This contribution lays the foundation for the European database of explanted UHMWPE liners from total joint replacements. Three EU countries (Czech Republic, Italy and Spain) have joined their datasets containing anonymized patient data (such as age and BMI), manufacturer data (such as information on UHMWPE crosslinking, thermal treatment and sterilization), orthopedic evaluation (such as total duration of the implant in vivo and reasons for its revision) and material characterization (such as oxidative degradation and micromechanical properties). The joined database contains more than 500 entries, exhibiting gradual growth, and it is beginning to show interesting trends, which are discussed in our contribution, including (i) strong correlations between UHMWPE oxidative degradation, degree of crystallinity and microhardness; (ii) statistically significant differences between UHMWPE liners with different types of sterilization; (iii) realistic correlations between the extent of oxidative degradation and the observed reasons for total joint replacement failures. Our final objective and task for the future is to continuously expand the database, involving researchers from other European countries, in order to create a robust tool that will contribute to the better understanding of structure-properties-performance relationships in the field of arthroplasty implants.

1st Orthopedics Clinic of the 1st Faculty of Medicine of Charles University and Motol University Hospital 15006 Prague Czech Republic

Chemistry Department and NIS Centre University of Torino 10125 Torino Italy

Department of Mechanical Engineering Institute of Engineering Research of Aragon University of Zaragoza 50018 Zaragoza Spain

Department of Orthopaedic Surgery and Traumatology Miguel Servet University Hospital 50009 Zaragoza Spain

Department of Orthopaedic Surgery and Traumatology Royo Villanova Hospital 50015 Zaragoza Spain

Department of Surgery Medicine School University of Zaragoza 50009 Zaragoza Spain

Department of Surgery Orthopedics and Traumatology Cardinal Massaia Hospital 14100 Asti Italy

Institute of Macromolecular Chemistry of the Czech Academy of Sciences 16206 Prague Czech Republic

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Cieza A., Causey K., Kamenov K., Hanson S.W., Chatterji S., Vos T. Global Estimates of the Need for Rehabilitation Based on the Global Burden of Disease Study 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:2006–2017. doi: 10.1016/S0140-6736(20)32340-0. PubMed DOI PMC

Price A.J., Longino D., Rees J., Rout R., Pandit H., Javaid K., Arden N., Cooper C., Carr A.J., Dodd C.A.F., et al. Are Pain and Function Better Measures of Outcome than Revision Rates after TKR in the Younger Patient? Knee. 2010;17:196–199. doi: 10.1016/j.knee.2009.09.003. PubMed DOI

Dakin H., Gray A., Fitzpatrick R., MacLennan G., Murray D. The KAT Trial Group Rationing of Total Knee Replacement: A Cost-Effectiveness Analysis on a Large Trial Data Set. BMJ Open. 2012;2:e000332. doi: 10.1136/bmjopen-2011-000332. PubMed DOI PMC

Katz J.N., Arant K.R., Loeser R.F. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2021;325:568. doi: 10.1001/jama.2020.22171. PubMed DOI PMC

Arthoplasty Registries Arthroplasty Registries—NORE—EFORT. [(accessed on 25 November 2022)]. Available online: https://nore.efort.org/arthroplasty-registries.

Bracco P., Bellare A., Bistolfi A., Affatato S. Ultra-High Molecular Weight Polyethylene: Influence of the Chemical, Physical and Mechanical Properties on the Wear Behavior. A Review. Materials. 2017;10:791. doi: 10.3390/ma10070791. PubMed DOI PMC

Bistolfi A., Giustra F., Bosco F., Sabatini L., Aprato A., Bracco P., Bellare A. Ultra-High Molecular Weight Polyethylene (UHMWPE) for Hip and Knee Arthroplasty: The Present and the Future. J. Orthop. 2021;25:98–106. doi: 10.1016/j.jor.2021.04.004. PubMed DOI PMC

Cerquiglini A., Henckel J., Hothi H., Moser L.B., Eskelinen A., Hirschmann M.T., Hart A.J. Retrieval Analysis of Contemporary Antioxidant Polyethylene: Multiple Material and Design Changes May Decrease Implant Performance. Knee Surg. Sport. Traumatol. Arthrosc. 2019;27:2111–2119. doi: 10.1007/s00167-019-05387-5. PubMed DOI

Currier B.H., Van Citters D.W., Currier J.H., Carlson E.M., Tibbo M.E., Collier J.P. In Vivo Oxidation in Retrieved Highly Crosslinked Tibial Inserts. J. Biomed. Mater. Res. 2013;101B:441–448. doi: 10.1002/jbm.b.32805. PubMed DOI

Kurtz S.M., Medel F.J., MacDonald D.W., Parvizi J., Kraay M.J., Rimnac C.M. Reasons for Revision of First-Generation Highly Cross-Linked Polyethylenes. J. Arthroplast. 2010;25:67–74. doi: 10.1016/j.arth.2010.04.018. PubMed DOI PMC

Spece H., Schachtner J.T., MacDonald D.W., Klein G.R., Mont M.A., Lee G.-C., Kurtz S.M. Reasons for Revision, Oxidation, and Damage Mechanisms of Retrieved Vitamin E-Stabilized Highly Crosslinked Polyethylene in Total Knee Arthroplasty. J. Arthroplast. 2019;34:3088–3093. doi: 10.1016/j.arth.2019.07.018. PubMed DOI PMC

Medel F.J., Kurtz S.M., Hozack W.J., Parvizi J., Purtill J.J., Sharkey P.F., MacDonald D., Kraay M.J., Goldberg V., Rimnac C.M. Gamma Inert Sterilization: A Solution to Polyethylene Oxidation? J. Bone Jt. Surg.-Am. Vol. 2009;91:839–849. doi: 10.2106/JBJS.H.00538. PubMed DOI PMC

Day J.S., MacDonald D.W., Ramsey M.L., Abboud J.A., Kurtz S.M. Quantitative Ultrahigh-Molecular-Weight Polyethylene Wear in Total Elbow Retrievals. J. Shoulder Elb. Surg. 2020;29:2364–2374. doi: 10.1016/j.jse.2020.03.026. PubMed DOI

Mathis D.T., Schmidli J., Hirschmann M.T., Amsler F., Henckel J., Hothi H., Hart A. Comparative Retrieval Analysis of Antioxidant Polyethylene: Bonding of Vitamin-E Does Not Reduce in-Vivo Surface Damage. BMC Musculoskelet. Disord. 2021;22:1003. doi: 10.1186/s12891-021-04898-y. PubMed DOI PMC

Rowell S.L., Reyes C.R., Hopper R.H., Engh C.A., Muratoglu O.K. Do Total Hip Arthroplasty Polyethylene Liners without Free Radicals Oxidize in Vivo or Ex Vivo? J. Biomed. Mater. Res. 2022;110:1113–1119. doi: 10.1002/jbm.b.34985. PubMed DOI

Slouf M., Arevalo S., Vlkova H., Gajdosova V., Kralik V., Pruitt L. Comparison of Macro-, Micro- and Nanomechanical Properties of Clinically-Relevant UHMWPE Formulations. J. Mech. Behav. Biomed. Mater. 2021;120:104205. doi: 10.1016/j.jmbbm.2020.104205. PubMed DOI

Costa L., Luda M.P., Trossarelli L., Brach del Prever E.M., Crova M., Gallinaro P. Oxidation in Orthopaedic UHMWPE Sterilized by Gamma-Radiation and Ethylene Oxide. Biomaterials. 1998;19:659–668. doi: 10.1016/S0142-9612(97)00160-9. PubMed DOI

Medel F.J., Rimnac C.M., Kurtz S.M. On the Assessment of Oxidative and Microstructural Changes after in Vivo Degradation of Historical UHMWPE Knee Components by Means of Vibrational Spectroscopies and Nanoindentation. J. Biomed. Mater. Res. 2009;89A:530–538. doi: 10.1002/jbm.a.31992. PubMed DOI PMC

Slouf M., Vackova T., Nevoralova M., Pokorny D. Micromechanical Properties of One-Step and Sequentially Crosslinked UHMWPEs for Total Joint Replacements. Polym. Test. 2015;41:191–197. doi: 10.1016/j.polymertesting.2014.12.003. DOI

Fulin P., Pokorny D., Slouf M., Nevoralova M., Vackova T., Dybal J., Pilar J. Quantification of Structural Changes of UHMWPE Components in Total Joint Replacements. BMC Musculoskelet. Disord. 2014;15:109. doi: 10.1186/1471-2474-15-109. PubMed DOI PMC

Tabor D. The Hardness of Metals. Oxford University Press; Oxford, UK: New York, NY, USA: 1951. (Oxford Classic Texts in the Physical Sciences).

Oliver W.C., Pharr G.M. Nanoindentation in Materials Research: Past, Present, and Future. MRS Bull. 2010;35:897–907. doi: 10.1557/mrs2010.717. DOI

Herrmann K. Hardness Testing: Principles and Applications. ASM International; Materials Park, OH, USA: 2011. Instrumented Indentation Test.

Fischer-Cripps A.C. Nanoindentation. Springer; New York, NY, USA: 2011. (Mechanical Engineering Series).

Slouf M., Pavlova E., Krejcikova S., Ostafinska A., Zhigunov A., Krzyzanek V., Sowinski P., Piorkowska E. Relations between Morphology and Micromechanical Properties of Alpha, Beta and Gamma Phases of IPP. Polym. Test. 2018;67:522–532. doi: 10.1016/j.polymertesting.2018.03.039. DOI

Slouf M., Krajenta J., Gajdosova V., Pawlak A. Macromechanical and Micromechanical Properties of Polymers with Reduced Density of Entanglements. Polym. Eng. Sci. 2021;61:1773–1790. doi: 10.1002/pen.25699. DOI

Gajdosova V., Strachota B., Strachota A., Michalkova D., Krejcikova S., Fulin P., Nyc O., Brinek A., Zemek M., Slouf M. Biodegradable Thermoplastic Starch/Polycaprolactone Blends with Co-Continuous Morphology Suitable for Local Release of Antibiotics. Materials. 2022;15:1101. doi: 10.3390/ma15031101. PubMed DOI PMC

Zamfirova G., Pereña J.M., Benavente R., Pérez E., Cerrada M.L., Nedkov E. Mechanical Properties of Ultra High Molecular Weight Polyethylene Obtained with Different Cocatalyst Systems. Polym. J. 2002;34:125–131. doi: 10.1295/polymj.34.125. DOI

Bolland J.L. Kinetics of Olefin Oxidation. Q. Rev. Chem. Soc. 1949;3:1. doi: 10.1039/qr9490300001. DOI

Kamel I., Finegold L. A Model for Radiation-Induced Changes in Ultrahigh-Molecular-Weight Polyethylene. J. Polym. Sci. Polym. Phys. Ed. 1985;23:2407–2409. doi: 10.1002/pol.1985.180231113. DOI

Zhao Y., Luo Y., Jiang B. Effect of Irradiation on Crystallinity and Mechanical Properties of Ultrahigh Molecular Weight Polyethylene. J. Appl. Polym. Sci. 1993;50:1797–1801. doi: 10.1002/app.1993.070501015. DOI

Goldman M., Gronsky R., Pruitt L. The Influence of Sterilization Technique and Ageing on the Structure and Morphology of Medical-Grade Ultrahigh Molecular Weight Polyethylene. J. Mater. Sci. Mater. Med. 1998;9:207–212. doi: 10.1023/A:1008836107186. PubMed DOI

Nevoralova M., Baldrian J., Pospisil J., Chodak I., Horak Z. Structure Modification of UHMWPE Used for Total Joint Replacements. J. Biomed. Mater. Res. 2005;74B:800–807. doi: 10.1002/jbm.b.30317. PubMed DOI

Slouf M., Synkova H., Baldrian J., Marek A., Kovarova J., Schmidt P., Dorschner H., Stephan M., Gohs U. Structural Changes of UHMWPE after E-Beam Irradiation and Thermal Treatment. J. Biomed. Mater. Res. 2008;85B:240–251. doi: 10.1002/jbm.b.30942. PubMed DOI

Balta-Calleja F.J., Fakirov S. Microhardness of Polymers. Cambridge University Press; Cambridge, UK: 2000. Microhardness of Crystalline Polymers. (Cambridge Solid State Science Series).

Flores A., Ania F., Baltá-Calleja F.J. From the Glassy State to Ordered Polymer Structures: A Microhardness Study. Polymer. 2009;50:729–746. doi: 10.1016/j.polymer.2008.11.037. DOI

Fulin P. The Quality of Articular Surfaces and Its Influence on the Proces of Early Failure of Joint Replacements. Charles University Prague; Prague, Czech Republic: 2020.

Daniel M., Rijavec B., Dolinar D., Pokorný D., Iglič A., Kralj-Iglič V. Patient-Specific Hip Geometry Has Greater Effect on THA Wear than Femoral Head Size. J. Biomech. 2016;49:3996–4001. doi: 10.1016/j.jbiomech.2016.10.030. PubMed DOI

Vavrik P., Landor I., Gallo J., Koudela K. Revizní Operace Totálních Náhrad Kolenního Kloubu. Maxdorf; Praha, Czech Republic: 2019.

Landor I. Revizní Operace Totálních Náhrad Kyčelního Kloubu. Maxdorf; Praha, Czech Republic: 2012.

Urdan T.C. Statistics in Plain English. 4th ed. Routledge; New York, NY, USA: 2017.

Balta-Calleja F.J., Fakirov S. Microhardness of Polymers. Cambridge University Press; Cambridge, UK: 2000. Microhardness Determination in Polymeric Materials. (Cambridge Solid State Science Series).

Kurtz S.M., Rimnac C.M., Hozack W.J., Turner J., Marcolongo M., Goldberg V.M., Kraay M.J., Edidin A.A. In Vivo Degradation of Polyethylene Liners After Gamma Sterilization in Air. J. Bone Jt. Surg. 2005;87:815–823. doi: 10.2106/JBJS.D.02111. PubMed DOI

McKELLOP H., Shen F.-W., Lu B., Campbell P., Salovey R. Effect of Sterilization Method and Other Modifications on the Wear Resistance of Acetabular Cups Made of Ultra-High Molecular Weight Polyethylene: A Hip-Simulator Study. J. Bone Jt. Surg.-Am. Vol. 2000;82:1708–1725. doi: 10.2106/00004623-200012000-00004. PubMed DOI

Collier M.B., Engh C.A., McAuley J.P., Engh G.A. Factors Associated with the Loss of Thickness of Polyethylene Tibial Bearings After Knee Arthroplasty. J. Bone Jt. Surg. 2007;89:1306–1314. doi: 10.2106/00004623-200706000-00020. PubMed DOI

Fulin P., Pokorny D., Slouf M., Vacková T., Dybal J., Sosna A. Effect of sterilisation with formaldehyde, gamma irradiation and ethylene oxide on the properties of polyethylene joint replacement components. Acta Chir. Orthop. Traumatol. Cech. 2014;81:33–39. PubMed

Kurtz S.M. UHMWPE Biomaterials Handbook: Ultra-High Molecular Weight Polyethylene in Total Joint Replacement and Medical Devices. Elsevier; Amsterdam, The Netherlands: Boston, MA, USA: 2016. In Vivo Oxidation of UHMWPE.

MacDonald D., Hanzlik J., Sharkey P., Parvizi J., Kurtz S.M. In Vivo Oxidation and Surface Damage in Retrieved Ethylene Oxide-Sterilized Total Knee Arthroplasties. Clin. Orthop. Relat. Res. 2012;470:1826–1833. doi: 10.1007/s11999-011-2184-4. PubMed DOI PMC