Schroeder Stefan, Braun Steffen, Mueller Ulrike, Vogel Matthias, Sonntag Robert, Jaeger Sebastian, Kretzer Jan Philippe
Laboratory of Biomechanics and Implant Research, Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
J Mech Behav Biomed Mater. 2020 Jan;101:103434. doi: 10.1016/j.jmbbm.2019.103434. Epub 2019 Sep 13.
For prosthetic knee joints of the hinged type, typically polyethylene (PE) flexion bushings are used between axis and femoral component to prevent metallic wear. Nevertheless, PE-wear can lead to periprosthetic osteolysis followed by aseptic loosening of the implant. Based on high creep and wear resistance carbon-fibre-reinforced polyether ether ketones (CFR-PEEKs) could provide an alternative material to ultra-high-molecular-weight polyethylene (UHMWPE) for this bearing type.
Flexion bushings of four different materials were investigated (CFR-PEEK pitch fibres, CFR-PEEK PAN fibres, virgin PEEK without carbon fibres and UHMWPE) using a bushing tester. For determination of the polymeric and metallic wear, gravimetric measurements and particle analyses were performed.
The polymeric wear rates of CFR-PEEK PAN (6.657 ± 0.714 mg/10 cycles) and CFR-PEEK pitch (32.085 ± 2.748 mg/10 cycles) were significantly higher compared to the polymeric wear rates of virgin PEEK (0.764 ± 0.283 mg/10 cycles) or UHMWPE (-0.015 ± 0.011 mg/10 cycles) (p < .001). In addition, the metallic wear rates were significantly higher when using bushings made of CFR-PEEK PAN (3.373 ± 0.214 mg/10 cycles) and CFR-PEEK pitch (3.604 ± 0.355 mg/10 cycles), than when using bushings made of virgin PEEK (0.177 ± 0.049 mg/10 cycles) or UHMWPE (0.031 ± 0.011 mg/10 cycles) (p < .001). The mean particle size of the two CFR-PEEK groups was significantly smaller compared to the virgin PEEK and UHMWPE group (p < .001).
According to these results, the clinical use of CFR-PEEK in combination with CoCr could lead to higher wear rates and this should be avoided. Virgin PEEK may still be considered as an alternative to UHMWPE to use it for flexion bushings in a hinged knee joint.
对于铰链式人工膝关节，通常在轴与股骨部件之间使用聚乙烯（PE）屈曲衬套以防止金属磨损。然而，PE磨损会导致假体周围骨溶解，进而导致植入物无菌性松动。基于高蠕变和耐磨性，碳纤维增强聚醚醚酮（CFR-PEEK）可为这种轴承类型提供一种替代超高分子量聚乙烯（UHMWPE）的材料。
使用衬套测试仪研究了四种不同材料的屈曲衬套（CFR-PEEK沥青纤维、CFR-PEEK聚丙烯腈纤维、无碳纤维的纯PEEK和UHMWPE）。为了测定聚合物和金属磨损，进行了重量测量和颗粒分析。
与纯PEEK（0.764±0.283 mg/10次循环）或UHMWPE（-0.015±0.011 mg/10次循环）的聚合物磨损率相比，CFR-PEEK聚丙烯腈（6.657±0.714 mg/10次循环）和CFR-PEEK沥青（32.085±2.748 mg/10次循环）的聚合物磨损率显著更高（p<.001）。此外，使用由CFR-PEEK聚丙烯腈（3.373±0.214 mg/10次循环）和CFR-PEEK沥青（3.604±0.355 mg/10次循环）制成的衬套时，金属磨损率显著高于使用由纯PEEK（0.177±0.049 mg/10次循环）或UHMWPE（0.031±0.011 mg/10次循环）制成的衬套时（p<.001）。与纯PEEK和UHMWPE组相比，两个CFR-PEEK组的平均颗粒尺寸显著更小（p<.001）。
根据这些结果，CFR-PEEK与钴铬合金联合临床使用可能会导致更高的磨损率，应避免这种情况。纯PEEK仍可被视为UHMWPE的替代品，用于铰链式膝关节的屈曲衬套。
