In-vitro oxidation model for UHMWPE incorporating synovial fluid lipids

Post-irradiation melting of ultra-high molecular weight polyethylene (UHMWPE) reduced the oxidation potential of UHMWPE in vivo. After mid-term (5-10 years) use in vivo, there is detectable oxidation in irradiated and melted joint implant retrievals. The absorption of the synovial fluid lipid squalene was identified as a possible factor initiating oxidation. We investigated the role of lipids in UHMWPE oxidation by asking: (1) Do other synovial fluid lipids initiate oxidation in irradiated and melted UHMWPE?; (2) What is the effect of the absorption of multiple lipids on UHMWPE oxidation?; (3) How does lipid-initiated oxidation in vitro compare to what is observed in long-term retrievals? We diffused emulsified single and mixed lipids into irradiated and melted UHMWPE and accelerated aged them. We analyzed the oxidation in these samples and in four long-term highly crosslinked, irradiated, and melted Longevity™ UHMWPE liner retrievals (in vivo for up to 190 months) using Fourier Transform Infrared Spectroscopy (FTIR). We showed that lipids other than squalene could initiate oxidation in UHMWPE and that the types of absorbed lipids determined the amount of resultant oxidation. Although mixed lipids doping and accelerated aging reproduced the average and maximum oxidation values and oxidation products observed in vivo, the oxidation depth profile and its effect on cross-link density was different. One reason for this was the variability of oxidation in retrievals, suggesting additional factors contributing to oxidation. The understanding of oxidative processes in vivo and the development of clinically relevant in vitro protocols to evaluate implant materials is crucial for their long-term performance. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1833-1839, 2018.