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Radioisotope Tracing Polyethylene Wear in Knee Prostheses

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Radioisotope Tracing Polyethylene Wear in Knee Prostheses RADIOISOTOPE TRACING POLYETHYLENE WEAR IN KNEE PROSTHESES Jacob Alan Warner School of Physical, Environmental and Mathematical Sciences, University of New South Wales, Canberra. A thesis submitted to the University of New South Wales for the degree of Doctor of Philosophy “Osteolysis is the most common, long term complication of joint replacement surgery and it causes the need for revision surgery, which is associated with increased complications and is an expensive procedure. There are no real medical therapies for osteolysis beyond having a revision surgery, and it is a very difficult disease to track.” -Dr. Ed Purdue, Director of the Osteolysis Laboratory at the Hospital for Special Surgery i Originality Statement I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation, and linguistic expression is acknowledged. Signed ……………………………… Date ……………………………… ii Copyright Statement I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International. I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation. Signed ……………………………… Date ……………………………… iii Authenticity Statement I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format. Signed ……………………………… Date ……………………………… iv v Abstract Harmful immunological consequences from ultra-high molecular weight polyethylene (UHMWPE) wear debris in knee prostheses can lead to osteolysis, aseptic loosening of the prosthesis and revision surgery. Following revision surgery, polyethylene debris particles are commonly identified in numerous locations. In order to more clearly understand the process of particle generation and their associated pathways to ultimate locations of osteolysis in the surrounding joint space, UHMWPE was labelled with radioisotope tracers. In a broader sense, the ultimate goal is to work toward the minimisation of wear debris produced in the knee joint, thereby resulting in a longer prosthetic lifetime. The wear mechanisms and their relevant debris generation were investigated in vitro using the characteristic gamma-rays emitted from radioisotopes attached to the polyethylene. Three separate methods of introduction have been explored in this work: direct ion implantation at low energy, recoil implantation, and diffusion. The direct ion implantation of 111In to a depth of 200 nm in UHMWPE has been successfully implemented, providing effectively a surface labelling of the polymer sample. The recoil implantation of 97Ru, 100Pd, 100Rh, and 101mRh into UHMWPE has been demonstrated. This introduction technique labels the polyethylene with an essentially uniform profile to a depth of 4.4 μm. The feasibility of both radioisotope labelling methods based on ion implantation was verified for two model systems. The wear-in phase of the uni-directional sliding system has been found to exhibit a process of debris transfer between the metal and polymer surfaces. During this transfer process, the theoretical description developed alludes to a stochastic dropout of debris into the lubricant. Fluid dynamics calculations suggest that the cyclic fluid motion may periodically re-introduce these removed particles as 3rd-body wear, resulting in an exacerbated rate of wear. Computation Fluid Dynamic simulations have confirmed these cyclic debris pathways continually passing vi through the wear region. Results from the bi-directional model system suggest a decrease in the rate of debris transfer to the metal surface possibly due to the different motion, and an increase in dispersion of debris to the deionised water lubricant. A load dependence has been observed, and an increase in the surface roughness of the steel counterface corresponded with an increased wear rate and volume of debris transferred between the two bearing surfaces. The diffusion of the antioxidant Vitamin E into UHMWPE was successfully reproduced, thus motivating the use of this substance as a potential radioisotope carrier. 111In radioisotopes were subsequently mixed with Vitamin E and diffused into UHMWPE. The resulting diffusion profile maximum depth attained is of the order of micrometres. Localised tracing of wear was successfully demonstrated on UHMWPE tibial inserts. UHMWPE plugs were recoil-implanted, following synthesis of the 97Ru, 100Pd, 100Rh, and 101mRh radioisotopes. The plugs were inserted into the superior and inferior wear surfaces of tibial inserts and worn in a constant load actuator and a state-of-the-art ProSim knee simulator. For the constant load actuator, the results from the superior side plug revealed an increased propensity for debris dispersion into the lubricant, as opposed to a transfer to the femoral component. Using the ProSim knee motion simulator, the dependence of wear rate on position was studied for the backsides of tibial inserts and particle transport to different prosthesis locations was searched for. The extrapolated backside wear rate was 0.8 mm3/Mc, which compares well with the range of published values. Debris was not shown to transfer in significant amounts to the femoral component from the backside of the tibial insert, which provides evidence for osteolytic regions formed from locally produced debris. Hopefully the results of this work will aid toward the understanding of debris production and their subsequent pathways in the knee joint so that future prostheses can be designed to minimise the adverse biological response to these particles. vii Publications Related to this Thesis This thesis work has been published in three journal papers, and has been submitted to a fourth where it is presently under review. Furthermore, it has been presented at two international, and five regional conferences. JOURNAL J A Warner, L G Gladkis, T Geruschke, R Vianden, P N Smith, J M Scarvell, W Zeitz, H Timmers (2010). Ion-implanted Indium-111 as a Quantitative Tracer of Polymer Wear Debris. Wear, Volume 268: 1257-1265. J A Warner, P N Smith, J M Scarvell, L G Gladkis, and H Timmers (2011). Tribology Letters, submitted January 2012. J A Warner, L G Gladkis, H Timmers (2010). A new radioisotope tracing method of UHMWPE wear particle dispersion using 97RU. Journal of the Mechanical Behavior of Biomedical Materials, Volume 4, Issue 5: 776-784. H Timmers, L Gladkis, J A Warner, A P Byrne, M F del-Grosso, C R Arbeitman, G Garcia- Bermudez, T Geruschke, and R Vianden (2010). Polymer tribology by combining ion- implantation and radionuclide tracing. NIM B Beam Interactions with Materials and Atoms, Volume 268, Issue 11-12: 2119-2123. PEER-REVIEWED CONFERENCE PAPERS J A Warner, L G Gladkis, R Vianden, M F del Grosso, H Timmers (2010). Ion Implantation of Radioisotopes for Tracing Prosthetic Wear. 16th AINSE Conference on Nuclear and Complementary Techniques of Analysis, 25 - 27 November 2009 at Lucas Heights, Sydney. viii H Timmers, L G Gladkis, and J A Warner (2010). Characterisation and Tracing of Prosthesis Debris: Towards Suppressing the Pathways of Ultra-high Molecular Weight Polyethylene Wear Particles. Proceedings of the 34th Annual Australia &New Zealand Institute of Physics Condensed Matter and Materials Meeting. http://www.aip.org.au/wagga2010/2010_21.pdf J A Warner, P N Smith, J M Scarvell, L Gladkis, and H Timmers (2010). Production and Recoil-Implantation of Multiple Radioisotopes towards the Tracing of Prosthetic Joint Wear Particles. Proceedings of the 21st International Conference on the Application of Accelerators in Research and Industry, Volume 1336: 655-659. J A Warner, L G Gladkis, A E Kiss, J Young, P N Smith, J Scarvell, C C O’Brien, and H Timmers (2010). UHMWPE Prosthetic Wear Debris Transport in a Wheel-on-Plate Model System. Proceedings of the 35th Annual Australia &New Zealand Institute of Physics Condensed Matter and Materials Meeting. http://www.aip.org.au/content/publications POSTER PRESENTATIONS $500 Poster Prize: J A Warner (2009). Radioisotope Tracing Wear Debris in Metal-on-Polymer Systems. Australia Institute of Physics in Industry Day 2009, 11 November 2009, Sydney, Australia. J A Warner, P N Smith, J M Scarvell, L Gladkis, and H Timmers (2010). Tracing and Size Characterisation of Wear Debris from Knee Prostheses: Local Measurement of the Initial Tibial Backside Wear Rate. 19th Australian Institute of Physics Congress. 5-9 December 2010, Melbourne, Australia. OTHER PUBLICATIONS J A Warner, K E Fitzsimmons, E M Reynolds, L Gladkis, H Timmers (2010). Exploration of Activity Measurements and Equilibrium Checks for Sediment Dating Using Thick-Window Germanium Detectors. Proceedings of the 21st International Conference on the Application of Accelerators in Research and Industry, Volume 1336: 213-218. ix Acknowledgements First and foremost, I thank my supervisor Heiko Timmers.
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