Wear of sequentially enhanced 9-Mrad polyethylene in 10 million cycle knee simulation study

Highly crosslinked polyethylene (HXPE) has been shown to be effective in reducing wear in total hip replacements. HXPE has not found widespread use in TKR, because the crosslinking inevitably leads to reductions in critical properties such as toughness and fatigue strength. Sequentially enhanced crosslinking (SXPE) have been suggested for improved wear resistance for tibial inserts with maintenance of mechanical properties and anticipated high oxidation resistance superior to conventional polyethylene (XLPE). We compared the wear of SXPE (9Mrad) to XLPE inserts (3Mrad) to 10 million cycles. Triathlon femoral condyles were identical in both. This is the first wear study of SXPE inserts. According to the power law relating irradiation dose to wear of XLPE inserts, wear of 9 Mrad inserts should be reduced by 70% compared to 3Mrad controls. The wear rates of the SXPE inserts were reduced by 86% at 10 million cycles duration, somewhat greater than predicted. The one prior investigation by the manufacturer reported a 79% wear reduction for SXPE compared to controls in a 5 million cycle simulator study in knee design and test parameters. There were important differences between the two studies. Nevertheless there clearly appeared to be a major benefit for sequentially enhanced polyethylene in tibial inserts. This combined wear reduction of 80-85% with improved oxidation resistance and retention of mechanical properties may prove beneficial for active patients who may otherwise risk high wear rates over many years of use.