Duke University Medical Center, Chapel Hill, NC, USA.
J Am Acad Orthop Surg. 2011 Mar;19(3):143-51. doi: 10.5435/00124635-201103000-00003.
Polyethylene wear, with resultant particle-induced osteolysis, is a cause of late failure of total knee arthroplasty. The causes of both wear and osteolysis are multifactorial; still, improvements in the polyethylene liner have been investigated. Available highly cross-linked polyethylene tibial liners and patellar prostheses differ greatly in the amount and method of irradiation, thermal treatments, and sterilization techniques they undergo. Several varieties of highly cross-linked polyethylene reduce the gravimetric and volumetric wear of tibial liners in knee simulator studies. However, reduced fracture toughness and the generation of smaller and possibly more reactive particles also have been reported with some varieties of polyethylene. Clinical studies of the use of highly cross-linked polyethylene in total knee arthroplasty are limited. Two nonrandomized trials of highly cross-linked polyethylene in total knee arthroplasty have reported a nonsignificant decrease in radiolucent lines at 2 and 5 years, respectively. The risks of using highly cross-linked polyethylene include fracture of the liner or of a posterior-stabilized tibial post, liner dislodgement or locking mechanism disruption, and possibly more osteolysis. Highly cross-linked polyethylene tibial liners may be considered for younger, more active patients. However, until additional clinical results are available, a cautious approach is warranted to the widespread use of highly cross-linked polyethylene in total knee arthroplasty.
聚乙烯磨损，导致颗粒诱导性骨溶解，是全膝关节置换术晚期失败的原因。磨损和骨溶解的原因是多因素的；尽管如此，人们仍在研究改进聚乙烯衬垫。现有的高交联聚乙烯胫骨衬垫和髌骨假体在辐照量和方法、热处理和灭菌技术方面有很大的不同。几种高交联聚乙烯减少了膝关节模拟器研究中胫骨衬垫的重量和体积磨损。然而，一些种类的聚乙烯也报道了断裂韧性降低和产生更小、可能更具反应性的颗粒。高交联聚乙烯在全膝关节置换术中的临床研究有限。两项关于高交联聚乙烯在全膝关节置换术中应用的非随机试验分别报告了在 2 年和 5 年时射线不透线线的非显著性减少。使用高交联聚乙烯的风险包括衬垫或后稳定胫骨柱骨折、衬垫移位或锁定机构损坏，以及可能更多的骨溶解。高交联聚乙烯胫骨衬垫可考虑用于更年轻、更活跃的患者。然而，在更多的临床结果可用之前，在全膝关节置换术中广泛使用高交联聚乙烯需要谨慎。
