. Packaging and sterilization of UHMWPE. 3rd ed. Oxford: William Andrew Publishing; 2016. Chapter 3.
111.
AffatatoS, BersagliaG, EmilianiD, et al. The performance of gamma-and EtO-sterilised UHMWPE acetabular cups tested under severe simulator conditions. Part 2: wear particle characteristics with isolation protocols. Biomaterials. 2003;24(22):4045–4055.
112.
CollierJP, SutulaLC, CurrierBH, et al. Overview of polyethylene as a bearing material comparison of sterilization methods. Clin Orthop Relat Res. 1996;333:76–86.
113.
GoldmanM, PruittL.Comparison of the effects of gamma radiation and low temperature hydrogen peroxide gas plasma sterilization on the molecular structure, fatigue resistance, and wear behavior of UHMWPE. J Biomed Mater Res A. 1998;40(3):378–384.
114.
KyiMS, HoltonJ, RidgwayGL.Assessment of the efficacy of a low temperature hydrogen peroxide gas plasma sterilization system. J Hosp Infection. 1995;31(4):275–284.
115.
ChuPK, ChenJY, WangLP, et al. Plasma-surface modification of biomaterials. Mater Sci Eng R: Reports. 2002;36(5):143–206.
116.
CostaL, BraccoP, Brach del PreverEM, et al. Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components. J Biomed Mater Res B Appl Biomater. 2006;78(1):20–26.
117.
RothAK, Boon-CeelenK, SmeltH, et al. Radiopaque UHMWPE sublaminar cables for spinal deformity correction: preclinical mechanical and radiopacifier leaching assessment. J Biomed Mater Res B Appl Biomater. 2018;106:771–779.
118.
HughesKF, RiesMD, PruittLA.Structural degradation of acrylic bone cements due to in vivo and simulated aging. J Biomed Mater Res A. 2003;65(2):126–135.
119.
KozakiewiczM, OlbrzymekL, StefanczykL, et al. Radio-opaque polyethylene for personalized craniomaxillofacial implants. Clin Oral Investig. 2016;21:1853–1859.
VazquezB, GinebraMP, GilFJ, et al. Radiopaque acrylic cements prepared with a new acrylic derivative of iodo-quinoline. Biomaterials. 1999;20(21):2047–2053.
123.
RohrW.Method of manufacturing an articulating bearing surface for an orthopaedic implant. US Patent 6,143,232. 2000.
124.
GreenbaumES, BurroughsBB, HarrisWH, et al. Effect of lipid absorption on wear and compressive properties of unirradiated and highly crosslinked UHMWPE: an in vitro experimental model. Biomaterials. 2004;25(18):4479–4484.
125.
SobierajMC, RimnacCM.Ultra high molecular weight polyethylene: mechanics, morphology, and clinical behavior. J Mech Behav Biomed Mater. 2009;2(5):433–443.
126.
Sánchez-SánchezX, Hernández-AvilaM, ElizaldeL, et al. Micro injection molding processing of UHMWPE using ultrasonic vibration energy. Mater Des. 2017;132:1–12.
127.
OralE, GhaliBW, RowellSL, et al. A surface crosslinked UHMWPE stabilized by vitamin E with low wear and high fatigue strength. Biomaterials. 2010;31(27):7051–7060.
128.
PeersmanG, LaskinR, DavisJ, et al. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.
129.
UlrichSD, SeylerTM, BennettD, et al. Total hip arthroplasties: what are the reasons for revision?Int Orthop. 2008;32(5):597–604.
130.
EhrlichGD, StoodleyP, KathjuS, et al. Engineering approaches for the detection and control of orthopaedic biofilm infections. Clin Orthop Relat Res. 2005;437(437):59–66.
131.
StoodleyP, KathjuS, HuFZ, et al. Molecular and imaging techniques for bacterial biofilms in joint arthroplasty infections. Clin Orthop Relat Res. 2005;437:31–40.
132.
KumarRM, GuptaP, SharmaSK, et al. Sustained drug release from surface modified UHMWPE for acetabular cup lining in total hip implant. Mater Sci Eng C. 2017;77:649–661.
133.
MuratogluO, OralE, SuhardiV, et al. Therapeutic UHMWPE bearing surface against periprosthetic infection. Bone Joint J. 2017;99(Suppl 5):69–69.
134.
NassisiV, DelleSide D, VelardiL, et al. Enhancing antibacterial properties of UHMWPE via ion implantation. In: APS meeting abstracts; 2012.
O
ceramic, under dry and lubricated conditions
) histological evidence of intense foreign body reaction