October 2000

The Evolution of Paradigms for Wear in Total Joint Arthroplasty
The Role of Design, Material, and Mechanics

A.A. Edidin and S.M. Kurtz

Abstract
In 2000, ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard for bearing materials in total joint replacement, against which all current and future modifications are and will be compared. In the United States alone, between 500,000 and 600,000 total joint arthroplasties are currently performed. Consequently, further elucidation of wear mechanisms and paradigms for the "gold standard" UHMWPE is warranted, solely on the basis of the existing patient population currently implanted with components fabricated from conventional UHMWPE. In this article, we examine the evolution of new paradigms for wear and mechanical performance of UHMWPE in total joint replacements. We focus our attention on the development of ideas related to wear and surface damage in UHMWPE total joint replacement components during the past six years. Specifically, in this paper we address the following research questions: 1) What are the mechanistic origins of wear debris and surface damage in UHMWPE components? 2) What modifications of UHMWPE influence the wear and mechanical behavior? and 3) What aspects of mechanical behavior influence wear? Our goal is to highlight the emergence of new theories which may lead to quantitative understanding, and ultimately theoretical prediction, of wear and surface damage mechanisms in UHMWPE components for total joint replacement.

Key Words: Ultrahigh molecular weight polyethylene, UHMWPE, wear, mechanical properties.

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