Effects of sterilization on wear in total knee arthroplasty

Twenty-nine Ortholoc II ultrahigh molecular weight polyethylene tibial components were retrieved from 27 patients at revision surgery from the same hospital. The polyethylene material grade, method of sterilization, and sterilization dosage for 26 of the tibial components were determined by tracing the material lot number for each component. Each tibial surface was scored for wear using a qualitative scoring system that evaluated delamination, pitting, scratching, cold flow, abrasion, and burnishing. After the wear score analysis, 14 of the 26 components were analyzed to determine the physical and mechanical properties of the polyethylene including toughness and elongation. Seven of these 14 components were sterilized using ethylene oxide and 7 were sterilized using gamma radiation. Tibial components sterilized with gamma radiation had significantly higher wear rates than those sterilized with ethylene oxide. Thirteen of the 18 components sterilized with gamma radiation had delamination of the articular surface compared with 2 of 8 components sterilized with ethylene oxide. Mechanical properties were significantly affected by the sterilization method. Components sterilized with ethylene oxide had significantly higher toughness and percent elongation than those sterilized with gamma radiation. These findings suggest that ethylene oxide sterilization caused less microstructural damage to the polyethylene and resulted in significantly less wear than was found in those components sterilized with gamma radiation.