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Advanced Testing Protocols Simulate Failures and Validate Antioxidant Polyethylene in Ankle Implants.

Ryan Siskey1,2, Patrick Hall1, Ruth Heckler3

  • 1Exponent Inc., Philadelphia, Pennsylvania, USA.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|May 19, 2025
PubMed
Summary
This summary is machine-generated.

Oxidation causes polyethylene fatigue failure in total ankle replacements (TAR), especially with varus-valgus rotation. Antioxidant stabilization significantly improves UHMWPE durability, enhancing TAR performance and implant longevity.

Keywords:
oxidation and antioxidant effectspolyethylene fatigue resistancetotal ankle replacement (TAR)varus‐valgus rotationvitamin E‐stabilized polyethylene

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Area of Science:

  • Biomaterials Engineering
  • Orthopedic Surgery
  • Mechanical Engineering

Background:

  • Total ankle replacement (TAR) is a treatment for end-stage ankle osteoarthritis.
  • Polyethylene (PE) fatigue is a critical factor affecting TAR survivorship.
  • Mobile-bearing TAR designs are susceptible to specific failure modes.

Purpose of the Study:

  • To establish a clinically relevant testing protocol simulating PE fatigue in mobile-bearing TAR.
  • To evaluate the impact of oxidation and antioxidant stabilization on UHMWPE performance.
  • To assess the fatigue resistance of conventional versus vitamin E-stabilized UHMWPE.

Main Methods:

  • Developed a six-degree-of-freedom simulator to replicate clinical PE fatigue failures.
  • Applied varus-valgus rotation and cyclic loading (1500-3000 N) at body temperature.
  • Tested conventional and vitamin E-stabilized UHMWPE inserts to fracture or 3 million cycles.
  • Measured oxidation levels using Fourier-transform infrared spectroscopy (ASTM F2102).

Main Results:

  • Conventional UHMWPE failed due to fatigue under varus-valgus rotation (OI = 2.59 ± 1.11).
  • No fatigue failure occurred in conventional UHMWPE without varus-valgus rotation.
  • Vitamin E-stabilized UHMWPE showed no fatigue failure after 3 million cycles, even with rotation (OI = 0.23 ± 0.02).
  • Fractography indicated crack initiation at the trough and propagation with cyclic loading.

Conclusions:

  • Oxidation significantly reduces UHMWPE fatigue life in mobile-bearing TAR.
  • Varus-valgus rotation exacerbates PE fatigue failure in TAR implants.
  • Antioxidant stabilization (vitamin E) demonstrates superior resistance to fatigue and oxidation.
  • Developed protocols can assess the safety and performance of alternative biomaterials for TAR.