Background Reading

If you are looking for a background reading list to familiarize yourself with the field, or on the lookout for an interesting topic for a thesis, then you have come to the right place! Here I have collected some of my favorite papers and references dealing with UHMWPE and alternative bearings that continue to be relevant today, and in my opinion, have withstood the test of time. This reading list is not meant to be exhaustive or all-inclusive compendium of primary references - please refer to the extensive bibliographies at the end of each chapter in the 2nd edition of the UHMWPE Biomaterials Handbook for such "raw data." Instead, I am offering here a collection of reviews that summarize the evolution of scientific opinion in the field, along with the reasons why I thought the reviews were noteworthy. When possible, I have included links to Amazon, DOI, and other external websites to help locate the referenced documents.

-S.M. Kurtz, August 14, 2009

Books and Monographs

There are very few books written on the subject of UHMWPE over the years. I am naturally partial to the most recent (2nd) edition of the UHMWPE Handbook, which is intended to be the current state-of-the-art reference covering all the major topics in the field.

Kurtz SM (ed.). The UHMWPE Biomaterials Handbook: Ultra-High Molecular Weight Polyethylene in Total Joint Replacement and Medical Devices (2nd Edition). Burlington, MA: Academic Press, 2009.

The book can be ordered via the Amazon website or downloaded as an Ebook. A preview of the Ebook is also available.

Kurtz SM, Gsell RA, Martell J (Eds). STP1445: Crosslinked and Thermally Treated Ultra-High Molecular Weight Polyethylene for Joint Replacements. Conshohocken: ASTM International, 2004. Doi: 10.1520/STP1445-EB.

This book is a collection of testing-related papers that were presented at an ASTM symposium related to highly crosslinked UHMWPE. The book is currently out of print, so the options for obtaining a copy include downloading an electronic version from the ASTM Website or tracking a used copy from Amazon.

Kurtz SM. The UHMWPE Handbook: Ultra-High Molecular Weight Polyethylene in Total Joint Replacement (First Edition). New York: Academic Press, 2004.

This book went out of print in 2008, which inspired the preparation of a greatly expanded 2nd edition. You can still find new and used copies on Amazon.

Costa L, Brach de Prever EM. UHMWPE for Arthroplasty. Turin: Edizioni Minerva Medica, 2000.

This monograph was written primarily for an orthopedic surgeon audience. Half of the book is in Italian, the second half is its English translation. Since this book was privately printed and circulated in Italy by Prof. Luigi Costa from the University of Torino, the best source for a copy is to contact directly.

Willert HG, Buchhorn GH, Eyerer P. Ultra-high Molecular Weight Polyethylene as Biomaterial in Orthopedic Surgery. Toronto: Hogrefe & Huber Publishers, 1991.

This book is an early collection of papers written on the subject of UHMWPE and is a good historical reference. Currently long out of print, maybe you can get lucky and find a used copy on Amazon.

Recent Reviews about Highly Crosslinked UHMWPE for Clinicians

As the number of highly crosslinked UHMWPE formulations has grown over the past decade, so too has the need to summarize these findings for the surgical community. The following recent reviews about UHMWPE technology and wear were written primarily for a surgeon audience and to provide insight into the divergent clinical opinions on this subject.

Brach Del Prever EM, Bistolfi A, Bracco P, Costa L. UHMWPE for arthroplasty: past or future? J Orthop Traumatol 2009 Mar;10(1):1-8. Doi: 10.1007/s10195-008-0038-y

Gomez-Barrena E, Puertolas JA, Munuera L, Konttinen YT. Update on UHMWPE research: from the bench to the bedside. Acta orthopaedica 2008 Dec;79(6):832-840. Doi: 10.1080/17453670810016939

Kurtz S, Medel F, Manley M. Wear in highly crosslinked polyethylenes. Current Orthopaedics 2008;22:392-399. Doi: 10.1016/j.cuor.2008.10.011

Jacobs CA, Christensen CP, Greenwald AS, McKellop H. Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am 2007 Dec;89(12):2779-2786. Doi: 10.2106/JBJS.G.00043

Ries MD. Highly cross-linked polyethylene: the debate is over--in opposition. J Arthroplasty 2005 Jun;20(4 Suppl 2):59-62. Doi: 10.1016/j.arth.2005.03.016867

Jasty M, Rubash HE, Muratoglu O. Highly cross-linked polyethylene: the debate is over--in the affirmative. J Arthroplasty 2005 Jun;20(4 Suppl 2):55-58. Doi: 10.1016/j.arth.2005.03.015

Metal Wear Debris and Squeaking with Alternative Bearings

Today two main issues related to hard-on-hard bearings are adverse reactions to metal wear debris (for metal-on-metal bearings) and squeaking (for ceramic-on-ceramic bearings). Below I have listed two recent reviews, one on each subject, that summarize the state of knowledge on these topics.

Jacobs JJ, Urban RM, Hallab NJ, Skipor AK, Fischer A, Wimmer MA. Metal-on-metal bearing surfaces. The Journal of the American Academy of Orthopaedic Surgeons 2009 Feb;17(2):69-76. This article can be found on the JAAOS website.

Walter WL, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, et al. Squeaking hips. J Bone Joint Surg Am 2008 Nov;90 Suppl 4:102-111.Doi:10.2106/JBJS.H.00867

Proceedings from NIH/AAOS Symposia on Implant Wear

Periodically, the National Institutes of Health and the American Academy of Orthopedic Surgeons have sponsored joint symposia to bring together researchers with clinical, biologic, and engineering backgrounds to summarize the state-of-the-art knowledge with respect to implant wear. The two most recent symposia, in 2000 and 2007, resulted in subsequent publication in both hardcopy and electronic formats. These consensus documents underwent extensive editing under the direction of the symposium organizers, Stuart Goodman, M.D., and Timothy Wright, Ph.D., and thus controversial aspects of current research often did not survive the editing process. Nonetheless, these works are extremely useful from the perspective of identifying gaps in knowledge for future research. Although these symposia were not dedicated to UHMWPE per se, many of the reviews included research directly related to this family of biomaterials.

The 2007 AAOS/NIH Osteolysis and Implant Wear research symposium was published as the July 2008 Supplement for the Journal of the American Academy of Orthopedic Surgeons. All of the review articles on clinical, biologic, and engineering aspects of implant wear can be downloaded for free from the JAAOS website.

The 2000 AAOS/NIH Osteolysis and Implant Wear research symposium was published in 2001 by the AAOS as a book, entitled Implant Wear in Total Joint Replacement: Clinical and Biologic Issues, Material and Design Considerations. The entire contents of the book are available online for free from the AAOS website.

Reviews of Wear and Tribology UHMWPE in Joint Replacement

The following review articles contain an overview of opinions and theories related to UHMWPE tribology and provide a more detailed treatment of the subject than can be found in the NIH/AAOS consensus conferences outlined in the previous section.

Fisher J, Jennings LM, Galvin AL, Jin ZM, Stone MH, Ingham E. 2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees. Clin Orthop Relat Res 2009 Aug 11. Doi: 10.1007/s11999-009-1033-1

McKellop HA. The lexicon of polyethylene wear in artificial joints. Biomaterials 2007 Dec;28(34):5049-5057. Doi: 10.1016/j.biomaterials.2007.07.040

Edidin A and Kurtz SM. The evolution of paradigms for wear in total joint arthroplasty: The role of design, material, and mechanics. October 2000. This article is made available on the UHMWPE Lexicon website.

Wang A, Essner A, Polineni VK, Stark C, Dumbleton JH. Lubrication and wear of ultra-high molecular weight polyethylene in total joint replacements. Tribology International 1998;31(1-3):17-33. Doi: 10.1016/S0301-679X(98)00005-X

Schmalzried TP, Dorey FJ, McKellop H. The multifactorial nature of polyethylene wear in vivo. J Bone Joint Surg Am 1998;80(8):1234-1242; discussion 1242-1233. This article can be downloaded for free directly from the JBJS Website.

Sauer WL, Anthony ME. Predicting the clinical wear performance of orthopaedic bearing surfaces. In: Jacobs JJ, Craig TL, editors. Alternative Bearing Surfaces in Total Joint Replacement. West Conshohoken: American Society for Testing and Materials, 1998. p. 1-29. Doi: 10.1520/STP12827S

McKellop HA, Campbell P, Park SH, Schmalzried TP, Grigoris P, Amstutz HC, et al. The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop Relat Res 1995 Feb(311):3-20.

Cooper JR, Dowson D, Fisher J. Macroscopic and microscopic wear mechanisms in ultra-high molecular weight polyethylene. Wear 1993;162-164:378-384.

Technical Reviews of UHMWPE Materials Science and Technology

Here is a list of my favorite contemporary and "historical" review articles on UHMWPE materials science and technology that I continue to refer to today.

Sobieraj MC, Rimnac CM. Ultra high molecular weight polyethylene: mechanics, morphology, and clinical behavior. J Mech Behav Biomed Mater 2009 Oct;2(5):433-443. Doi: 10.1016/j.jmbbm.2008.12.006

Oral E, Muratoglu OK. Radiation cross-linking in ultra-high molecular weight polyethylene for orthopaedic applications. Nucl Instrum Methods Phys Res B 2007 Dec;265(1):18-22. Doi: 10.1016/j.nimb.2007.08.022

Shibata N, Kurtz SM, Tomita N. Advances of mechanical performance and oxidation stability in ultrahigh molecular weight polyethylene for total joint replacement: Highly crosslinked and α-tocopherol doped. J Biomed Sci Eng 2006;1(1):107-123. Doi: 10.1299/jbse.1.107

Pruitt LA. Deformation, yielding, fracture and fatigue behavior of conventional and highly cross-linked ultra high molecular weight polyethylene. Biomaterials 2005 Mar;26(8):905-915. Doi: 10.1016/j.biomaterials.2004.03.022

Kurtz SM, Muratoglu OK, Evans M, Edidin AA. Advances in the processing, sterilization, and crosslinking of ultra- high molecular weight polyethylene for total joint arthroplasty. Biomaterials 1999;20(18):1659-1688. Doi: 10.1016/S0142-9612(99)00053-8

Stein, HL. Ultra-high molecular weight polyethylene (UHMWPE). Guide to Engineering Plastics Families: Thermoplastic Resins, Vol. 2. Engineered Materials Handbook, ASM International, Materials Park, OH, pp. 167-171, 1999. Click here to download a pdf of the book chapter, made available with the permission of the author.

Premnath V, Harris WH, Jasty M, Merrill EW. Gamma sterilization of UHMWPE articular implants: an analysis of the oxidation problem. Biomaterials 1996;17(18):1741-1753. Doi: 10.1016/0142-9612(95)00349-5

Li S, Burstein AH. Ultra-high molecular weight polyethylene. The material and its use in total joint implants. J Bone Joint Surg Am 1994;76(7):1080-1090. This article can be downloaded for free directly from the JBJS Website.