Meng Xiangchao, Du Zhe, Wang You
Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University 145 Middle Shandong Road Shanghai China
Department of Trauma and Emergency Center, Peking University People's Hospital Beijing China.
RSC Adv. 2018 Aug 28;8(53):30330-30339. doi: 10.1039/c8ra04661a. eCollection 2018 Aug 24.
Polyether-ether-ketone (PEEK) has been used clinically for intervertebral fusion and internal fixators in spine and trauma surgery because of its mechanical properties and bioinertness. The present study aimed to assess the suitability of PEEK as an alternative material to cobalt-chromium-molybdenum alloy in total knee arthroplasty (TKA) and evaluate the wear property on the contact surface of the PEEK-on-highly cross-linked polyethylene (HXLPE). PEEK prosthesis was designed and manufactured using injection molding based on the computed tomography data of a standard goat right hind limb. Fifteen goats underwent TKA using PEEK-on-HXLPE prosthesis on the right hind limb. The goats were sacrificed at 12, 24, and 48 weeks postoperatively. The mean surface roughness ( ) of the retrieved components, proinflammatory cytokines in the synovial fluid, and characteristics of wear particles in the synovial membrane were investigated using laser confocal microscopy, ELISA and polarized light microscopy. The of the femoral component was about 0.08, 0.1, 0.2, and 0.26 μm at pre-study, 12-, 24-, and 48 weeks in the retrievals, respectively. The of the HXLPE bearing samples was approximately 0.38, 0.4, 0.1, and 0.42 μm at pre-study, 12-, 24-, and 48 weeks in the retrievals, respectively. The median size of the particles was 2.63 μm, 1.98 μm, and 3.00 μm at 12, 24, and 48 weeks, respectively. The particles ranged in size from 0.4 μm to 15 μm, and particles <1 μm accounted for 7-13%, those of size 2-5 μm accounted for 67-76%, and those >5 μm accounted for 11-22%. Levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-α (TNF-α) were significantly increased in synovial fluids at 24- and 48 weeks after surgery. Wear occurred on the surfaces of the PEEK and HXLPE material and the size of most wear particles was 1-5 μm. This induced an inflammatory response in the synovial membrane and release of proinflammatory cytokines. A high polishing process may be necessary to lengthen the life of the PEEK prosthesis by reducing the wear and the generation of debris. The PEEK prosthesis as a new generation of artificial joints is promising to be used clinically in the future.
聚醚醚酮（PEEK）因其机械性能和生物惰性，已在脊柱和创伤手术的椎间融合及内固定器中得到临床应用。本研究旨在评估PEEK作为全膝关节置换术（TKA）中钴铬钼合金替代材料的适用性，并评估高度交联聚乙烯（HXLPE）上PEEK接触表面的磨损特性。基于标准山羊右后肢的计算机断层扫描数据，采用注射成型设计并制造了PEEK假体。15只山羊右后肢采用PEEK-on-HXLPE假体进行TKA手术。术后12周、24周和48周处死山羊。使用激光共聚焦显微镜、酶联免疫吸附测定法（ELISA）和偏振光显微镜研究取出部件的平均表面粗糙度、滑液中的促炎细胞因子以及滑膜中磨损颗粒的特征。在取出物中，术前、术后12周、24周和48周时股骨部件的平均表面粗糙度分别约为0.08μm、0.1μm、0.2μm和0.26μm。在取出物中，术前、术后12周、24周和48周时HXLPE承重样本的平均表面粗糙度分别约为0.38μm、0.4μm、0.1μm和0.42μm。在术后12周、24周和48周时，颗粒的中位尺寸分别为2.63μm、1.98μm和3.00μm。颗粒尺寸范围为0.4μm至15μm，<1μm的颗粒占7 - 13%，2 - 5μm的颗粒占67 - 76%，>5μm的颗粒占11 - 22%。术后24周和48周时，滑液中白细胞介素（IL）-6、IL-10和肿瘤坏死因子-α（TNF-α）水平显著升高。PEEK和HXLPE材料表面均出现磨损，大多数磨损颗粒尺寸为1 - 5μm。这在滑膜中引发炎症反应并释放促炎细胞因子。可能需要进行高度抛光工艺，以通过减少磨损和碎屑产生来延长PEEK假体的使用寿命。PEEK假体作为新一代人工关节，未来有望在临床上得到应用。
